A Pharmacologic Review of Anaphylaxis

Abstract

Anaphylaxis occurs in the surgical population and may have devastating consequences. Anaphylaxis and anaphylactoid reactions are immediate hypersensitivity reactions that are most commonly precipitated by medications, insect stings, and foods. In the surgical population, 47.4% of immediate hypersensitivity reactions were precipitated by neuromuscular blocking agents, followed by latex and antibiotics in 20% and 18.1% of cases, respectively. Initial treatment consists of removing the precipitating trigger, administering epinephrine, and correct patient positioning. Secondary prevention measures should be instituted to prevent future occurrences. All health care professionals should have an understanding of the clinical presentation and medical management of anaphylaxis to improve patient outcomes.

Urticaria After Lidocaine Use for Pecto-Intercostal Nerve Block

“…Immediate hypersensitivity reactions occur within one hour and are associated with urticaria in locations away from the lidocaine injection site [1]. They typically occur upon subsequent exposure to an allergen and are dose-independent [2]. Delayed hypersensitivity reactions are experienced between two and three days after exposure and have been shown to exhibit skin findings localized to the site of lidocaine injection [1,3].…”

“…Delayed hypersensitivity reactions are experienced between two and three days after exposure and have been shown to exhibit skin findings localized to the site of lidocaine injection [1,3]. Nonallergic hypersensitivity reactions often occur on first exposure and can be dose-dependent [2]. Characteristics of nonallergic hypersensitivity reactions include widespread exanthematous rashes, psychomotor reactions, and vasovagal symptoms [1,[3][4][5].…”

“…Based on the timing of the case, the patient's presentation after lidocaine injection, distribution of skin findings, and lack of other systemic symptoms, type I hypersensitivity to lidocaine is a rare consideration. It is more likely that the patient experienced an anaphylactoid urticarial reaction to the lidocaine, as this is known to primarily be a dose-dependent reaction, with cutaneous symptoms being the most common presenting feature [2]. Anaphylaxis and anaphylactoid reactions may both present with elevated histamine and tryptase levels.…”

“…True immunologically mediated allergic reactions to lidocaine are rare and represent only 1% of all adverse reactions [1]. A commonly seen symptom of true allergic hypersensitivity to lidocaine is an urticarial rash [1][2][3][4]. Rashes such as these are not specific to lidocaine allergies.…”