We welcome the appreciation by Orihara et al1 of our efforts to elucidate the molecular basis of allergic recognition of the sugammadex-rocuronium inclusion complex (S-R-Cx).2 In our particular case, and in accord with earlier predictions,3 the S-R-Cx was shown to be allergenic and to trigger IgE/FcεRI-dependent anaphylaxis due to a shape alteration involving the thio (carboxyethyl)sodium side…

We read with great interest and were very impressed by the report regarding sugammadex-induced anaphylaxis by Ebo et al.1 In their patient who developed anaphylaxis after the administration of sugammadex, they showed that sugammadex acted as an antigen only after forming a complex with rocuronium. Although similar cases have been previously reported,2,3 their detailed skin tests and basophil…