Intraoperative Anaphylaxis in Response to Hemostatic Agents With Protein Derivatives

Alpha-gal syndrome is an unconventional food allergy, characterized by IgE-mediated hypersensitivity responses to the glycan galactose-alpha-1,3-galactose (alpha-gal) and not to a food-protein. In this review, we discuss how alpha-gal syndrome reframes our current conception of the mechanisms of pathogenesis of food allergy. The development of alpha-gal IgE is associated with tick bites though the possibility of other parasites promoting sensitization to alpha-gal remains. We review the immune cell populations involved in the sensitization and effector phases of alpha-gal syndrome and describe the current understanding of why allergic responses to ingested alpha-gal can be delayed by several hours. We review the foundation of management in alpha-gal syndrome, namely avoidance, but also discuss the use of antihistamines, mast cell stabilizers, and the emerging role of complementary and alternative therapies, biological products, and oral immunotherapy in the management of this condition. Alpha-gal syndrome influences the safety and tolerability of medications and medical devices containing or derived from mammalian products and impacts quality of life well beyond food choices.

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“…111 There have also been case reports of intraoperative anaphylaxis to gelatin-based hemostatic agents in patients with AGS. [112][113][114]…”

Section: Perioperative and Intraoperative Settingmentioning

confidence: 99%

The Meat of the Matter: Understanding and Managing Alpha-Gal Syndrome

Macdougall¹,

Thomas²,

Iweala³

2022

ITT

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“…Gelatin was responsible for anaphylaxis after its injection into vertebral bone under pressure in two children with spinal deformity undergoing posterior spinal fusion procedures [60]. A past tick bite and subsequent development of an allergic reaction to mammalian protein products, most notably red meat, may pose a high risk to the patient if gelatin is used during surgery [61,62]. IgE-mediated anaphylaxis to albumin provoked intraoperative hypotension during exposure for planned T5-L4 posterior spinal fusion shortly after infusion in an adolescent patient [63].…”

Section: Colloids/plasma Expandersmentioning

confidence: 99%

Could Artificial Intelligence Prevent Intraoperative Anaphylaxis? Reference Review and Proof of Concept

et al. 2022

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Drugs and various medical substances have been used for many decades to diagnose or treat diseases. Procedures like surgery and anesthesia (either local or general) use different pharmacological products during these events. In most of the cases, the procedure is safe and the physician performs the technique without incidents. Although they are safe for use, these substances (including drugs) may have adverse effects, varying from mild ones to life-threatening reactions in a minority of patients. Artificial intelligence may be a useful tool in approximating the risk of anaphylaxis before undertaking a medical procedure. This material presents these undesirable responses produced by medical products from a multidisciplinary point of view. Moreover, we present a proof of concept for using artificial intelligence as a possible guardship against intraoperative anaphylaxis.

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“…27 Gelatin allergy is a contraindication to gelatin-based haemostatic agents; however, there is concern regarding physician awareness of individual components of haemostatic agents with protein derivatives. 28 This is evidenced in this study with 33% of cases having a pre-identified reaction to gelatin containing products.…”

Section: Discussionmentioning

confidence: 50%

“…In patients with known Alpha-Gal syndrome, intolerance of red meats, or history of tick bites should consider alternative haemostatic agents if surgery is required. 28…”

Section: Discussionmentioning

confidence: 99%

Review of topical gelatin‐based haemostatic agents; an insidious culprit of intraoperative anaphylaxis?

White

Kerr

White

et al. 2021

ANZ Journal of Surgery

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Background: An under-recognized complication of gelatin-based haemostatic agents is their potential to cause anaphylactic reactions. This review aims to collate and analyse case in the literature of intraoperative anaphylaxis secondary to locally applied haemostatic agents. Methods: An electronic search was performed on databases Medline, Embase, Pubmed and ProQuest. A total of 7671 articles were reviewed from title and abstract. After exclusion criteria and duplicates removed, 19 articles with 21 cases were included for analysis. Data extracted from each of the articles included patient demographics, haemostatic agent used, surgery type, known allergies and any objective evidence of hypersensitivity post anaphylactic episode, that is tryptase levels, IgE levels, skin prick testing. Results: Fifty-seven percent of cases involved patients <18 years of age; 57% of cases involved spinal surgery; 100% of cases displayed objective evidence of hypersensitivity (tryptase levels, bovine or porcine IgE levels, or skin prick testing). Thirty-three percent of patients had exposure preoperatively to a known agent causing anaphylaxis or allergy which would preclude the use of a gelatin-based haemostat. These products included vaccines, spam meats, red meat, Jell-O and CollaPlug. Gelatin-based haemostat agents included Floseal, Gelfoam, Surgiflo, fibrin glue, Avitene, haemofibrine sponge, topical bovine thrombin and thrombin-soaked gelatin. Conclusion: Increased awareness of allergy to gelatin-based haemostats for surgical and anaesthetic is imperative, with 33% of cases having a known contraindication to gelatinbased haemostat. This review highlights important aspects in the pre-operative patient history and post-event patient investigation that could assist anaesthetists and surgeons in the prevention of future events.

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Intraoperative Anaphylaxis in Response to Hemostatic Agents With Protein Derivatives

Cited by 5 publications

References 6 publications

The Meat of the Matter: Understanding and Managing Alpha-Gal Syndrome

The Meat of the Matter: Understanding and Managing Alpha-Gal Syndrome

Could Artificial Intelligence Prevent Intraoperative Anaphylaxis? Reference Review and Proof of Concept

Review of topical gelatin‐based haemostatic agents; an insidious culprit of intraoperative anaphylaxis?

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