Perioperative Allergy: Uncommon Agents

Abstract

Anesthesia may often be considered as a high-risk procedure and anaphylaxis remains a major cause of concern for anesthetists who routinely administer many potentially allergenic agents. Neuromuscular blocking agents, latex and antibiotics are the substances involved in most of the reported reactions. Besides these three agents, a wide variety of substances may cause an anaphylactic reaction during anesthesia. Basically all the administered drugs or substances may be potential causes of anaphylaxis. Among them, those reported the most in literature include hypnotics, opioids, local anesthetics, colloids, dye, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Iodinated Contrast Media (ICM), antiseptics, aprotinin, ethylene oxyde and formaldehyde, and protamine and heparins. No premedication can effectively prevent an allergic reaction and a systematic preoperative screening is not justified for all patients; nevertheless, an allergy specialist should evaluate those patients with a history of anesthesia-related allergy. Patients must be fully informed of investigation results, and advised to provide a detailed report prior to future anesthesia.

Practical Guidelines for Perioperative Hypersensitivity Reactions

“…In these cases there is no indication of performing STs (grade of recommendation, B) [12,118,128] ii) patients with a previous history of reactions, with detailed information available regarding the reaction kinetics and drugs and agents administered. In these cases, STs are mandatory for all the agents administered plus latex [129] and clorhexidine [71,103,104,130] (grade of recommendation, C), however ST results may not be reliable until 4-6 weeks after the initial reaction [131]; iii) Patients with reactions but without clear information about the episode, which is the most complex scenario, especially when there is a long interval between the reaction and the study. In this case the type of surgery and anaesthesia and severity of the reaction can help to decide the agents to test, nevertheless it is recommended to perform ST with all the essential agents needed for anaesthesia, including a muscle relaxant derivative and an opioid (grade of recommendation, D) ( Table 3).…”

Acetylbritannilactone attenuates contrast-induced acute kidney injury through its anti-pyroptosis effects

“…Mice were assigned randomly into five groups: control group (Cont, n=6), vehicle (Veh, n=6), ABL group (ABL, n=6), IOP group (n=6), and IOP + ABL group (n=6). IOP (Ultravist; 370 mg iodine/ml, 3.7 g iodine/kg; Bayer HealthCare LLC, Leverkusen, Germany) was used as the iodinated CM in the present study [23]. Mice in Cont or ABL group were given saline or ABL (25 mg/kg) via gavage administration for 6 days, respectively.…”

Anaphylactic reaction 5 minutes after the start of surgery: a case report

“…Caffarelli et al advised against relying on premedication because of the lack of documented evidence on its effectiveness in preventing allergic reactions to natural latex rubber [16]. The cost of extensive pre-surgery screening is also not justified for every patient [17]. Preoperative testing by means of the ‘skin prick method’ is not required but can aid diagnosing, particularly for patients with Spina bifida (up to 44% show latex allergies), dysplasia of the genitourinary tract, and atopic dermatitis, as well as for patients with occupational exposure to latex and allergies to Ficus elastica or food (kiwis, figs, papayas, and chestnuts).…”