Perioperative Anaphylaxis

Abstract

Anesthesiologists routinely manage patients receiving drugs and agents, all of which have the potential for anaphylaxis, the life-threatening presentation of an allergic reaction. Clinicians must be ready to diagnose and manage the acute cardiopulmonary dysfunction that occurs.

Perioperative Anaphylaxis: Comment

“…We read the interesting review published by Tacquard et al 1 and appreciated the effort to provide evidence on the epidemiology, clinical manifestations, and management of perioperative anaphylaxis. While we recommend reading this review to the practitioner who wishes to better understand the mechanisms underlying drug-induced hypersensitivity reactions and anaphylaxis, we would comment on the statement, “pretreatment with antihistamines and glucocorticoids can reduce the severity or frequency of certain non-immunologic reactions, including those to radiocontrast media.”…”

“…Thanks to the thoughtful insights derived from the paper by Tacquard et al ., 1 we had the opportunity to examine the recent evidence available to date on perioperative anaphylaxis. We agree that in specific situations such as immunologic disorders ( i.e.…”

Perioperative Anaphylaxis: Comment

“…We read with interest the clinical focus review “Perioperative Anaphylaxis” by Tacquard et al . 1 The authors address management of perioperative anaphylaxis and the use of epinephrine, stating specifically, “Unlike out-of-hospital anaphylaxis where intramuscular epinephrine is the cornerstone of management, intravenous epinephrine, and potentially other vasoactive agents are important for initial management, as noted in advanced cardiac life support algorithms titrated to specific effects.” They reference international consensus recommendations published in 2019 by a group of experts in perioperative allergy, which recommends the IV route for administration of epinephrine. 2 However, in 2020, the American Academy of Allergy, Asthma and Immunology (Milwaukee, Wisconsin) published a systematic review and practice parameter update for anaphylaxis recommending intramuscular injection of epinephrine to the anterolateral thigh as first-line therapy for anaphylaxis.…”

Perioperative Anaphylaxis: Comment

“…We read with great interest the erudite review of anaphylaxis by Tacquaer et al 1 and summary by Avram, 2 which appeared in the January 2023 issue of Anesthesiology . The review is comprehensive and timely.…”