Subscribe - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 24 May 2022

Advanced search - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder


Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases  
Conference Diary
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links

Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

Classical Case Studies



Click a heading in the right-hand column to see the selected articles in that subject area

See any comments for this case

Stephen Malnik and Gabriel Duek Acute meperidine-induced urticarial reaction during colonoscopy
Stephen Malnik and Gabriel Duek, 28 September 2011


Case history

A 53-year-old lady underwent screening colonoscopy. After receiving intravenous meperidine (pethidine) 50 mg and subsequently 2 mg midazolam she developed an acute urticarial reaction along her right arm (Fig. 1).

Fig. 1.

She had no systemic complaints, especially none of angioneurotic edema. Physical examination was unremarkable except for the findings on the right arm.

A photograph was taken with an iPhone 4 and the colonoscopy completed uneventfully. Upon discharge home an e-mail was sent to her physician with the digital image, again by use of the ipPhone 4.

We suspect that the urticarial reaction was due to the meperidine. Opiates are known to cause histamine release, resulting in urticaria [1]. This is not antagonized by naloxone [2].

 Physicians should be aware of this complication of opiates, in order to avoid inappropriate treatments.  With the increasing uptake of screening colonoscopies, more patients over that age of 50 with other medical illnesses will be exposed to intravenous narcotics and thus the number of such urticarial reactions may increase.

Inappropriate administration of epinephrine for a suspected systemic allergic reaction may precipitate a myocardial infarction.

In addition, the near ubiquitous use of smartphones enables accurate recording and distribution of information and is likely to be of increasing importance in medical communication.



1.  Nabil R, Fahmy MD. Hemodynamics, plasma histamine and catecholamine concentrations reaction to morphine. Anesthesiology 1981 ;55: 329-31

2.  McLelland J. The mechanism of morphine-induced urticaria. Arch Dermatol 1986; 122: 138-9.


Author information

Stephen Malnick and Gabriel Duek

Kaplan Medical Center,

Rehovot 76100,


Affiliated to the Hebrew University, Jerusalem, Israel.

No conflicts of interest exist.

Go to top of page


Go to top of page Email this page Email this page to a colleague

Close folder Gastroenterology
Stomach & duodenum
Helicobacter pylori
Small intestine
Colo-rectum and anus
Inflammatory bowel disease
Functional bowel disorders
Symptoms/signs of gastrointestinal disease
Basic science
Close folder Hepatology
Biliary tract
Viral hepatitis
Liver diseases
Cirrhosis and portal hypertension
Liver transplantation
Liver & other diseases
Pediatric hepatology
Basic science
Close folder Endoscopy
Upper endoscopy
Endoscopic ultrasound
Practice issues

Blackwell Publishing

Our site uses cookies to improve your experience.You can find out more about our use of cookies in our standard cookie policy, including instructions on how to reject and delete cookies if you wish to do so.

By continuing to browse this site you agree to us using cookies as described in our standard cookie policy .

CLOSE is a Blackwell Publishing registered trademark
© 2022 Wiley-Blackwell and and contributors
Privacy Statement
About Us