Systematic follow‐up increases incidence of anaphylaxis during adverse reactions in anesthetized patients

Malinovsky, J. M.; Decagny, S.; Wessel, F.; Guilloux, L.; Mertès, Paul-Michel

doi:10.1111/j.1399-6576.2007.01489.x

Cited by 77 publications

(41 citation statements)

References 23 publications

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“…In our cohort of 'pre-operative' patients, 29 (30.8%) had a diagnosis of IgE-mediated hypersensitivity reactions, lending weight to this argument. Further support for investigating unexplained peri-operative adverse reactions comes from the study by Malinovsky et al [37], who also demonstrated that a systematic approach to investigating such reactions identified the culprit agent in a significant number of cases.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic

McEwan

Karanam

et al. 2015

Anaesthesia

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SummaryOur bi-specialty clinic was established to systematically investigate patients with suspected peri-operative hypersensitivity reactions. Four hundred and ten patients were studied; 316 following an intra-operative reaction ('postoperative' group) and 94 with a previous history of reaction, referred before undergoing anaesthesia ('pre-operative' group). In the postoperative group, 173 (54.7%) were diagnosed with IgE-mediated reactions: 65 (37.6%) to neuromuscular blocking drugs; 54 (31.2%) antibiotics; 15 (8.7%) chlorhexidine and 12 (6.9%) patent blue dye. Reactions were severe in 114 patients (65.9%). All reactions to patent blue dye were severe. We identified IgE sensitisation in 22 (13.2%) cases with isolated mucocutaneous reactions. Only 173 (54.7%) patients had serum tryptase samples taken. Referrers' suspected causal agent was confirmed in only 37.2% of patients. Of 94 patients reviewed 'pre-operatively', 29 (30.8%) were diagnosed with IgE-mediated hypersensitivity reactions, reinforcing the importance of investigating this group of patients. Knowledge of the range of causative agents identified in our study should guide the investigation of suspected peri-operative hypersensitivity reactions.

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Section: Discussionmentioning

confidence: 99%

Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic

McEwan

Karanam

et al. 2015

Anaesthesia

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“…68,73 Only one of these studies, a single-centre survey, provided a rate based on a known number of patients and even this was approximate: Malinowsky et al 68 reported 6 cases of anaphylaxis among approximately 70,000 exposures, a rate of 1/11,667. Three cases were attributed to succinylcholine and one each to rocuronium, atracurium and cisatracurium.…”

Section: Anaphylactic and Allergic Reactionsmentioning

confidence: 99%

Sugammadex for the reversal of muscle relaxation in general anaesthesia: a systematic review and economic assessment

Chambers

Paulden²,

Paton³

et al. 2010

Health Technol Assess

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“…The test appears to be the most efficient test to screen sera for the presence of IgE antibodies to ammonium groups of NMBAs. Guilloux and coworkers have reported 97% specificity and 94% positive predictive value of the PAPPC RIA (40). No inhibition test has been done to detect the specificity of the antibodies detected by the PAPPC-RIA.…”

Section: Serum -Specific Ige Assaymentioning

confidence: 99%

“…Indeed, Malinovski and coworkers demonstrated that neither a modification of the actual diagnostic threshold nor the determination oftryptase values the day following an adverse reaction wil1 increase the diagnostic value in a clinically relevant manner (40).…”

Section: Basophil Activation Assaymentioning

confidence: 99%

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Muscle Relaxants Allergy

Peroni

Sansotta

Bernardini

et al. 2011

Int J Immunopathol Pharmacol

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The most common agents that are responsible for intraoperative anaphylaxis are muscle relaxants. In fact, neuromuscular blocking agents (NMBAs) contribute to 50–70% of allergic reactions during anaesthesia. The main mechanism of hypersensitivity reactions to NMBAs is represented by acute type I allergic reactions and the most severe form is anaphylaxis. The rate of non IgE mediated immediate hypersensitivity reactions usually varies between 20 % and 35% of the reported cases in most large series. In a recent report, non allergic suspected reactions to NMBAs occurred with almost the same frequency as did those with an allergic component. Although the precise mechanisms of these reactions remain difficult to ascertain, they usually result from direct non specific mast cell and basophil activation. After diagnostic procedures, regardless of the specific IgE results, NMBAs are contraindicated if the skin tests were positive. In view of the constantly evolving anesthesiologic practices, and of the complexity of allergy investigation, an active policy to identify patients at risk and to provide any necessary support to anaesthetists and allergologists should be promoted. The high frequency of IgE anaphylactic reactions and the feasibility of skin tests in children justify systematic allergy testing whenever hypersensitivity reaction occurs during general anaesthesia.

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Systematic follow‐up increases incidence of anaphylaxis during adverse reactions in anesthetized patients

Abstract: Systematic follow-up of patients with unexplained reactions during anesthesia increases the estimated incidence of IgE-mediated hypersensitivity reactions during anesthesia by 50%.

Cited by 77 publications

References 23 publications

Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic

Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic

Sugammadex for the reversal of muscle relaxation in general anaesthesia: a systematic review and economic assessment

Muscle Relaxants Allergy

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