Consultant anaesthetist Director

allergy, cough suppressants, neuromuscular blocking drugs, pholcodine Aust Prescr 2014;37:74–6 from a single state which contained a little over 10% of the Australian population in 20118, suggests that anaphylaxis to neuromuscular blocking drugs is under-reported. The quaternary ammonium ion in neuromuscular blocking drugs is the allergenic portion (epitope). It allows specific binding of immunoglobulin (IgE) to the drug,9 which can result in IgE-mediated anaphylaxis. However, in up to 50 % of cases, anaphylaxis occurs on first exposure to a neuromuscular blocking drug.5,10 This suggests that there is an alternative source o