Anaphylaxis during induction of general anesthesia: Subsequent evaluation and management

Moscicki, Richard A.; Sockin, Steven M.; Corsello, Bruce F.; Ostro, M.G.; Bloch, Kurt J.

doi:10.1016/s0091-6749(05)80095-8

Cited by 81 publications

(26 citation statements)

References 48 publications

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“…The skin prick tests were performed using undiluted commercial preparations. The intracutaneous tests were carried out in dilutions ranging from 1:100,000 to 1:100, as stated in several papers [20,21,22,23]. The saline solution produced a negative result, and the histamine 1 mg/ml epicutaneous prick test resulted in an 8-mm wheal with a flare.…”

Section: Methodsmentioning

confidence: 99%

Delayed Allergic Reaction to Suxamethonium Driven by Oligoclonal Th1-Skewed CD4+CCR4+IFN-γ+ Memory T Cells

Scala

Guerra

Giani

et al. 2006

Int Arch Allergy Immunol

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Background: Muscle relaxants represent the drugs most frequently involved in intraoperative anaphylaxis during surgical procedures. Our aim was to report the case of a delayed reaction to suxamethonium and analyze specific T cell lines with regard to their specificity, phenotype and cytokine profile. Methods: We generated a drug-specific T cell line from a biopsy at the site of positive intradermal reactions and analyzed the immunophenotype, T cell receptor Vβ domain expression and cytokine profile. Results: T cells isolated from positive intradermal test reactions to suxamethonium showed a strict dose-dependent proliferation in response to drug-pulsed autologous antigen-presenting cells. The drug-specific CD4+ T cells were oligoclonal memory CD3+CD4+ T cells and expressed the skin homing receptors cutaneous lymphocyte antigen (CLA) and CCR4. Furthermore CD4+ suxamethonium-reactive T cell lines were IFN-γ-positive and synthesized high levels of IFN-γ and TNF-α. Conclusion: The study describes a delayed hypersensitivity to suxamethonium, driven by an oligoclonal T helper cell 1-skewed CD4+ memory T cell population, expressing the skin homing receptors CLA and CCR4.

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Section: Methodsmentioning

confidence: 99%

Delayed Allergic Reaction to Suxamethonium Driven by Oligoclonal Th1-Skewed CD4+CCR4+IFN-γ+ Memory T Cells

Scala

Guerra

Giani

et al. 2006

Int Arch Allergy Immunol

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“…Because no preemptive therapeutic strategies exist, the most important thing to do to prevent anaphylaxis is to avoid the antigen. Avoidance of drugs that produced anaphylaxis and positive tests during a prior period of anesthesia has been demonstrated to prevent an episode of anaphylaxis from recurring [15]. When a specific allergen was not identified, it is necessary to test the agents used during the previous anesthesia by using the skin prick test and the antigen-specific IgE assay [4].…”

Section: Case Reportmentioning

confidence: 99%

Anaphylaxis to topical bovine thrombin used for hemostasis during surgery for herniated nucleus pulposus −A case report−

Kim¹,

Lee²,

Lee³

et al. 2015

Anesth Pain Med

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“…Anaphylaxis severity has been addressed in most studies [7,8,16,17,20,22], with a positive skin test fi nding being more likely in more severe reactions [7,8,16,22]. This may be explained in part by the lack of a gold standard for diagnosing anaphylaxis, with more severe reactions more likely to refl ect true anaphylaxis.…”

Section: Differential Diagnosis Of Anaphylaxis In General Anesthesiamentioning

confidence: 99%

“…Others refer to skin testing as the "golden standard" rather than the gold standard [26]. Given that multiple techniques, concentrations, and interpretations are used for GAA skin testing [2,7,8,[15][16][17][18][19]22], its use as the reference or gold standard is problematic and should be avoided.…”

Section: Differential Diagnosis Of Anaphylaxis In General Anesthesiamentioning

confidence: 99%

General anesthetic allergy testing

Bleasel

Donnan²,

Unglik³

2008

Curr Allergy Asthma Rep

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Anaphylaxis in the setting of general anesthesia is a rare but potentially lethal event. The investigation of severe reactions is important for confirming the clinical diagnosis and identifying likely causative agents and safe agents that may be used in the future. Many comprehensive reports have described the testing protocol of individual specialized units, whereas there has been no standardization of testing techniques or formal assessment of these tests' diagnostic accuracy. We review the literature with reference to the recently published standards for reporting of diagnostic accuracy (STARD) and make recommendations for future studies of diagnostic accuracy in the field.

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Anaphylaxis during induction of general anesthesia: Subsequent evaluation and management

Cited by 81 publications

References 48 publications

Delayed Allergic Reaction to Suxamethonium Driven by Oligoclonal Th1-Skewed CD4+CCR4+IFN-γ+ Memory T Cells

Delayed Allergic Reaction to Suxamethonium Driven by Oligoclonal Th1-Skewed CD4+CCR4+IFN-γ+ Memory T Cells

Anaphylaxis to topical bovine thrombin used for hemostasis during surgery for herniated nucleus pulposus −A case report−

General anesthetic allergy testing

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