Perioperative Anaphylaxis

Mertès, Paul-Michel; Tajima, K; Regnier-Kimmoun, M.A.; Lambert, M.; Iohom, Gabrielle; Guéant-Rodriguez, R.-M.; Malinovsky, Jean‐Marc

doi:10.1016/j.mcna.2010.04.002

Cited by 129 publications

(61 citation statements)

References 134 publications

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“…This is a bovine-derived protease inhibitor used via the parenteral route as a fibrinolysis inhibitor or topically as a surgical glue [17]. The incidence of reactions in cardiac surgery is 0.5% but it can increase to 2.5-2.8% in patients who have previously undergone multiple surgeries [99,100], especially in the previous six months [31]. Perioperative anaphylaxis has also occurred upon the first parenteral administration in patients that had previously received topical aprotinin [17].…”

Section: B) High Molecular Weight Agentsmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and Resumen:Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias.

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Section: B) High Molecular Weight Agentsmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

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“…The reported incidence of anaphylaxis during anesthesia is approximately 1 case per 5,000-20,000 patients per year; this estimate may be increasing secondary to improved accounting measures [48][49][50]. Patients with mastocytosis experience both immune (IgE-related) and non-immune anaphylaxis, and the overall incidence of anaphylaxis in patients with mastocytosis has been reported to be higher than in the general population [1,16,35,51].…”

Section: Preoperative Preparationmentioning

confidence: 99%

“…During the early phase of immune-mediated anaphylaxis, both serum histamine and tryptase levels increase. The serum half-life of histamine is less than 30 min and levels fall abruptly within 1 h of anaphylaxis [18,49,66]. In both IgE-like and nonimmune anaphylaxis-like incidents, tryptase, with a longer serum half life of approximately 90 min, peaks as histamine levels are declining and will not typically fall to normal levels for 4-6 h after the incident [91].…”

Section: Intraoperative Crisis Managementmentioning

confidence: 99%

“…If reliable tryptase testing (by fluoroimmune enzyme assay) is unavailable or if results are inconclusive, 24-hour urine histamine and PGD 2 (which is not released by basophils) levels may be considered, although diagnostic values for MCA have not yet been validated [10]. If a particular agent is suspected, IgE-specific assays are recommended at the time of the incident or shortly thereafter [49].…”

Section: Intraoperative Crisis Managementmentioning

confidence: 99%

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Anesthetic considerations in pediatric mastocytosis: a review

Klein

Misseldine

2013

J Anesth

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Mastocytosis is an orphan disease rarely encountered by practicing anesthesiologists. Children with mastocytosis often present for procedures or surgery requiring anesthesia. Because many of the medications commonly used in pediatric anesthesia have been reported to initiate mast cell activation, parents are often very anxious about their child's perioperative experience. Laboratory investigations of serum histamine assays associated with different anesthetic drugs have not been shown to predict mast cell degranulation in these patients. However, the pediatric literature suggests that children with disease limited to the skin rarely suffer serious side effects from anesthesia, and there are no reported fatalities. Preoperative prophylaxis is usually based on expert opinion and case reports. Detailed tables summarizing reports of anesthetic medications used for children with mastocytosis undergoing anesthesia, reported side effects, and suggested prophylaxis regimens are included in this review.

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“…In a recent review analyzing 9 retrospective studies and 16 prospective studies, the incidence of anaphylactic reactions was estimated to be 0.19% (retrospective studies) and 0.69% (prospective studies), respectively (33). Protamine can cause significant histamine release resulting in hypotension and bronchospasm, and even pulmonary hypertension (34).…”

Section: Protamine and Heparinsmentioning

confidence: 99%

Perioperative Allergy: Uncommon Agents

Caimmi

Cardinale

et al. 2011

Int J Immunopathol Pharmacol

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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.

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Perioperative Anaphylaxis

Cited by 129 publications

References 134 publications

Practical Guidelines for Perioperative Hypersensitivity Reactions

Practical Guidelines for Perioperative Hypersensitivity Reactions

Anesthetic considerations in pediatric mastocytosis: a review

Perioperative Allergy: Uncommon Agents

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