Early skin testing is effective for diagnosis of hypersensitivity reactions occurring during anesthesia

Lafuente, Alberto; Javaloyes, Gracia; Berroa, Felicia; Goikoetxea, M. J.; Moncada, Rafael; Núñez‐Córdoba, Jorge M.; Cabrera‐Freitag, Paula; D'Amelio, Carmen; Sánz, M L; Gastaminza, Gabriel

doi:10.1111/all.12154

Cited by 36 publications

(23 citation statements)

References 9 publications

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“…This likely helped us to find a higher rate of positive skin tests, since previously published data report a decline over time in IgE antibodies in patients with drug allergy. 6,9,10,16,17 In 2013 Lafuente et al, found 25 patients (57%) with positive skin testing when performed at 0–4 days (Stage 1) and again at 4–8 weeks (Stage 2) after perioperative HSR. 17 Interestingly, a higher rate of skin test positivity was found in the Stage 1 (60%) compared to Stage 2 (40%) with three patients having positive skin testing only in Stage 1.…”

Section: Discussionmentioning

confidence: 99%

Antibiotics Are the Most Commonly Identified Cause of Perioperative Hypersensitivity Reactions

Kuhlen

Camargo

Balekian

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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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.

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Section: Discussionmentioning

confidence: 99%

Antibiotics Are the Most Commonly Identified Cause of Perioperative Hypersensitivity Reactions

Kuhlen

Camargo

Balekian

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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“…The guidelines concur that triggers should be confirmed by re-taking the history of the anaphylactic episode and using this as a guide to selection of allergens for skin prick tests, measurement of allergen-specific IgE levels in serum, and additional investigations as needed [2-4,13-15,22,53,99-106]. Intradermal tests are helpful in investigation of anaphylaxis induced by insect venoms or drugs such as beta-lactam antibiotics [103-106].…”

Section: Comparative Review Of Collaborating Organizations’ Principalmentioning

confidence: 99%

“…Intradermal tests are helpful in investigation of anaphylaxis induced by insect venoms or drugs such as beta-lactam antibiotics [103-106]. Negative skin tests and absent or undetectable allergen-specific IgE levels have a high negative predictive value; however, positive tests have a lower positive predictive value because allergen sensitization without symptoms is widespread in the general population.…”

Section: Comparative Review Of Collaborating Organizations’ Principalmentioning

confidence: 99%

“…Negative skin tests and absent or undetectable allergen-specific IgE levels have a high negative predictive value; however, positive tests have a lower positive predictive value because allergen sensitization without symptoms is widespread in the general population. Ideally, tests to assess sensitization to allergens should be interpreted by an allergy/immunology specialist [2-4,13-15,22,53,64,99-106] (Table 5). Medically-supervised incremental allergen challenge tests, indicated in some patients with food or drug allergy, should be conducted only by experienced healthcare professionals in settings where anaphylaxis can be treated promptly [2-4,13,15,22,53,104,105].…”

Section: Comparative Review Of Collaborating Organizations’ Principalmentioning

confidence: 99%

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International consensus on (ICON) anaphylaxis

Simons

Ardusso

Bilò

et al. 2014

World Allergy Organization Journal

418

379

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ICON: Anaphylaxis provides a unique perspective on the principal evidence-based anaphylaxis guidelines developed and published independently from 2010 through 2014 by four allergy/immunology organizations. These guidelines concur with regard to the clinical features that indicate a likely diagnosis of anaphylaxis -- a life-threatening generalized or systemic allergic or hypersensitivity reaction.They also concur about prompt initial treatment with intramuscular injection of epinephrine (adrenaline) in the mid-outer thigh, positioning the patient supine (semi-reclining if dyspneic or vomiting), calling for help, and when indicated, providing supplemental oxygen, intravenous fluid resuscitation and cardiopulmonary resuscitation, along with concomitant monitoring of vital signs and oxygenation. Additionally, they concur that H1-antihistamines, H2-antihistamines, and glucocorticoids are not initial medications of choice.For self-management of patients at risk of anaphylaxis in community settings, they recommend carrying epinephrine auto-injectors and personalized emergency action plans, as well as follow-up with a physician (ideally an allergy/immunology specialist) to help prevent anaphylaxis recurrences.ICON: Anaphylaxis describes unmet needs in anaphylaxis, noting that although epinephrine in 1 mg/mL ampules is available worldwide, other essentials, including supplemental oxygen, intravenous fluid resuscitation, and epinephrine auto-injectors are not universally available.ICON: Anaphylaxis proposes a comprehensive international research agenda that calls for additional prospective studies of anaphylaxis epidemiology, patient risk factors and co-factors, triggers, clinical criteria for diagnosis, randomized controlled trials of therapeutic interventions, and measures to prevent anaphylaxis recurrences. It also calls for facilitation of global collaborations in anaphylaxis research.In addition to confirming the alignment of major anaphylaxis guidelines, ICON: Anaphylaxis adds value by including summary tables and citing 130 key references. It is published as an information resource about anaphylaxis for worldwide use by healthcare professionals, academics, policy-makers, patients, caregivers, and the public.

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“…The odds ratio of obtaining a false-negative test 0-4 days after the reaction was 3.3 versus later testing (p = 0.09). The investigators noted that while early testing can be useful in some patients, it does not replace later testing [77]. …”

Section: Long-term Management: Prevention Of Recurrencementioning

confidence: 99%

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

Simons

Ardusso

Dimov

et al. 2013

Int Arch Allergy Immunol

247

181

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The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis are a widely disseminated and used resource for information about anaphylaxis. They focus on patients at risk, triggers, clinical diagnosis, treatment in health care settings, self-treatment in the community, and prevention of recurrences. Their unique strengths include a global perspective informed by prior research on the global availability of essentials for anaphylaxis assessment and management and a global agenda for anaphylaxis research. Additionally, detailed colored illustrations are linked to key concepts in the text [Simons et al.: J Allergy Clin Immunol 2011;127:593.e1-e22]. The recommendations in the original WAO Anaphylaxis Guidelines for management of anaphylaxis in health care settings and community settings were based on evidence published in peer-reviewed, indexed medical journals to the end of 2010. These recommendations remain unchanged and clinically relevant. An update of the evidence base was published in 2012 [Simons et al.: Curr Opin Allergy Clin Immunol 2012;12:389-399]. In 2012 and early 2013, major advances were reported in the following areas: further characterization of patient phenotypes; development of in vitro tests (for some allergens) that help distinguish clinical risk of anaphylaxis from asymptomatic sensitization; epinephrine (adrenaline) research, including studies of a new epinephrine auto-injector for use in community settings, and randomized controlled trials of immunotherapy to prevent food-induced anaphylaxis. Despite these advances, the need for additional prospective studies, including randomized controlled trials of interventions in anaphylaxis is increasingly apparent. This 2013 Update highlights publications from 2012 and 2013 that further contribute to the evidence base for the recommendations made in the original WAO Anaphylaxis Guidelines. Ideally, it should be used in conjunction with these Guidelines and with the 2012 Guidelines Update.

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Early skin testing is effective for diagnosis of hypersensitivity reactions occurring during anesthesia

Cited by 36 publications

References 9 publications

Antibiotics Are the Most Commonly Identified Cause of Perioperative Hypersensitivity Reactions

Antibiotics Are the Most Commonly Identified Cause of Perioperative Hypersensitivity Reactions

International consensus on (ICON) anaphylaxis

World Allergy Organization Anaphylaxis Guidelines: 2013 Update of the Evidence Base

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