Patients with a positive history of antibiotic hypersensitivity seem to have a higher incidence of positive skin tests for NMBAs. They might represent a group at higher risk for developing intraoperative anaphylaxis compared to the general population.

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Abstract"ackground Flowcytometry-assisted basophil activation tests ""T are useful in vitro diagnostic tools for drug-induced immediate-type hypersensitivity.Objective The study aimed to perform a medical literature review on the performance of CD ""T.Results Seven studies for antibiotics, eleven for neuromuscular blocking agents NM""s , and for nonsteroidal anti-inflammatory drugs NS"IDs were included. The reference standards such as history, skin tests, challenge tests, and/or IgE, along with the concentrations, varied among studies. The thresholds for ""T positivity varied from basophils in the range greater than %, a net percentage of activated basophils greater than % or a stimulation index ranging .. , to the use of more complex composite indexes for NM""s. For antibiotics and NS"IDs, a stimulation index > was generally chosen. ""T sensitivity for β-lactams was %, while specificity was . %. For NM""s, ""T sensitivity was %, while specificity was %. For NS"IDs, ""T sensitivity was . % and specificity was %.Discussion ""T for the diagnosis of drug hypersensitivity has good specificity, but only moderate sensitivity. Despite the shortcomings and the methodological differences in ""T, the potential benefits to avoid challenge tests and increase the allergologic survey sensitivity have led to their widespread use in the clinical practice and warrant their future standardization.

Risk factors for intraoperative immediate-type hypersensitivity reactions may require allergological evaluation. We report the case of a hairdresser with a positive history of penicillin hypersensitivity and anaphylactic shock during previous general anesthesia, whose in vivo and in vitro allergy tests were positive for neuromuscular blocking agents, opioids, and midazolam. Immediate-type hypersensitivity reactions to antibiotics and professional exposure to hairdressing products might induce simultaneous cross-sensitization to multiple drugs that are commonly used during general anesthesia.