Local Urticarial Reaction Above the Site of an Intravenous Cannula: Possible Allergy to Remimazolam in a Fourteen-Year-Old Adolescent

Abstract

Remimazolam is an intravenous, ultra-short acting benzodiazepine that has been most commonly used for procedural sedation. It received approval for procedural sedation in adults by the United States Food and Drug Administration (FDA) in 2020. Despite an overall favorable safety profile, anecdotal experience has suggested a potential for allergic phenomena, including anaphylaxis. We present a 14-year-old patient who developed a localized reaction with urticaria in an extremity following the administration of remimazolam. Although we cannot definitively identify remimazolam as the cause of the hypersensitivity reaction and no formal allergy testing was completed, the temporal association of its administration with the development of the local reaction suggests a possible relationship. Previous reports of allergic reactions following the administration of remimazolam are reviewed, mechanisms discussed, and guidelines for clinical care presented.