Antibiotics Are the Most Commonly Identified Cause of Perioperative Hypersensitivity Reactions

Abstract

Background Hypersensitivity reactions (HSR) during the perioperative period are unpredictable and can be life threatening. Prospective studies for evaluation of perioperative HSR are lacking and data on causative agents varies between different studies. Objective To prospectively determine the success of a comprehensive allergy evaluation plan for patients with HSR during anesthesia, including identification of causative agent and outcomes during subsequent anesthesia exposure. Methods All patients referred for perioperative HSR between November 2013 and March 2015, from a Boston teaching hospital, were evaluated using a standardized protocol with skin testing (ST) within 6 months of HSR. Comprehensive allergy evaluation included collection of patient information, including characteristics of HSR during anesthesia. We reviewed results of ST and/or test doses for all potential causative medications Event-related tryptase levels were reviewed when available. Results Over 17 months, 25 patients completed the comprehensive allergy evaluation. Fifty-two percent (13/25) were female with a median age of 52 (IQR 43–66) years. The most frequently observed HSR systems were cutaneous (68%), cardiovascular (64%), and pulmonary (24%). A culprit drug, defined as a positive ST, was identified in 36% (9/25) of patients. The most common agent identified was cefazolin (6/9). Following our comprehensive evaluation and management plan, seven (7/8, 88%) patients tolerated subsequent anesthesia. Conclusions Cefazolin was the most commonly identified cause of perioperative HSR in our study population. Skin testing patients within 6 months of a perioperative HSR may improve the odds of finding a positive result. Tolerance of subsequent anesthesia is generally achieved in patients undergoing our comprehensive evaluation.

Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy

“…Our study is in line with previously published data reporting cefazolin as the most common cause of perioperative hypersensitivity reactions [8, 9, 19]. In a study performed by Kuhlen et al [19], including patients referred due to perioperative hypersensitivity reactions, the culprit drug was identified in 36% (9 of 25) patients, cefazolin being the most common drug used (6 of 9).…”

“…In a study performed by Kuhlen et al [19], including patients referred due to perioperative hypersensitivity reactions, the culprit drug was identified in 36% (9 of 25) patients, cefazolin being the most common drug used (6 of 9).…”

Hypersensitivity Reactions During Anaesthesia Care: An 11-Year Experience From A Tertiary Hospital

“…These results are similar to previous studies, in which the main agents involved in IgE-mediated perioperative anaphylaxis were neuromuscular blocking agents, latex, antibiotics, hypnotics, opioids, and colloids [7,13,14]. In the United States, antibiotics, contrary to NMBAs, were the most common identifiable cause of Perioperative Anaphylaxis [15,16].…”

Approach to the diagnosis of drug hypersensitivity reactions: similarities and differences between Europe and North America

“…Moreover, chlorhexidine is an integral part of the perioperative test panel in some European and U.S. centres [28, 29]. …”