Persistence of Allergy to Anaesthetic Drugs

Abstract

Intradermal testing and RIA testing for specific IgE antibodies to neuromuscular blocking drugs (NMBDs) were performed in patients referred to an Anaesthetic Allergy Clinic. Six patients were initially investigated four to 29 years after clinical anaphylaxis during anaesthesia and two of these patients and sixteen others were investigated by intradermal testing on two occasions at least four years apart. Seven patients had RIA tests for NMBD-specific IgE antibodies on two occasions at the time of skin testing. In all but two patients the evidence for drug-specific antibodies persisted 4-29 years after the reactions. In one patient all tests became negative and in another the skin test became negative but the positive RIA persisted. Evidence of antibodies to NMBDs persisted in 21 of 22 patientswho had had anaphylactic reactions to these drugs during anaesthesia. In the absence of evidence of allergy diminishing with time in the majority of patients it would seem wise to avoid drugs responsible for reactions for the rest of the patient's life.

Suspected allergy to local anaesthetics: follow‐up in 135 cases

“…In a few cases, the delay from reaction to testing was very long. Even though allergy to anaesthetic drugs has been shown to last for up to 27 years, 12 testing when delayed for several years, as in the present study, appears more to be a demonstration of tolerance rather than an investigation of the mechanism of the primary reaction. The variable amount of tests performed in each case limits the analyses of the entire population.…”

Follow-up after anaesthetic anaphylaxis

“…However, the best and safest information is logically a documented uneventful anaesthetic subsequent to the reaction. Allergy to NMBDs persists up to at least 30 years 17 and patients remain at risk.…”

Anaphylaxis during anesthesia: results of a 12‐year survey at a French pediatric center

“…Based on the model of skin sensitization to penicillins, it is possible that sensitization is lost without clinical allergy being lost (28). However, with NMBA, specific IgE persist and skin tests are reproducible for up to 30 years after the first accident (29, 30).…”