Opioid Hypersensitivity: Predictors of Allergy and Role of Drug Provocation Testing

Li, Philip H.; Ue, Kok Loong; Wagner, Annette; Rutkowski, Ryszard; Rutkowski, Krzysztof

doi:10.1016/j.jaip.2017.03.035

Cited by 39 publications

(20 citation statements)

References 34 publications

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“…91,92 When investigating drug groups where the mechanism is unlikely to be IgE-mediated, for example opioids or NSAIDs, DPT may be the only reliable test. [92][93][94] It has been argued that without DPT, the causal relationship as well as sensitivity and specificity for skin tests, sIgEs and cellular tests cannot be reliably determined. 95 An important drawback is the risk of inducing anaphylaxis, making DPT in POH a high-risk procedure, less likely to become an available option in most centres.…”

Section: Drug Provocation Testing (Dpt)mentioning

confidence: 99%

An EAACI position paper on the investigation of perioperative immediate hypersensitivity reactions

Garvey

Ebo

Mertès

et al. 2019

Allergy

142

202

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Perioperative immediate hypersensitivity reactions are rare. Subsequent allergy investigation is complicated by multiple simultaneous drug exposures, the use of drugs with potent effects and the many differential diagnoses to hypersensitivity in the perioperative setting. The approach to the investigation of these complex reactions is not standardized, and it is becoming increasingly apparent that collaboration between experts in the field of allergy/immunology/dermatology and anaesthesiology is needed to provide the best possible care for these patients. The EAACI task force behind this position paper has therefore combined the expertise of allergists, immunologists and anaesthesiologists. The aims of this position paper were to provide recommendations for the investigation of immediate-type perioperative hypersensitivity reactions and to provide practical information that can assist clinicians in planning and carrying out investigations. | 1873GARVEY Et Al.

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Section: Drug Provocation Testing (Dpt)mentioning

confidence: 99%

An EAACI position paper on the investigation of perioperative immediate hypersensitivity reactions

Garvey

Ebo

Mertès

et al. 2019

Allergy

142

202

View full text Add to dashboard Cite

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“…opioids or NSAIDs), DPT may be the only reliable test. 108,109 DPT has only recently been recommended in perioperative allergy investigation, and very limited literature is available. 7,8,43,110 When involving drugs specific to anaesthesia, it should only be undertaken in specialised centres after ensuring informed consent.…”

Section: Drug Provocation Testingmentioning

confidence: 99%

Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Garvey

Dewachter

Hepner

et al. 2019

British Journal of Anaesthesia

130

178

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Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

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“…9 Such concerns have led some to argue about the greater adoption of drug provocation testing to avoid overdiagnosis and unnecessary avoidance of medications. 10 Minimizing the chances of false-positive results, we tested our loperamide concentrations on healthy volunteers and used authoritative, published maximum nonirritating concentrations. 1 In summary, we report a unique case of loperamide anaphylaxis confirmed on intradermal testing with possibledbut not confirmeddcross-sensitization to fentanyl.…”

Section: An Unusual Case Of Loperamide Anaphylaxismentioning

confidence: 99%

An unusual case of loperamide anaphylaxis

Lee

Smith

Krummenacher

et al. 2020

Annals of Allergy, Asthma & Immunology

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Opioid Hypersensitivity: Predictors of Allergy and Role of Drug Provocation Testing

Cited by 39 publications

References 34 publications

An EAACI position paper on the investigation of perioperative immediate hypersensitivity reactions

An EAACI position paper on the investigation of perioperative immediate hypersensitivity reactions

Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

An unusual case of loperamide anaphylaxis

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