Comparative epidemiology of suspected perioperative hypersensitivity reactions

Mertès, Paul-Michel; Ebo, Didier G.; Garcez, Tomaz; Rose, Michael; Sabato, Vito; Takazawa, Tomonori; Cooke, Peter; Clarke, Russell C.; Dewachter, Pascale; Garvey, Lene Heise; Guttormsen, Anne Berit; Hepner, David L.; Hopkins, Phil; Khan, David A.; Kolawole, Helen; Kopač, Peter; Krøigaard, Mogens; Laguna, José Julio; Marshall, Stuart; Platt, Peter; Sadleir, P. H. M.; Savic, Louise; Savic, Sinisa; Volcheck, Gerald W.; Voltolini, Susanna

doi:10.1016/j.bja.2019.01.027

Cited by 104 publications

(116 citation statements)

References 167 publications

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“…Recently, the maximum ranges of 11.4 mg L -1 have been abandoned and the 42+1.2 Â baseline tryptase algorithm is suggested. Baseline blood samples should be taken a minimum of 24 hours after the event appearance and can be performed postmortem, because of high chemical stability (1)(2)(3)(4).…”

Section: ' Discussionmentioning

confidence: 99%

“…Long-term observations showed a reduction in the occurrence of hypersensitivity reactions related to latex ( 26 - 29 ). Dominance of muscle relaxants in the induction of PHRs is a characteristic and permanent phenomenon in European and Scandinavian countries ( 1 , 3 , 4 , 10 ). Data were from the American population indicated that the main factors causing hypersensitivity were antibiotics, especially penicillin and cephalosporin, which constituted up to 50% of cases, while neuromuscular blocking agents constituted only 10% of etiological factors ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative hypersensitivity reactions (PHRs) are an important issue in safety and perioperative care. Epidemiological data show an increase in the incidence of hypersensitivity reactions, and they remain a life-threatening complication of general anesthesia with the mortality rate ranging from 3 to 9% ( 1 , 2 ). Such a trend was observed in Europe, Scandinavia, Australia, and New Zealand.…”

Section: Introductionmentioning

confidence: 99%

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Effect of body mass index and rocuronium on serum tryptase concentration during volatile general anesthesia: an observational study

Kościuczuk

Knapp

Jakubów

2020

Clinics

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Female sex, body mass index (BMI), and neuromuscular blocking agents are risk factors of perioperative hypersensitivity reactions. This study aimed to investigate the effect of rocuronium on serum tryptase concentrations during general anesthesia in overweight and obese women. METHODS: The study was conducted in two groups: Group I (n=66) underwent volatile anesthesia with rocuronium and group II (n=60) underwent volatile anesthesia without any muscle relaxant. Serum tryptase concentration (STC) measurements were performed at baseline (STC 0) and postoperatively (STC 1). ClinicalTrials. gov: NCT04035707 RESULTS: The highest median value of STC 0 was seen in obese patients (3.44 mg L-1) and it was significantly higher than in overweight (p=0.01) and underweight patients (p=0.03). The maximum STC 0 was observed in overweight patients (20.4 mg L-1). In group I, STC 0 in obese patients presented the highest median value (4.49 mg L-1), and was significantly higher than in overweight patients (p=0.03), and had significantly higher STC 1 than patients with normal BMI (p=0.04). STC 0 and STC 1 in overweight and obese female patients did not differ significantly between groups. STC 1 did not correlate with rocuronium doses. In group I, BMI positively correlated with the duration of rocuronium infusion (rho=0.37) and STC 1 positively correlated with BMI (rho=0.32). CONCLUSION: Excess weight and obesity predispose to higher preoperative serum tryptase values. Postoperative STC is not linked to rocuronium doses. BMI is the main determinant factor of STC during combined volatile general anesthesia.

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Section: ' Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of body mass index and rocuronium on serum tryptase concentration during volatile general anesthesia: an observational study

Kościuczuk

Knapp

Jakubów

2020

Clinics

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“…However, due to the difficulty of predicting the occurrence of anaphylaxis, the risk of developing perioperative anaphylaxis cannot be reduced even with these efforts. Although the severity of reactions ranges from mild to severe, in extreme cases, anaphylaxis may be fatal despite prompt recognition, prolonged adequate resuscitation, and treatment [1]. Therefore, anesthesiologists need to have sufficient knowledge of the epidemiology of perioperative anaphylaxis and appropriate coping strategies to deal with it.…”

Section: Introductionmentioning

confidence: 99%

Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study

et al. 2021

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Since perioperative anaphylaxis occurs suddenly, and it can be life-threatening, anesthesiologists need to have sufficient knowledge of the epidemiology of perioperative anaphylaxis and appropriate coping strategies to deal with it. Recent studies conducted in Western countries reported the characteristics of perioperative anaphylaxis in each country. However, there are few studies of perioperative anaphylaxis in Japan. To bridge the gap between Japan and other countries, the data of 46 anaphylaxis patients at Gunma University Hospital and 13 neighboring hospitals between 2012 and 2018 were collected and analyzed. The recently developed clinical scoring system was combined with a skin test to include only cases with a definite diagnosis. The most common causative agents were sugammadex, followed by rocuronium, cefazolin, and antibiotics other than cefazolin. Furthermore, the characteristics of anaphylaxis for each causative drug were identified. Time from drug administration to appearance of the first symptom was the longest in the cefazolin group. The incidence of canceled operation was the highest in the rocuronium group. Although it is unclear whether the results of this study can apply to Japan as a whole, the information about the agents responsible for perioperative anaphylaxis and the characteristics of anaphylaxis due to each agent would be helpful to anesthesiologists.

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“…There is significant geographical variability and the incidence ranges from 1:18,600 to 1:353 anaesthetic procedures. 1 Common culprits include antibiotics, neuromuscular blocking agents, chlorhexidine, sugammadex and patent blue dye. When the usual culprits are found not to be responsible, one important class of potential triggers that must be considered are pharmaceutical excipients.…”

Section: Introductionmentioning

confidence: 99%

Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

Preuss

Goddard

Clarke

et al. 2020

Anaesth Intensive Care

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Investigation of intraoperative anaphylaxis includes the exclusion of potential trigger agents the individual was exposed to within a plausible interval preceding the reaction. Occasionally, none of these agents will test positive. In this situation it is important to consider that excipients may be responsible for anaphylaxis, that the dilutions prepared to test the medication may not contain an appropriate concentration of the excipient to induce a positive skin reaction, or if an alternative formulation of the medication is tested, it may not contain the culprit excipient. This case describes a patient, who previously experienced an anaphylactic reaction to Betadine® (Sanofi-Aventis Australia Pty Ltd, North Ryde BC, NSW) experiencing anaphylaxis in the recovery period after general anaesthesia where Betadine was avoided. The recently administered therapeutics were excluded by skin testing, however further investigation determined that a povidone-containing formulation of paracetamol had been administered. Skin testing with povidone-containing paracetamol resulted in a positive reaction in the patient, but not in a volunteer control. Pharmaceutical excipients are added to medications to increase absorption, shelf-life and efficacy. Different brands of the same drug may contain different excipients. When testing for anaphylaxis with such compounds one must be sure the dilution is appropriate for both the parent compound and the excipient to ensure the accuracy of skin-prick and intradermal testing. This case demonstrates the potential for excipients to cause severe allergy and the importance of detailed history pertaining to previous allergic episodes as even the most unlikely of medications can potentially result in anaphylaxis due to excipients.

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Comparative epidemiology of suspected perioperative hypersensitivity reactions

Cited by 104 publications

References 167 publications

Effect of body mass index and rocuronium on serum tryptase concentration during volatile general anesthesia: an observational study

Effect of body mass index and rocuronium on serum tryptase concentration during volatile general anesthesia: an observational study

Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study

Anaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia

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