Allergic Reactions During Anesthesia at a Large United States Referral Center

Gurrieri, Carmelina; Weingarten, Toby N.; Martin, David P.; Babovic, Nikola; Narr, Bradly J.; Šprung, Juraj; Volcheck, Gerald W.

doi:10.1213/ane.0b013e31822d45ac

Cited by 130 publications

(63 citation statements)

References 37 publications

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“…In recent studies performed in Spain (56 %) [7], the USA (47 %) [8], and France (63 %) [9], an IgE-mediated mechanism was identified in more than half of the cases of perioperative immediate hypersensitivity. Perioperative anaphylaxis is more likely to occur following anesthetic induction and is unlikely to occur during childhood.…”

Section: Epidemiology Of Perioperative Anaphylaxismentioning

confidence: 99%

“…However, the incidence of perioperative latex allergy is currently decreasing in France, as observed in clinical practice. Likewise, the incidence of latex allergy is decreasing in other countries including Spain and the USA [7,8]. This trend is due to the fact that most hospitals now use powder-free latex gloves, latex gloves with negligible allergen content, or non-latex surgical material including gloves [4].…”

Section: Epidemiology Of Perioperative Anaphylaxismentioning

confidence: 99%

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Perioperative Anaphylaxis: What Should Be Known?

Dewachter

Mouton‐Faivre²,

Hepner

2015

Curr Allergy Asthma Rep

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Perioperative anaphylaxis is a unique condition as a result of the additive cardiovascular effects of anesthetics on the cardiovascular disturbances of anaphylaxis. It occurs mainly in adulthood, primarily follows anesthetic induction, and for the most part, is an IgE-mediated pathomechanism. Neuromuscular blocking agents (NMBAs) and antibiotics are the main culprit drugs, while latex is now infrequently involved. The Ring and Messmer scale is a useful tool for demonstrating the clinical severity of perioperative immediate hypersensitivity and guiding its management. Grades III and IV are life-threatening and are referred to as anaphylaxis. Three different clinical patterns of grade III may be observed, where cardiovascular collapse is the cardinal sign. Grade IV presents as cardiac arrest. The initial diagnosis is presumptive, whereas the etiological assessment is linked to the clinical presentation, tryptase levels, and skin test results. Since anaphylaxis presents with significant hypovolemia and vasoplegia, aggressive fluid therapy and epinephrine are the cornerstones of management. Whenever possible, anesthetic discontinuation is also recommended. Scientific evidence in favor of preemptive therapeutic strategies to prevent anaphylaxis in the operative setting is lacking.

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Section: Epidemiology Of Perioperative Anaphylaxismentioning

confidence: 99%

Section: Epidemiology Of Perioperative Anaphylaxismentioning

confidence: 99%

Perioperative Anaphylaxis: What Should Be Known?

Dewachter

Mouton‐Faivre²,

Hepner

2015

Curr Allergy Asthma Rep

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“…The proportion of patients in our study for whom no causative agent could be determined was comparable to those in other reports. [12][13][14] Among the 21 patients who suffered anaphylaxis during anaesthesia and the cause was subsequently identified, antibiotics were the most common causative agent (52.3%), followed by NMBAs (38.1%), opioids (4.8%) and gelofusine (4.8%). In contrast, data from 4000 patients reported by Mertes et al indicated that NMBAs accounted for 63% of reactions, followed by latex (14%), hypnotics (7%), antibiotics (6%), plasma substitutes (3%) and opioids (2%).…”

Section: Discussionmentioning

confidence: 99%

“…According to Gurrieri et al, 14 they could be classified as non-IgE and possible non-IgE mediated anaphylaxis, but it is also possible that our investigations or the clinical history missed hidden IgE-mediated culprit. Tryptase was not available for two patients and hence we were not able to comment on the mechanism of their reaction.…”

Section: Norwaymentioning

confidence: 97%

Anaphylaxis during general anaesthesia: experience from a drug allergy centre in theUK

Meng

Rotiroti

Burdett

et al. 2017

Acta Anaesthesiol Scand

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BackgroundAnaphylaxis during general anaesthesia is rare but often severe. Identification of the cause of anaphylaxis and recommendation of a range of drugs or agents likely to be safer for future surgery is a collaborative venture between the allergists and the anaesthesiologists, but it often poses a significant challenge.MethodsA total of 31 patients who attended the Drug Allergy Unit at University College London Hospital with suspected perioperative anaphylaxis between March 2013 and January 2016 were reviewed retrospectively.ResultsThe culprit drug was identified in 21 patients (67.7%): antibiotics (n = 11, 52.3%), neuromuscular blocking agents (n = 8, 38.1%), morphine (n = 1, 4.8%) and gelofusine (n = 1, 4.8%). No cause was identified in six patients (19.4%), and four patients (12.9%) had non‐allergic reactions.ConclusionOur results confirm that antibiotics and neuromuscular blocking agents are common causative agents of perioperative anaphylaxis in the United Kingdom.

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“…3,5 Neuromuscular blocking agents remain the most common cause of perioperative anaphylaxis, though prevalence differs depending on geographic location. 6,7 Identifying the culprit agent is paramount in managing and preventing recurrence with future procedures. Identification of the offending agent is complicated by the fact that few culprit drugs have reliable or standardized testing available.…”

Section: Disclosure Of Significant Relationships With Relevant Commermentioning

confidence: 99%

Perioperative Anaphylaxis

Hartman¹

2015

The Journal of Allergy and Clinical Immunology: In Practice

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Allergic Reactions During Anesthesia at a Large United States Referral Center

Cited by 130 publications

References 37 publications

Perioperative Anaphylaxis: What Should Be Known?

Perioperative Anaphylaxis: What Should Be Known?

Anaphylaxis during general anaesthesia: experience from a drug allergy centre in theUK

Perioperative Anaphylaxis

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