Specialist perioperative allergy clinic services in the <scp>UK</scp> 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (<scp>NAP</scp>6) investigation of perioperative anaphylaxis

Egner, William; Cook, Tim; Garcez, Tomaz; Marinho, Susana; Kemp, Harriet; Lucas, D.N.; Floss, K.; Farooque, Sophie; Torevell, H.; Thomas, Mark; Ferguson, K.; Nasser, Shuaib; Karanam, S.; Kong, K.-L.; McGuire, N.; Bellamy, Mark; Warner, Amena; Hitchman, John; Farmer, L.; Harper, N.J.N.

doi:10.1111/cea.13180

Cited by 23 publications

(26 citation statements)

References 31 publications

(95 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,2,10 In others, including NAP6 recommendations, it is suggested to take the first sample as soon as the patient is stable. 5,7,40,73 In our Delphi process, the strongest consensus supported the first sample being obtained at 1 h after reaction onset and we recommend samples at 1 h and 2e4 h with a baseline sample for comparison obtained at least 24 h post reaction.…”

Section: Mast Cell Tryptase Samplingmentioning

confidence: 79%

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

Garvey

Dewachter

Hepner

et al. 2019

British Journal of Anaesthesia

129

175

View full text Add to dashboard Cite

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.

show abstract

Section: Mast Cell Tryptase Samplingmentioning

confidence: 79%

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

Garvey

Dewachter

Hepner

et al. 2019

British Journal of Anaesthesia

129

175

View full text Add to dashboard Cite

show abstract

“…In patients with confirmed PA, sBT levels >5 μg/L were more prevalent in grade 3 and 4 reactions. Elevated sBT may indicate MC‐related conditions such as mastocytosis or hereditary alpha‐tryptasemia, and has been associated in some but not all studies with an increased risk of PA …”

Section: Discussionmentioning

confidence: 99%

Paired acute‐baseline serum tryptase levels in perioperative anaphylaxis: An observational study

Vitte

Amadei

Gouitaa

et al. 2019

Allergy

View full text Add to dashboard Cite

Background: Anaphylaxis is recognized mainly through clinical criteria, which may lack specificity or relevance in the perioperative setting. The transient increase in serum tryptase has been proposed since 1989 as a diagnostic tool. Sampling for well-defined acute and baseline determinations has been recommended. We assessed the performance of four proposed algorithms with tightly controlled time frames for tryptase sampling, their robustness with inadequate sampling times, and the possible use of mature tryptase determination. Methods:A retrospective study was performed on 102 adult patients from the Aix-Marseille University Hospitals who had experienced a perioperative hypersensitivity reaction clinically suggesting anaphylaxis. EAACI and ICON criteria were used to diagnose anaphylaxis. Mature and total serum tryptase levels were measured.Results: Based on EAACI guidelines, clinical diagnostic criteria for anaphylaxis were found in 76 patients and lacking in 26. The most effective algorithm was the international consensus recommendation of 2012 that acute total tryptase levels should be greater than ([1.2×baseline tryptase] + 2] μg/L to be considered a clinically significant rise. In our cohort, this algorithm achieved 94% positive predictive value (PPV), 53% negative predictive value (NPV), 75% sensitivity, 86% specificity, and a Youden's index value of 0.61. A detectable acute mature tryptase level showed lower sensitivity, particularly in patients with acute total tryptase levels lower than 16 μg/ L. Acute tryptase levels varied as a function of the clinical severity of anaphylaxis. Conclusion:Total tryptase levels in serum discriminated between nonanaphylactic and anaphylactic events in a perioperative setting when acute and baseline levels were collected and analyzed by the consensus algorithm. K E Y W O R D Sacute tryptase, anaphylaxis, anesthesia, baseline tryptase, hypersensitivity reaction, mast cell, mature tryptase, perioperative anaphylaxis, positive predictive value Abbreviations: Ig, immunoglobulin; IQR, interquartile range; MC, mast cell; NMBA, neuromuscular blocking agents; NPV, negative predictive value; PA, perioperative anaphylaxis; PPV, positive predictive value; sAT, serum acute tryptase; sBT, serum baseline tryptase; SHR, systemic hypersensitivity reaction.

show abstract

“…Last year saw the publication of the Royal College of Anaesthetists 6th National Audit Project. 39,40 They describe the causes and investigation of peroperative anaphylaxis using a registry approach. The authors noted that harmonization of the approach to testing, access to services, and MHRA reporting was needed.…”

Section: Drug Allergymentioning

confidence: 99%

Developments in the field of clinical allergy in 2018 through the eyes of Clinical and Experimental Allergy, Part II

Roberts

Almqvist

Boyle

et al. 2019

Clin Experimental Allergy

View full text Add to dashboard Cite

show abstract

Specialist perioperative allergy clinic services in the UK 2018: Results from the Royal College of Anaesthetists Sixth National Audit Project (NAP6) investigation of perioperative anaphylaxis

Cited by 23 publications

References 31 publications

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

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

Paired acute‐baseline serum tryptase levels in perioperative anaphylaxis: An observational study

Developments in the field of clinical allergy in 2018 through the eyes of Clinical and Experimental Allergy, Part II

Contact Info

Product

Resources

About