Australian and New Zealand Anaesthetic Allergy Group/ Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines

Abstract

Anaphylaxis is an uncommon but important cause of serious morbidity and even mortality in the perioperative period. The Australian and New Zealand College of Anaesthetists (ANZCA) with the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) have developed clinical management guidelines that include six crisis management cards. The content of the guidelines and cards is based on published literature and other international guidelines for the management of anaesthesia-related and non-anaesthesia-related anaphylaxis. The evidence is summarised in the associated background paper (Perioperative Anaphylaxis Management Guidelines [2016] www.anzca.edu.au/resources/endorsed-guidelines and www.anzaag.com/Mgmt%20Resources.aspx). These guidelines are intended to apply to anaphylaxis occurring only during the perioperative period. They are not intended to apply to anaphylaxis outside the setting of dedicated monitoring and management by an anaesthetist. In this paper guidelines will be presented along with a brief background to their development.

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

“…NAP6 data shows rapid falls within 30 minutes and support BSACI and AAGBI Guidelines (1st sample immediately post‐reaction, 2nd at 1‐2 hours, plus a 24‐hour baseline . Second samples within 6 hours can still be informative (ANZAAG guidelines suggest 1‐, 4‐ and 24‐hour samples) …”

“…20,24 Second samples within 6 hours can still be informative (ANZAAG guidelines suggest 1-, 4-and 24-hour samples). 2,14 Ten per cent had elevated baseline tryptase suggesting mastocytosis or raised alpha tryptase due to gene duplication now sometimes referred to as hyper-alpha tryptasaemia syndrome (HATS). 26 It is impossible to verify that these are truly raised, due to the variation in baseline sampling and lack of follow-up samples.…”

“…13 • The incidence of latex allergy is probably decreasing. 4,14 • Rocuronium may now be a leading cause of NMBA reactions. 15 • Chlorhexidine and teicoplanin are triggers on the rise.…”

“…One hundred and seventy-five (76%) were taken within the hour, consistent with the ANZAAG (Australian and New Zealand Anaesthetic Allergy Group) guidelines ( Figure 1A). 1,14,[22][23][24] Twenty-three (3%) T2 samples were taken within 60 and 74 (32%) at <120 minutes, consistent with BSACI guidance, rising to 43% within 3 and 71% within 6 hours. One hundred and sixty-eight (73%) had satisfactory T3 >24 hours baseline samples, 12% were too early <20 hours.…”

“…Basal tryptase levels may correlate with severity of anaphylaxis in non‐perioperative settings The incidence of latex allergy is probably decreasing Rocuronium may now be a leading cause of NMBA reactions …”