Drug Challenge Tests With General Anesthetics: Predictive Value of Skin Tests

Molina, Pampa; Rojas-Pérez-Ezquerra, Patricia; Noguerado-Mellado, Blanca; Ocariz, Maria Luisa Baeza Ochoa de; Sánchez, A Garrido; Mateos, Miriam; Zubeldía, J M

doi:10.18176/jiaci.0402

Cited by 11 publications

(5 citation statements)

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“…Then, as for any suspected immediate hypersensitivity reaction, the clinician uses tools (eg ST, sIgE, DPT) to test the different suspected culprits. Although the investigation of different culprits relies mostly on different combinations of tests (eg ST and DPT for antibiotics, analgesics; ST and sIgE for latex, chlorhexidine and quaternary ammonium), there is evidence that has accumulated over several decades that provides valuable insight into the value of these tests, including PPV of ST (eg beta‐lactam antibiotics), 24 NPV of ST (eg beta‐lactam antibiotics, NMBAs, morphinics) 25–27 and NPV of DPT (eg beta‐lactam antibiotics, analgesics) 28 . However, to establish a final diagnosis, more complex reasoning come into play because manifestations resembling anaphylaxis may be elicited by intrinsic pharmacological effects of drugs and factors related to the anaesthetic and/or surgical management, or to the state of the patient at the time of the administration of general anaesthesia (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of serial serum total tryptase measurement to differentiate positive from negative allergy testing among patients with suspected perioperative hypersensitivity

Srisuwatchari

Tacquard

Borushko

et al. 2021

Clin Experimental Allergy

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Background Serum total tryptase has been shown to increase during acute allergic reactions (acute tryptase, TA); however, few studies have investigated the values of TA or a combination of TA and baseline tryptase (TB) to discriminate positive from negative testing in perioperative hypersensitivity reaction (POH) allergy work‐up. The aim of this study was to determine the diagnostic performance of TA in order to differentiate positive from negative allergy testing suspected POH and analyse the diagnostic performance of serial tryptase levels using several formulas. Methods All patients from the University hospital of Montpellier and Strasbourg, France, who presented with suspected POH and underwent complete drug allergy work‐up between March 2011 and December 2019 with available TA and TB were included. Four formulas, including a change in TA > 11 (F1), or >2 + 1.2 × TB (F2), or >3 + TB (F3), or >120%TB (F4), were applied. Results One hundred and sixty‐two patients were included, and 131 of them (80.8%) had Grade III or IV reactions. Ninety patients had positive allergy testing. The optimal cut‐off value of TA to distinguish positive from negative allergy testing patients was 9.8 μg/L with an AUC of 0.817 (95% CI: 0.752–0.882, p < .001). The 93% PPV threshold for TA was 33 μg/L (95.8% specificity). Paired tryptase levels according to formulas F2 and F3 yielded the highest Youden index (0.54 and 0.53, respectively). Conclusion The optimal cut‐off point for TA for distinguishing positive from negative allergy testing suspected POH was 9.8 μg/L. TA value of 33 μg/L was required to achieve >90% PPV.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of serial serum total tryptase measurement to differentiate positive from negative allergy testing among patients with suspected perioperative hypersensitivity

Srisuwatchari

Tacquard

Borushko

et al. 2021

Clin Experimental Allergy

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“…In the majority of clinical settings where graded drug challenges are not available, the possibility of false negative as well as false positive tests must be considered. Skin testing for neuromuscular blocking agents is in general considered sensitive with a high negative predictive value 17–19 whereas skin testing for antibiotics such as cephalosporins may be less sensitive, 20 so could potentially result in false negative skin tests when a drug provocation test would be positive. At the conclusion of a testing protocol, a careful interpretation of test findings and re‐evaluation of all possible drugs and exposures as well as underlying disease is therefore necessary in all patients with suspected POH.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of a medical algorithm for investigation of perioperative hypersensitivity reactions

Sverrild

Carruthers

Murthee

et al. 2022

Allergy

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Perioperative hypersensitivity (POH) following administration of anaesthetics or other agents during anaesthesia for surgical procedures is generally rare but can be severe and life-threatening. 1,2 Immunoglobulin E (IgE)-mediated reactions account for 50-70% of POH and confer a greater risk of severe reactions upon re-exposure. 3,4 Every effort should be made to identify and avoid the culprit agent in order to prevent future episodes.It is important to correctly diagnose patients likely to have experienced an IgE-mediated POH, so that they can proceed to appropriate testing for potential culprit agents. However, clinical evaluation of POH can be complex and challenging due to the simultaneous administration of multiple suspect agents exerting a variety of

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“…Drug challenge testing is recommended by allergists in some cases of presumed intra operative anesthetic allergic reaction and is reportedly the gold standard. However, there are currently no published protocols for graded challenge 22 . A study of 29 patients looked at drug challenge tests with general anesthetics and predictive value of skin tests.…”

Section: Discussionmentioning

confidence: 99%

“…All patients had negative propofol skin tests and 1 had a positive reaction of redness to the face, neck, and back. 22 Patients in our study given the possibility of propofol challenge testing in the operating room had not undergone such testing at this time.…”

Section: Allergic Cohortmentioning

confidence: 99%

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Food allergy history and reaction to propofol administration in a large pediatric population

Bagley

Kordun

Sinnott

et al. 2021

Pediatric Anesthesia

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Background Anaphylaxis to propofol is rare; however, providers face a clinical quandary as medication warnings still exist regarding propofol administration to egg‐, soy‐, and peanut‐allergic patients. Aims The primary aim evaluated the rate of allergic reactions during propofol‐containing anesthesia in patients listed allergic to egg, soy, or peanut compared with nonallergic patients who received propofol. The secondary aim evaluated the relationship between food allergy history and allergy testing data. Methods A retrospective chart review conducted between May 2012 and October 2018 identified pediatric patients listed allergic to egg, soy, and/or peanut, who received propofol. Allergy testing and results are presented. Evidence of allergic reaction to propofol during anesthesia was evaluated, and compared with a large nonallergic cohort who received propofol. Results Of the 232 392 anesthetics administered, 177 360 (76%) included propofol and 11308 (6%) involved a patient listed allergic to at least 1 index food. A large number of patients had no food allergy testing (n = 6153) or negative testing (n = 2198). Of the 3435 patients listed egg‐allergic, 976 tested positive; 750 tested negative; and 1709 had no testing. Of the 2011 patients listed soy‐allergic, 322 tested positive; 585 tested negative; and 1104 had no testing. Additionally, 5862 patients were listed peanut‐allergic; 1659 tested positive; 863 tested negative and 3340 had no testing. One record of proven propofol anaphylaxis occurred; it was in a patient without a history of food allergies. There were 6 other cases of suspected allergy to propofol. One had a peanut and tree nut allergy and was lost to follow‐up; one had no testing available, while 4 patients had positive propofol allergy testing and positive allergy tests to other medications. The rate of proven propofol anaphylaxis during anesthesia in the nonallergic cohort was 0.06/10 000, and the rate in egg‐ and soy‐allergic patients was 0/5446. One patient with a listed peanut allergy had a possible reaction to propofol. Conclusions In the listed food‐allergic cohort, the majority had no allergy testing or negative testing. We found no evidence of a relationship between food allergy history and perioperative propofol reaction. We suggest multiply allergic and atopic patients may have a similar likelihood of propofol reaction as with other medications.

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Drug Challenge Tests With General Anesthetics: Predictive Value of Skin Tests

Cited by 11 publications

References 0 publications

Diagnostic performance of serial serum total tryptase measurement to differentiate positive from negative allergy testing among patients with suspected perioperative hypersensitivity

Diagnostic performance of serial serum total tryptase measurement to differentiate positive from negative allergy testing among patients with suspected perioperative hypersensitivity

Diagnostic value of a medical algorithm for investigation of perioperative hypersensitivity reactions

Food allergy history and reaction to propofol administration in a large pediatric population

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