Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

Abstract

Background: Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents. Methods: We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1e9) and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated. Results: Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more) and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase. Conclusion: We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.

Comparison of incidence of anaphylaxis between sugammadex and neostigmine: a retrospective multicentre observational study

“…Clinical background, anaphylactic symptoms, and blood test results in patients with anaphylaxis attributable to sugammadex. All patients had a clinical score of 8 or above, suggesting possible anaphylaxis 16. Anaphylactic symptoms appeared after sugammadex 80 mg administration in Case 3 and sugammadex 200 mg in other cases.…”

“…Clinical background, anaphylactic symptoms, and blood test results in patients with anaphylaxis induced by drugs other than sugammadex. All patients had a clinical score of 8 or more, suggesting possible anaphylaxis 16. A past history of drug allergies to ciprofloxacin was seen in Case 6 and to tropicamide in Case 8.…”

Early Skin Test after Anaphylaxis during Induction of Anesthesia: A Case Report

“…Symptoms of anaphylaxis vary and may include hypotension, tachycardia, cardiovascular collapse, angioedema, bronchospasm, wheezing, hypoxia, pulmonary edema, and urticaria. In a new clinical scoring system, the impact of confounding factors and timing are also calculated [7]. Diagnosis of anaphylaxis which occurs in general anesthesia is challenging due to the concurrent administration of multiple drugs within a short period of time.…”

Anaphylactic Shock Case After Sugammadex Application

“…It is difficult to determine the cause of anaphylaxis as various medications are being used during anesthesia. The most common identifiable causes of perioperative anaphylaxis have been identified as antibiotics (the most common cause in several American studies), NMBAs (the most common cause in many European studies), latex, blood products, chlorhexidine and patent blue (5)(6)(7) . Sedatives, analgesics, local anesthetics, and other drugs are less common causes (1) .…”