Perioperative anaphylaxis and investigations: a local study in Hong Kong

Au, Elaine; Lau, Chak Sing; Lam, Ki; Chan, Eric

doi:10.11622/smedj.2019156

Cited by 8 publications

(9 citation statements)

References 19 publications

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“…The analysis of our registry did not reveal significant differences between the incidence of reactions induced by penicillin and cephalosporins, probably because of the small size of the analysed groups. Anaphylaxis due to cefuroxime (cefuroxime axetil) was rarely reported [52,54], but this is not true for our registry and data from Hong Kong [27]. Other classes of antibiotics caused anaphylaxis in single patients.…”

Section: Causes Of Anaphylaxismentioning

confidence: 60%

“…Most men and women with anaphylaxis developed cutaneous (75% and 78%), cardiovascular (71% and 74%), and respiratory (59.6% and 72.5%) symptoms. However, the data acquired from the research on perioperative anaphylaxis (according to a local study in Hong Kong) indicated cardiovascular manifestation as the one which occurs most often in this group (87, 3%) [27]. Only 12% of children did not have cutaneous symptoms in the conducted research, just like in the case of Poowuttikul [28], as compared to more than 20% in adults.…”

Section: Clinical Manifestationsmentioning

confidence: 84%

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Clinical Manifestations and Causes of Anaphylaxis. Analysis of 382 Cases from the Anaphylaxis Registry in West Pomerania Province in Poland

Poziomkowska-Gęsicka

Kurek

2020

IJERPH

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Anaphylaxis is most commonly defined as an acute, severe, potentially life-threatening systemic hypersensitivity reaction. Current expert consensus has defined anaphylaxis as a serious reaction that is rapid in onset and can be fatal, and is a severe, potentially life-threatening systemic hypersensitivity reaction that is still rarely diagnosed. For safety reasons, patients should visit an allergologist to identify potential causes of this reaction. There are no data from other health care centres in Poland presenting characteristics of anaphylactic reactions. Clinical manifestations of anaphylaxis should be analysed, because some patients (10–30%) with anaphylaxis can present without cutaneous findings. This lack of skin/mucosa involvement can lead to misdiagnosis or delayed diagnosis of anaphylaxis. Objectives—to gather epidemiological data on anaphylactic reactions, to identify clinical manifestations of anaphylaxis (organ systems involved), to present diagnostic methods useful for the identification of anaphylaxis triggers, and most importantly, to find causes of anaphylaxis. In this retrospective analysis, we used a questionnaire-based survey regarding patients visiting the Clinical Allergology Department, Pomeranian Medical University (PMU) in Szczecin, between 2006 and 2015. The registry comprised patients with grade II (Ring and Messmer classification) or higher anaphylaxis. Patients with grade I anaphylaxis (e.g., urticaria) were not included in the registry. The incidence of anaphylaxis was higher in women. Clinical manifestations included cutaneous and cardiovascular symptoms, but more than 20% of patients did not present with cutaneous symptoms, which may create difficulties for fast and correct diagnosis. Causes of anaphylaxis were identified and confirmed by means of detailed medical interview, skin tests (STs), and measurement of specific immunoglobulin E (sIgE) and tryptase levels. In the analysed group, the most common cause of anaphylaxis (allergic and nonallergic) was Hymenoptera stinging (wasp), drugs (nonsteroidal anti-inflammatory drugs, NSAIDs) and foods (peanuts, tree nuts, celery). The incidence of anaphylaxis is low, but because of its nature and potentially life-threatening consequences it requires a detailed approach. Comprehensive management of patients who have had anaphylaxis can be complex, so partnerships between allergy specialists, emergency medicine and primary care providers are necessary. Monitoring its range is very important to monitor changes in allergy development.

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Section: Causes Of Anaphylaxismentioning

confidence: 60%

Section: Clinical Manifestationsmentioning

confidence: 84%

Clinical Manifestations and Causes of Anaphylaxis. Analysis of 382 Cases from the Anaphylaxis Registry in West Pomerania Province in Poland

Poziomkowska-Gęsicka

Kurek

2020

IJERPH

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“…Recent studies showed that the incidence of POA is higher than thought (Au et al 2020 ). As the included patients were from different hospitals, this study was not able to provide the incidence of POA in China.…”

Section: Discussionmentioning

confidence: 93%

“…Perioperative anaphylaxis (POA) is a rare but often a potentially life-threatening condition that can contribute significantly to the morbidity and mortality of surgical patients (Au et al 2020 ; Gonzalez-Estrada et al 2021 ; Mertes et al 2019 ). It is reported that the estimated worldwide incidence of POA varies from 1 in 1250 to 1 in 20,000 procedures, with a mortality rate of 4%, and an additional 2% surviving with severe brain damage (Gandhi et al 2017 ; Mertes et al 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and allergen detection of perioperative anaphylaxis: a 12-year retrospective analysis from an anesthesia clinic in China

et al. 2022

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Background Anaphylaxis during anesthesia is a rare but often a potentially life-threatening event for patients. Identifying culprit agents responsible for anaphylaxis is of great important for avoiding potential re-exposure to allergens, but it poses great challenge for anesthetists. This retrospective study aimed to analyze the culprits of patients with a history of perioperative anaphylaxis referred to an anesthesia allergy clinic in China, and to evaluate the role of allergy diagnostic tests in clinical practice. Methods A total of 145 patients (102 female/43 male) who attended the Anesthesia Allergy Clinic for allergen detection between 1 January 2009 and 31 December 2020 were reviewed retrospectively. Clinical characteristics, results of allergy diagnostic tests including skin, and/or basophil activation tests, and the incidence of repeat anaphylaxis after use of recommended alternative anesthetics were obtained. Results Of these 145 patients, 109 patients (75.2%, 74 females/35 males) were determined to experience perioperative anaphylaxis. The most common presenting clinical feature was cardiovascular manifestations (n = 63, 57.8%). According to diagnostic work up, the most common causative agents for perioperative anaphylaxis were neuromuscular blocking agents (n = 35, 32.1%). After diagnostic work up, 52 patients underwent repeat anesthesia. None of these patients experienced recurrent anaphylaxis. Conclusions This study suggests that neuromuscular blocking agents are the main cause of perioperative anaphylaxis. For patients with perioperative anaphylaxis, allergy diagnostic tests are essential to identify causative agents, and to find suitable alternative drugs for the future planning of subsequent anesthetics.

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“…Essa reação inicia-se com congestão venosa propiciando a redução do retorno venoso e subsequente ativação dos receptores mecanossensoriais, sentidos que ativam o nervo vago e causam redução da frequência cardíaca, vasodilatação excessiva e possível perda da consciência. A síncope vasovagal é mediada por reflexos que incluem pródromo de tonturas, com ou sem náuseas, palidez e/ou sudorese (Au, Lau, Lam & Chan, 2020). Ainda, há outras causas com menores semelhanças, como os quadros de bradicardias provocados por betabloqueador, que apesar de menos frequentes ainda necessitam de um diagnóstico diferencial assertivo.…”

Section: Diagnóstico E Diagnóstico Diferencialunclassified

Critérios clínicos para diagnóstico e tratamento adequado da anafilaxia perioperatória

Sousa

Alves

Oliveira

et al. 2021

RSD

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A anafilaxia perioperatória é uma reação de hipersensibilidade imprevisível, severa e sistêmica mediada por imunoglobulinas do tipo E (IgE) ou não mediadas, de difícil diagnóstico que iminentemente pode ser fatal. Ainda, é importante citar que a anafilaxia mediada por IgE perioperatória tem relação direta com agentes administrados intravenosos, ocorrendo após anestesia, com agentes bloqueadores neuromusculares (BNMs) e antibióticos sendo os principais agentes causais. Após a administração do alérgeno, a evolução do paciente pode oscilar entre apenas efeitos colaterais, similares aos das medicações em uso, até evoluções graves como paradas cardiorrespiratórias, evidenciando uma necessidade de ser difundido o domínio teórico e técnico do manejo dessas situações para se obter melhores prognósticos. A base do tratamento da anafilaxia perioperatória inclui: manter a via aérea pérvia, fornecimento de oxigênio a 100%, administração de adrenalina intramuscular (IM) ou intravenosa (IV) e reposição de volume. Sendo assim, visto que o paciente pode vir a óbito em minutos, devido ao quadro agudo se intensificar de forma rápida, faz-se necessário a urgência no tratamento. E para isso, o presente trabalho traz a elucidação de critérios diagnósticos (quadro clínico, evolução e exames associados). Além disso, esclarece o manejo para tratamento de pacientes em quadros de anafilaxia perioperatória. Para essa pesquisa bibliográfica, utilizou-se como referência as bases de dados do PubMed, Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e MEDLINE.

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Perioperative anaphylaxis and investigations: a local study in Hong Kong

Abstract: CONCLUSION Proper workup after an intraoperative anaphylactic event has a fairly good chance of identifying the causative allergen. These results are useful for patient management and the planning of subsequent anaesthetic procedures.

Cited by 8 publications

References 19 publications

Clinical Manifestations and Causes of Anaphylaxis. Analysis of 382 Cases from the Anaphylaxis Registry in West Pomerania Province in Poland

Clinical Manifestations and Causes of Anaphylaxis. Analysis of 382 Cases from the Anaphylaxis Registry in West Pomerania Province in Poland

Clinical characteristics and allergen detection of perioperative anaphylaxis: a 12-year retrospective analysis from an anesthesia clinic in China

Critérios clínicos para diagnóstico e tratamento adequado da anafilaxia perioperatória

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