Perioperative anaphylaxis in children: Etiology, time sequence, and patterns of clinical reactivity

Abstract

BackgroundPerioperative anaphylaxis (PA) in children is an uncommon but potentially life‐threatening complication associated with anesthesia. Early identification and management of PA is essential to optimize clinical outcomes.MethodsWe performed a retrospective study of anesthesia records from pediatric patients with PA from centers in the United Kingdom, France, and the United States over a period of 10 years. Time sequence of clinical signs and physiological variables during PA were collected, along with results of allergy testing.ResultsTwenty‐nine children with PA were included. Median age was 11 years. Based on the modified Ring and Messmer Grading Scale, severe reactions were seen in 25 (86%) members of this cohort, with 4 (14%) experiencing cardiac arrest. Life‐threatening hypotension was the first clinical sign of PA in 59% of cases, followed by tachycardia and bronchospasm. In 16 (55%) cases, the initial signs of PA involved multiple organ systems. When the initial signs of PA were cardiovascular and/or respiratory, more epinephrine doses were administered. Average time from initial sign of PA to treatment with epinephrine was 6 minutes (SD: 6, range: 1‐25). The causative allergen was identified in 15 patients.ConclusionSevere hypotension is the most common presenting sign of PA in children. Initial cardiovascular and/or respiratory signs are associated with the need for increased epinephrine doses. Further studies should optimize the prediction, identification, and early management of PA in children.

Perioperative anaphylaxis: A five-year review in a tertiary paediatric hospital

“…3 The prevalence of chlorhexidine anaphylaxis in the paediatric population is still unreported and it was not featured in the multicentre study of Khaleva et al. 13 Its absence in our study was likely to be related to the small number of patients who completed allergy evaluation. Our study is in agreement with recent trends in which antibiotics are the commonest cause in predominantly adult studies from the United Kingdom, 10 United States and Spain.…”

“…performed a ten-year multicentre retrospective study identifying 29 cases of paediatric perioperative anaphylaxis. 13 In the study by Khaleva et al., hypotension was present early and throughout anaphylaxis, accounting for 58.6% of the initial presentation and 89.7% at any time. We postulate that the difference in initial presentation is due to the patient population as the study by Khaleva et al.…”

Perioperative anaphylaxis in children: A report from the Wake‐Up Safe collaborative

“…The reported reasons of delayed treatment included complexity of cases, often with a confounding differential diagnosis 3 . The other recent literature on perioperative anaphylaxis among multinational pediatric cohorts also showed that 38% of cases initially received alternate treatment prior to epinephrine 14 . Although many were treated with epinephrine, 5% of cases were managed with only phenylephrine.…”

Advances and novel developments in drug hypersensitivity diagnosis

“…However, a complete allergy assessment is crucial for allergy delabeling, especially in cystic fibrosis patients with antibiotic hypersensitivity reactions 5 . All this highlights the need for improving the different approaches for diagnosing patients with suspected DHRs 1,6 . In this review, we have analyzed the advances performed in DHRs diagnosis during the last 2 years 7 …”

“…5 All this highlights the need for improving the different approaches for diagnosing patients with suspected DHRs. 1,6 In this review, we have analyzed the advances performed in DHRs diagnosis during the last 2 years. 7 From a practical point of view, DHRs diagnosis can be performed by in vivo and in vitro tests (Figure 1) depending on the type of reactions, which can be immediate (I-DHRs) (appearing from 1 to 6 hours after drug intake) and nonimmediate (NI-DHRs) (appearing after 1 hour of drug intake), 8 inhibition (pharmacological effect) and MRGPRX2 receptor (direct stimulation), can be involved.…”