Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6)

Harper, N.J.N.; Cook, Tim; Garcez, Tomaz; Farmer, L.; Floss, K.; Marinho, Susana; Torevell, H.; Warner, Amena; Ferguson, K.; Hitchman, John; Egner, William; Kemp, Harriet; Thomas, Mark; Lucas, D.N.; Nasser, Shuaib; Karanam, S.; Kong, K.-L.; Farooque, Sophie; Bellamy, Mark; McGuire, N.

doi:10.1016/j.bja.2018.04.014

Cited by 406 publications

(498 citation statements)

References 48 publications

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“…No patient was persistently hypotensive and none developed erythema or generalised urticaria. In the NAP6 study, peri‐operative anaphylaxis was associated with hypotension in all cases .…”

Section: Discussionmentioning

confidence: 96%

Propofol use in children with allergies to egg, peanut, soybean or other legumes

et al. 2019

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Summary Propofol is the most commonly administered intravenous agent for anaesthesia in children. However, there are concerns that the emulsified preparation may not be safe in children with an allergy to egg, peanut, soybean or other legumes. We conducted a retrospective study of children with immunologically confirmed egg, peanut, soybean or legume allergy and who underwent general anaesthesia at Princess Margaret Hospital for Children between 2005 and 2015. We extracted details regarding allergy diagnosis, each anaesthetic administered and any adverse events or signs of an allergic reaction in the peri‐operative period. A convenience sample of patients without any known food allergies was identified from our prospective anaesthesia research database and acted as a control group. We identified 304 food‐allergic children and 649 procedures where propofol was administered. Of these, 201 (66%) had an egg allergy, 226 (74%) had a peanut allergy, 28 (9%) had a soybean allergy and 12 (4%) had a legume allergy. These were compared with 892 allergy‐free patients who were exposed to propofol. In 10 (3%) allergy patients and 124 (14%) allergy‐free patients, criteria for a possible allergic reaction were met. In nine of the food‐allergic children and in all the controls valid non‐allergic explanations for the clinical symptoms were found. One likely mild allergic reaction was experienced by a child with a previous history of intralipid allergy. We conclude that genuine serious allergic reaction to propofol is rare and is not reliably predicted by a history of food allergy.

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Section: Discussionmentioning

confidence: 96%

Propofol use in children with allergies to egg, peanut, soybean or other legumes

et al. 2019

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“…However, in a study on 103 patients with immunoglobulin E (IgE)‐mediated anaphylaxis during anesthesia, immediate hypersensitivity to PBV was suspected in 6% of patients. In a recent report of 266 cases of anaphylaxis collected over 1 year from all National Health Service hospitals, immediate hypersensitive reaction to PBV occurred in 4.5% of cases.…”

Section: Discussionmentioning

confidence: 99%

A case of immediate hypersensitivity reaction after an oral administration of patent blue dye

et al. 2019

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“…NAP6 received 266 completed and interpretable 2‐part reports from the UK. This suggests some under‐reporting …”

Section: Discussionmentioning

confidence: 99%

“…Grade of reaction was reviewed against criteria in the NAP6 epidemiology paper, consistent with WAO definitions . Grade 3, bronchospasm or hypotension (systolic nadir ≥50 mm Hg) together with any other features suggestive of anaphylaxis (rash, angioedema).…”

Section: Methodsmentioning

confidence: 99%

Specialist perioperative allergy clinic services in the UK 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6) investigation of perioperative anaphylaxis

Egner

Cook

Garcez

et al. 2018

Clin Experimental Allergy

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Current clinical assessment in the UK is effective but harmonization of approach to testing, access to services and MHRA reporting is needed. Expert anaesthetist involvement should increase to optimize diagnostic yield and advice for future anaesthesia. Dynamic tryptase evaluation improves detection of tryptase release where peak tryptase is <14 μg/L and should be adopted. Standardized clinic reports containing appropriate details of tests, conclusions, avoidance, cross-reactivity and suitable alternatives are required to ensure effective, safe future management options.

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Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6)

Abstract: The overall incidence of perioperative anaphylaxis was estimated to be 1 in 10 000 anaesthetics.

Cited by 406 publications

References 48 publications

Propofol use in children with allergies to egg, peanut, soybean or other legumes

Propofol use in children with allergies to egg, peanut, soybean or other legumes

A case of immediate hypersensitivity reaction after an oral administration of patent blue dye

Specialist perioperative allergy clinic services in the UK 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6) investigation of perioperative anaphylaxis

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