Skin testing in the investigation of reactions to intravenous anaesthetic drugs. A prospective trial of atracurium and tubocurarine

Can Clinical Anaphylaxis to Anaesthetic Drugs Be Predicted From Allergic History?

“…Further, the potential interventions based on such a history have not been validated. Choice of low-risk drugs and pretreatment have both been subject to failure with fatal consequences (Watkins, 1985), and preoperative intradermal testing does not appear a valid predictor in the absence of a past history of a reaction (Fisher, 1985;Wood et al, 1985). This is not to say that care should not be taken with potent histamine-releasing drugs in patients with an allergic or atopic history, as there is evidence that the direct histamine-releasing effects of drugs may be more pronounced in patients with such a history (Laxenaire et al, 1982), or in patients with cardiovascular disease (Philbin et al, 1981).…”

Histamine Release and Chandonium Iodide

“…High incidence of weals and flare reactions was observed with dtubocurarine and atracurium but not to vecuronium. Similarly, Wood et al reported high incidence of positive "intradermal" weal and flare at dilutions of 1:I,000 of d-tubocurarine and atracurium [3].…”

The undesirable effects of neuromuscular blocking drugs

“…Another factor may be the practical difficulties of implementing and monitoring standardisation of test methods and diagnostic criteria across multiple centres despite clear and comprehensive guidelines for investigation published by the Société Francaise d’Anesthésie et de Réanimation [23]. Performance of skin testing and interpretation of the results requires experience, and intradermal testing is particularly prone to producing false positive tests [24]. The concentrations used for skin testing have also been debated [25, 26], but a large study from France on 111 volunteers tested for all commercially available NMBs led to only minor modifications of the recommendations.…”