Positive intradermal tests to D-tubocurarine in patients with cholinergic urticaria.
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Patients with cholinergic urticaria exhibit increased hypersensitivity to cholinergic drugs. In the present study, an attempt was made to determine whether these patients would also cross-react to various neuromuscular blocking agents having structures analogous with acetylcholine. The four patients tested showed positive skin tests for D-tubocurarine at concentrations of 1/10,000. None of the 10 subjects in the control group and none of the patients with urticaria had positive responses, not even to a 10-fold higher concentration of D-tubocurarine. These findings suggest that caution should be exercised in the use of neuromuscular blocking agents in patients with cholinergic urticaria.