Allergy to low dose sugammadex

We describe the case of a fit 17-year-old man who developed a severe allergic reaction to a low clinical dose of sugammadex (3.2 mg kg(-1), 200 mg intravenously), 1 min after its administration. This was manifest by an intense erythema over the anterior part of the thorax, severe lip and palpebral oedema and bilateral wheeze. On later investigation, the patient had a positive skin prick test to sugammadex (5-mm diameter response, with a negative saline control and positive histamine control of 5 mm) and no response to any other drug tested. Other diagnostic tests supported a diagnosis of allergic reaction to sugammadex.