Immediate hypersensitivity reaction to Ketamine in children with history of atopic disease

Ki, Seunghee; Lim, Se Hun; Kim, Myoung-Hun; Kim, Young-Han

doi:10.12932/ap0871

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…Drug hypersensitivity appears in various patterns, i.e. immediate 13 or delayed hypersensitivity reactions. 14. The first exposure to an allergen or medication may cause sensitization without any significant symptoms.…”

Section: Discussionmentioning

confidence: 99%

Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective

Sany

Leow

Ghaffar

et al. 2020

APIC

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Patients with multiple drug hypersensitivity often pose significant challenge during surgery because of the greater risk of developing anaphylactic shock that could be fatal. The use of novel pharmaceutical agents such as anesthetic drugs and medical devices made from a wide range of chemicals and materials with unknown antigenicity potentially predisposes this subset of patients to hypersensitivity reactions in the perioperative period. The authors encountered a 20-year-old patient with a history of multiple drug hypersensitivities, who had been diagnosed with a huge ovarian tumor. She underwent surgery successfully but faced a rather difficult recovery. Herein, we discuss the management of unexpected perioperative outcomes with the support of literature review. This article also highlights the use of drug provocation tests and the necessary precautions to be taken in the absence of standardized preoperative guidelines for patients with multiple drug hypersensitivity syndrome undergoing major surgical procedures. Key words: Multiple hypersensitivity; Perioperative; Anesthesia; Suture; Drug provocation test Citation: Sany S, Leow VM, Ghaffar ZA, Lim JA, Chong SE. Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective. Anaesth. pain intensive care 2020;24(6):__ Received: 10 August 202-, Reviewed: 29 October, 1 November 2020, Accepted: 1 November 2020

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Section: Discussionmentioning

confidence: 99%

Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective

Sany

Leow

Ghaffar

et al. 2020

APIC

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Allergic and other adverse reactions to drugs used in anesthesia and surgery

Baldo

2023

APS

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The list of drugs patients may be exposed to during the perioperative and postoperative periods is potentially extensive. It includes induction agents, neuromuscular blocking drugs (NMBDs), opioids, antibiotics, sugammadex, colloids, local anesthetics, polypeptides, antifibrinolytic agents, heparin and related anticoagulants, blue dyes, chlorhexidine, and a range of other agents depending on several factors related to individual patients’ clinical condition and progress in the postoperative recovery period. To avoid poor or ultrarapid metabolizers to a particular drug (for example tramadol and codeine) or possible adverse drug reactions (ADRs), some drugs may need to be avoided during or after surgery. This will be the case for patients with a history of anaphylaxis or other adverse events/intolerances to a known drug. Other drugs may be ceased for a period before surgery, e.g., anticoagulants that increase the chance of bleeding; diuretics for patients with acute renal failure; antihypertensives relative to kidney injury after major vascular surgery; and serotonergic drugs that together with some opioids may rarely induce serotonin toxicity. Studies of germline variations shown by genotyping and phenotyping to identify a predisposition of genetic factors to ADRs offer an increasingly important approach to individualize drug therapy. Studies of associations of human leukocyte antigen (HLA) genes with some serious delayed immune-mediated reactions are ongoing and variations of drug-metabolizing cytochrome CYP450 enzymes, P-glycoprotein, and catechol-O-methyltransferase show promise for the assessment of ADRs and non-responses to drugs, particularly opioids and other analgesics. Surveys of ADRs from an increasing number of institutions often cover small numbers of patients, are retrospective in nature, fail to clearly identify culprit drugs, and do not adequately distinguish immune-mediated from non-immune-mediated anaphylactoid reactions. From the many surveys undertaken, the large list of agents identified during and after anesthesia and surgery are examined for their ADR involvement. Drugs are classified into those most often involved, (NMBD and antibiotics); drugs that are becoming more frequently implicated, namely antibiotics (particularly teicoplanin), and blue dyes; those becoming less frequently involved; and drugs more rarely involved in perioperative, and postoperative adverse reactions but still important and necessary to keep in mind for the occasional potential sensitive patient. Clinicians should be aware of the similarities between drug-induced true allergic type I IgE/FcεRI- and pseudoallergic MRGPRX2-mediated ADRs, the clinical features of each, and their distinguishing characteristics. Procedures for identifying MRGPRX2 agonists and diagnosing and distinguishing pseudoallergic from allergic reaction mechanisms are discussed. Graphical Abstract

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Immediate hypersensitivity reaction to Ketamine in children with history of atopic disease

Cited by 2 publications

References 16 publications

Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective

Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective

Allergic and other adverse reactions to drugs used in anesthesia and surgery

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