Enquête prospective préopératoire chez 300 patients par prick-tests aux myorelaxants

Maria, Y.; Grosdidier, R.; Haberer, J.-P.; Moneret‐Vautrin, D.A.

doi:10.1016/s0750-7658(89)80069-3

Cited by 14 publications

(3 citation statements)

References 19 publications

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“…atracurium and mivacurium) in which case a dilution of 10 −3 –10 −1 may be appropriate to avoid false‐positive results. Rarely it may also be useful to test these drugs at therapeutic concentrations when comparison with responses in ‘normal’ or unexposed individuals may be needed in order to exclude a ‘toxic’ response [103]. In any situation where the mechanism of ADR is unknown a negative result is unreliable.…”

mentioning

confidence: 99%

BSACI guidelines for the management of drug allergy

Mirakian

Ewan

Durham

et al. 2009

Clin Experimental Allergy

213

199

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SummaryThese guidelines have been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and are intended for allergists and others with a special interest in allergy. As routine or validated tests are not available for the majority of drugs, considerable experience is required for the investigation of allergic drug reactions and to undertake specific drug challenge. A missed or incorrect diagnosis of drug allergy can have serious consequences. Therefore, investigation and management of drug allergy is best carried out in specialist centres with large patient numbers and adequate competence and resources to manage complex cases. The recommendations are evidencebased but where evidence was lacking consensus was reached by the panel of specialists on the committee. The document encompasses epidemiology, risk factors, clinical patterns of drug allergy, diagnosis and treatment procedures. In order to achieve a correct diagnosis we have placed particular emphasis on obtaining an accurate clinical history and on the physical examination, as these are critical to the choice of skin tests and subsequent drug provocation. After the diagnosis of drug allergy has been established, communication of results and patient education are vital components of overall patient management.

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mentioning

confidence: 99%

BSACI guidelines for the management of drug allergy

Mirakian

Ewan

Durham

et al. 2009

Clin Experimental Allergy

213

199

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“…The conclusion of many studies was that there were too many positive skin test results when screening for allergy to anaesthetic drugs in the general population. The prevalence of positive skin tests was much higher than the incidence of intra‐anaesthetic anaphylaxis [2, 6, 20]. The presence of a positive test might not only be a false positive test, but a proof of latent sensitization, with future possible subclinical or clinical expression (minor or major) [7].…”

Section: Discussionmentioning

confidence: 99%

“…Prick and IDTs remain the reference of diagnosis with acceptable positive and predictive values for suspected drug allergy [18,19], but their clinical predictive value in a patient without a history of anaesthetic drug allergy has not been established. The conclusion of many studies was that there were too many positive skin test results when screening for allergy to anaesthetic drugs in the general population.The prevalence of positive skin tests was much higher than the incidence of intra-anaesthetic anaphylaxis [2,6,20]. The presence of a positive test might not only be a false positive test, but a proof of latent sensitization, with future possible subclinical or clinical expression (minor or major) [7].…”

Section: Discussionmentioning

confidence: 99%

Is a positive history of non‐anaesthetic drug allergy a predictive factor for positive allergy tests to anaesthetics?

Hagău

Gherman-Ionica

Hagau

et al. 2012

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• International recommendations stipulate not to perform skin tests to a drug in the absence of a clinical history consistent with drug allergy.• In 2006, two publications showed that a positive history of non-anaesthetic drug allergy was the only predictive factor for allergy to anaesthetic drugs when the screening was done in a general surgical population.• They concluded that their data supported the international recommendations that a prick test to neuromuscular blocking agents (NMBAs) is indicated only among those patients who have a history to an adverse reaction to them, but at the same time in the case of 2.8% of the patients with no history of peri-anaesthetic allergy, the NMBA to which they showed a positive prick test was avoided. WHAT THIS STUDY ADDS• The novelty of the study is our approach regarding a selected population (volunteers from a general surgical population with a prior history of immediate type hypersensitivity reaction to non-anaesthetic drugs) in which we performed pre-operative skin tests and in vitro tests to NMBAs and other anaesthetics.• Ten per cent of our selected patients had a positive prick test to NMBAs and the results of the basophil activation test (BAT) agreed with prick tests in 83% of patients. BAT is a test that detects IgE mediated effector cell activation, overcoming the concerns related to skin reactivity at different drug concentrations.• Our results could define a special risk group for intra-anaesthesia anaphylaxis, and they might lead to the necessity of changing the existing pre-operative allergy approach. AIMSInternational recommendations stipulate not performing screening skin tests to a drug in the absence of a clinical history consistent with that specific drug allergy. Nevertheless, two publications showed that a positive history of non-anaesthetic drug allergy was the only predictive factor for a positive skin test when screening for allergy to anaesthetic drugs was done. We selected from a surgical population 40 volunteers with a prior history of allergy to non-anaesthetic drugs in order to analyse the prevalence of positive allergy tests to anaesthetics. METHODSThe selected adult patients were tested for 11 anaesthetic drugs using in vivo tests: skin prick (SPT) and intradermal (IDT) tests and in vitro tests: the basophil activation test (BAT) and detection of drug-specific immunoglobulin E (IgE). RESULTSThe prevalence for the positive SPT and IDT was 1.6% and 5.8% respectively. The result of flow cytometry agreed with the SPT in five out of seven positive SPT (71%). IgEs confirmed two positive SPT with corresponding positive BAT. Ten per cent of the patients had a positive prick test to neuromuscular blocking agents (NMBA). For midazolam none of the SPT was positive, but 11 patients had positive IDT nonconfirmed by BAT. CONCLUSIONThe prevalence of positive in vivo and in vitro allergy tests to NMBAs is higher in our study population. This could be an argument for pre-operative SPT to NMBAs for the surgical popula...

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Vermeidung unerwünschter Wirkungen bei der Anwendung nichtdepolarisierender Muskelrelaxanzien

Diefenbach¹,

Buzello²

1993

Konzepte Zur Sicherheit in Der Anästhesie

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Enquête prospective préopératoire chez 300 patients par prick-tests aux myorelaxants

Cited by 14 publications

References 19 publications

BSACI guidelines for the management of drug allergy

BSACI guidelines for the management of drug allergy

Is a positive history of non‐anaesthetic drug allergy a predictive factor for positive allergy tests to anaesthetics?

Vermeidung unerwünschter Wirkungen bei der Anwendung nichtdepolarisierender Muskelrelaxanzien

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