Dilemmas of allergy diagnosis in perioperative anaphylaxis

Brockow, Knut

doi:10.1111/all.12485

Cited by 17 publications

(24 citation statements)

References 14 publications

(20 reference statements)

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“…This is considered the gold standard for diagnosing drug hypersensitivity (grade of recommendation, C) and consists of the administration of increasing doses of the drug at 30 minute intervals, in a single blinded and placebo controlled manner, until reaching the therapeutic dose or appearance of the reaction [143,144]. Many of the drugs administered during the perioperative period such as antibiotics or NSAIDs will be studied following regular procedures and are not going to be described in this review.…”

Section: Drug Provocation Testsmentioning

confidence: 99%

“…It is not recommended for muscle relaxants due to potential effects on breathing, with the exception of those cases where they are suspected to cause a reaction, and where they are absolutely necessary to perform the surgery and no alternatives exist [144]. It is indicated in specific situations where anaesthetist requires to know tolerance to NMBAs such as transplantations, in high-risk patients or when STs are not valuable.…”

Section: Drug Provocation Testsmentioning

confidence: 99%

See 1 more Smart Citation

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and Resumen:Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias.

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Section: Drug Provocation Testsmentioning

confidence: 99%

Section: Drug Provocation Testsmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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“…Anaphylaxis is a severe systemic allergic reaction that affects two or more systems, including the skin, respiratory, cardiovascular, and gastrointestinal systems [15]. Since chlorhexidine has become widely used in hospitals and private healthcare [5, 9–11, 15, 16], it has increasingly been reported to be a potential allergenic agent. Diagnostic investigation of the cause of perioperative anaphylaxis should be carefully performed by a medical specialist in Allergy and Immunology.…”

Section: Discussionmentioning

confidence: 99%

“…Prior contact with the agent is required for the development of this type of immediate hypersensitivity reaction. Target organs include the skin, mucous membranes, and the respiratory, cardiovascular, and gastrointestinal systems [11–15]. …”

Section: Introductionmentioning

confidence: 99%

Perioperative Anaphylaxis to Chlorhexidine during Surgery and Septoplasty

Abreu

Oliveira

Abreu

et al. 2017

Case Reports in Otolaryngology

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Chlorhexidine is an antiseptic and disinfectant used in surgical and clinical practice since 1954 and is available in aqueous or alcoholic solutions 0.5%–4.0% and has a broad-spectrum activity. Despite their widespread use, allergic reactions with chlorhexidine are rarely reported. We describe a case of anaphylaxis with chlorhexidine during a septoplasty, turbinectomy, and maxillary sinusectomy. The patient presented with periorbital edema, hives, hypotension, and wheezing. Immediately after the diagnosis of anaphylaxis promethazine, hydrocortisone, and epinephrine were administered with immediate clinical improvement. This case highlights the importance of assessing whether there is a previous clinical history of hypersensitivity to chlorhexidine in patients who will undergo surgical procedures.

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“…It has a longer elimination half-life than histamine, which renders it the most useful substance for testing as it can be detected from 30 minutes to 6 hours following the anaphylactic reaction and has a sensitivity of 60-70% [2]. Nevertheless, despite the usefulness of serum tryptase as an indicator of a hypersensitivity reaction, it must be noted that, as with clinical symptoms, it cannot distinguish between anaphylactic and anaphylactoid reactions [12]. In addition, even if serum tryptase is found to be in the normal range, anaphylactic reactions cannot be completely excluded [5] because a normal tryptase level may be significantly high if the baseline level was very low [13].…”

Section: Discussionmentioning

confidence: 99%

Absence of elevated serum tryptase in rocuronium-induced anaphylaxis during discectomy under general anesthesia: A case report

Lee¹

2016

SJAMS

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A 43-year-old female patient, who had previously undergone surgery under general anesthesia without any problems, was scheduled for discectomy. Propofol and rocuronium were injected sequentially to induce general anesthesia. Twenty minutes after the rocuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The operation was cancelled. No postoperative complications were evident, and the patient was discharged from the hospital. Serum tryptase value at the time of anaphylaxis was within normal ranges. But skin prick test and intradermal test was found to anaphylaxis caused by rocuronium after six weeks.

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Dilemmas of allergy diagnosis in perioperative anaphylaxis

Cited by 17 publications

References 14 publications

Practical Guidelines for Perioperative Hypersensitivity Reactions

Practical Guidelines for Perioperative Hypersensitivity Reactions

Perioperative Anaphylaxis to Chlorhexidine during Surgery and Septoplasty

Absence of elevated serum tryptase in rocuronium-induced anaphylaxis during discectomy under general anesthesia: A case report

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