Military Implications of Atropine Hypersensitivity

Military Medicine, May 2004 by Hague, Jenifer D, Derr, Jeffrey J

Questions remain to be answered regarding the use of glycopyrrolate or scopolamine for this indication, however. Given that these agents are infrequently used, it is not clear whether they would be available in sufficient quantities and in a usable form to be beneficial after large-scale exposure to nerve agents. Current military training allows for the easy administration of atropine autoinjectors in the event of a nerve agent mass casualty. Even if these agents were available in a packaging system like the atropine autoinjector, it is possible that attempting to incorporate their use into training programs for the relatively small number of individuals likely to have allergy or hypersensitivity to atropine may not be practical.

Conclusion

In a combat environment where the threat of nerve agent exposure exists, effective antidotes with cholinergic blocking properties are needed. Atropine has been the agent of choice for this indication for decades and is safe and effective in the vast majority of military service members. However, this case underscores the need for alternatives in select individuals who have adverse reactions to atropine if they are going to be retained on active duty and be placed in combat environments. Although there are potentially effective alternatives to atropine, there is little experience with procuring and using these agents in these relatively rare cases. Additional research and the formulation of guidelines for management of service members with atropine sensitivity would assist in the management of these isolated cases.

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