Outcome of repeat anaesthesia after investigation for perioperative anaphylaxis

Miller, Jason J.; Clough, Stacey; Pollard, R.C.; Misbah, Siraj

doi:10.1016/j.bja.2018.02.033

Cited by 31 publications

(19 citation statements)

References 21 publications

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“…This has been shown to be up to 63.15% in NSAID‐induced urticaria . Moreover, the incidence of repeated anaphylaxis after a perioperative‐allergy assessment was only 4% …”

Section: Mislabelling Influences Dhr Real Incidencementioning

confidence: 99%

“…49 Moreover, the incidence of repeated anaphylaxis after a perioperative-allergy assessment was only 4%. 50 This mislabelling is highly influenced by the over-reporting of allergies that happen in 8.3%, being higher in female, adults and inpatients 51 with BLs, NSAIDs and anaesthetics. 45,52 Parentally reported allergies in children are also important, indicating the need for a better training of families and verification by physicians.…”

Section: Mis L Ab Elling Influen Ce S Dhr Re Al In Ciden Cementioning

confidence: 99%

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Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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“…This has been shown to be up to 63.15% in NSAID‐induced urticaria . Moreover, the incidence of repeated anaphylaxis after a perioperative‐allergy assessment was only 4% …”

Section: Mislabelling Influences Dhr Real Incidencementioning

confidence: 99%

Section: Mis L Ab Elling Influen Ce S Dhr Re Al In Ciden Cementioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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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%

“…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%

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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“…In a retrospective analysis of POP, an absolute tryptase level of >15.7 mg/L or a percentage change of >141% was associated with a positive predictive value of 80% for identifying IgE-mediated anaphylaxis (8). Despite its undoubted utility it is disappointing to note that serial tryptase measurements were only undertaken in 34–67% of patients in surveys of POP in the UK (9, 12). Given its short half-life of ~2 h, tryptase levels should normalize at 24 h in virtually every patient with POP.…”

Section: Recognition Of Anaphylaxis During Anesthesiamentioning

confidence: 99%

Peri-Operative Anaphylaxis—An Investigational Challenge

Misbah

Krishna

2019

Front. Immunol.

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Patients with suspected peri-operative anaphylaxis (POP) require thorough investigation to identify underlying trigger(s) and enable safe anesthesia for subsequent surgery. The changing epidemiology of POP has been striking. Previous estimates of the incidence of POP have ranged between 1:6,000 and1:20,000 anesthetics, but more recent data from France and the United Kingdom suggest an estimated incidence of 1:10,000. Other important changes include a change in the hierarchy of well-recognized triggers, with antibiotics (beta-lactams) supplanting neuromuscular blockers (NMB) as the leading cause of POP. The emergence of chlorhexidine, patent blue dye, and teicoplanin as important triggers have also been noteworthy findings. The mainstay of investigation revolves around critical analysis of the time-line of events leading up to anaphylaxis coupled with judicious skin testing. Skin tests have limitations with respect to unknown predictive values for most drugs/agents and therefore, knowledge of background positivity in healthy controls, test characteristics of individual drugs and the use of non-irritant concentrations is essential to avoid both false-positive and false-negative results. Specific IgE assays for individual drugs are available only for a limited number of agents and are not a substitute for skin testing. Acute serum total tryptase has a high specificity and positive predictive value in IgE-mediated POP anaphylaxis but is limited by its moderate sensitivity and negative predictive value. Planning for safe anesthesia in this group of patients is particularly challenging and consequently anesthetists need to be alert to the possibility of repeat episodes of anaphylaxis. Because of the limitations of current investigations for POP, collecting systematic data on the outcome of repeat anesthesia is valuable in validating current investigatory approaches. This paper reviews the changing epidemiology of POP with reference to the main triggers, and the investigation and outcome of subsequent anesthesia.

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Outcome of repeat anaesthesia after investigation for perioperative anaphylaxis

Abstract: In our cohort, the incidence of repeat anaphylaxis after a comprehensive assessment in the drug-allergy clinic for suspected POA was 4%. Important risk factors include the completeness of referral information provided to the assessor and the role of exacerbating disorders, particularly SM.

Cited by 31 publications

References 21 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

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

Peri-Operative Anaphylaxis—An Investigational Challenge

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