BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia

Ewan, P. W.; Dugué, Pierre Antoine; Mirakian, Rita; Dixon, T. A.; Harper, J. N.; Nasser, Shuaib

doi:10.1111/j.1365-2222.2009.03404.x

Cited by 152 publications

(185 citation statements)

References 93 publications

(125 reference statements)

Supporting

Mentioning

178

Contrasting

Unclassified

Order By: Relevance

“…Only 173 (54.7%) patients with suspected hypersensitivity reaction referred to our clinic had bloods taken for serum tryptase measurement. An important message to clinicians who refer patients with suspected hypersensitivity reactions is to ensure blood samples are taken for serum tryptase analysis according to recommended time intervals [1][2][3][4]. Indeed, a recent editorial suggested that even more samples should be taken, for example at one, two, three, six, 12 and 24 hours after a reaction, to ensure that at least some of these samples reach the laboratory and demonstrate the rise and fall of serum tryptase concentrations [41].…”

Section: Discussionmentioning

confidence: 99%

“…A positive skin test and/or a positive serum-specific IgE assay result was regarded as confirmatory of IgE-mediated hypersensitivity. Limitations of skin tests and serum-specific IgE testing are well recognised [1]. False positive skin tests due to direct histamine-releasing effects of some drugs are well known.…”

Section: Methodsmentioning

confidence: 99%

“…We performed skin prick tests at therapeutic concentration or known non-irritant concentration based on the information available (EAACI guidelines 2005, BSACI guidelines 2009, ENDA guidance 2013) [1,9,10]. When applicable, in positive cases, alternative drugs from the same class (e.g.…”

Section: Methodsmentioning

confidence: 99%

“…Both the British Society for Allergy and Clinical Immunology (BSACI) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommend the involvement of both an anaesthetist and an allergist in these clinics, as the identification of the nature of the reaction and causative agents is often complex in the context of the peri-operative setting [1,2].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic

McEwan

Karanam

et al. 2015

Anaesthesia

View full text Add to dashboard Cite

SummaryOur bi-specialty clinic was established to systematically investigate patients with suspected peri-operative hypersensitivity reactions. Four hundred and ten patients were studied; 316 following an intra-operative reaction ('postoperative' group) and 94 with a previous history of reaction, referred before undergoing anaesthesia ('pre-operative' group). In the postoperative group, 173 (54.7%) were diagnosed with IgE-mediated reactions: 65 (37.6%) to neuromuscular blocking drugs; 54 (31.2%) antibiotics; 15 (8.7%) chlorhexidine and 12 (6.9%) patent blue dye. Reactions were severe in 114 patients (65.9%). All reactions to patent blue dye were severe. We identified IgE sensitisation in 22 (13.2%) cases with isolated mucocutaneous reactions. Only 173 (54.7%) patients had serum tryptase samples taken. Referrers' suspected causal agent was confirmed in only 37.2% of patients. Of 94 patients reviewed 'pre-operatively', 29 (30.8%) were diagnosed with IgE-mediated hypersensitivity reactions, reinforcing the importance of investigating this group of patients. Knowledge of the range of causative agents identified in our study should guide the investigation of suspected peri-operative hypersensitivity reactions.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic

McEwan

Karanam

et al. 2015

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…5,13 The aim of investigation is to identify the cause of reaction and recommend a range of drugs likely to be safe in the future.…”

Section: General Anaesthesiamentioning

confidence: 99%

Introduction to drug allergy, and whom to refer for specialist assessment?

Kasternow

Karim

2016

Clinical Medicine

View full text Add to dashboard Cite

Drug allergy is defined as an adverse drug reaction with an established immunological mechanism. The National Institute for Health and Care Excellence published clinical guidelines on drug allergy in 2014 and quality standards in 2015. The intention of this article is to highlight indications for referral to specialists for management of drug allergy. Accurate diagnosis of drug allergy is critical of course for patient safety, but also for better use of the drugs that we have available and to reduce unnecessary avoidance of drugs. However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. It is, therefore, important to highlight to general physicians and physicians of other specialties, those patients who do require referral for specialist review. IntroductionAn adverse drug reaction (ADR) is defined as 'an appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product '.1 However, drug allergy has a more specific definition. It has been defined by the British Society for Allergy and Clinical Immunology (BSACI) as 'an ADR with an established immunological mechanism'.2,3 The subject of drug allergy is very topical, particularly with the focus on patient safety, and has attracted the attention of the National Institute for Health and Care Excellence (NICE) with publication of clinical guidelines on drug allergy in 2014 and quality standards in 2015.3,4 The intention of this article is not to provide a comprehensive review of drug allergy, but rather to introduce the topic and highlight indications for referral to specialists for management of drug allergy. Accurate diagnosis of drug allergy is critical for patient safety, for better use of the drugs that we have available and to reduce the unnecessary ABSTRACT Introduction to drug allergy, and whom to refer for specialist assessment?avoidance of drugs. However, there are significant limitations in terms of resource availability and also in terms of testing. There is a careful balance here in that drug allergy is very common and clearly there is neither indication nor sufficient resource in the NHS for all patients with drug allergy to be reviewed by a specialist. AssessmentThere is an issue of perception versus reality with respect to drug allergy. The prevalence of drug allergy estimated by patients in the general population is much higher than can be found objectively. For example, there are significant differences in the perception of the frequency of penicillin allergy. 5 This raises an important point in the initial evaluation of the patient with suspected drug allergy. In most cases, clinical ...

show abstract