pISSN 2005-9159
eISSN 2093-0569

Case Report

Korean J Pain 2011; 24(4): 221-225

Published online December 31, 2011 https://doi.org/10.3344/kjp.2011.24.4.221

Copyright © The Korean Pain Society.

Anaphylactic Shock Caused by the Epidurally-Administered Hyalurinidase

Hae Kwang Lee, MD, Eun Joo Choi, MD, Pyung Bok Lee, MD, and Francis Sahngun Nahm, MD*

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Correspondence to: Francis Sahngun Nahm, MD. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea. Tel: +82-31-787-7499, Fax: +82-31-787-4063, hiitsme@snubh.org

Received: October 11, 2011; Revised: November 11, 2011; Accepted: November 11, 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hyaluronidase is an enzyme that has temporary and reversible enzymatic effects on the matrix of connective tissue. When added to local anesthetics in pain treatments, it enhances their infiltration and dispersal into tissues. It is widely used in anesthesia for ocular, dental, and plastic surgery. Reports of drug hypersensitivity to hyaluronidase are rare and are usually confined to peribulbar or retrobulbar anesthesia during ophthalmic surgery. However, few reports exist on adverse drug reaction after epidural injection. We have observed two patients experiencing anaphylactic shock caused by hyaluronidase following epidural injection. Most of the patients with a hypersensitivity to hyaluronidase had one previous uneventful injection containing hyaluronidase, implying that sensitization had taken place. However, hypersensitivity occurring at the first administration is possible. A positive skin test can help establish the diagnosis. Although rare, the possibility of an allergic reaction to hyaluronidase should be considered even in patients with no known previous exposure.

Keywords: adverse drug reaction, drug hypersensitivity, epidural injection, hyaluronidase