The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: allergen exposure, epidemiology, and diagnosis of anaphylaxis during general anaesthesia

Takazawa, Tomonori; Horiuchi, Tatsuo; Nagumo, Kazuhiro; Sugiyama, Yuki; Akune, Tsubasa; Amano, Yasuhiro; Fukuda, Masataka; Haraguchi, Takashi; Ishibashi, Chika; Kanemaru, Eiki; Kato, Takao; Katoh, K.; Kawano, Takashi; Kochiyama, Tsukasa; Kuri, Michioki; Kurita, Akihide; Matsuoka, Yoshikazu; Muramatsu, Takahiro; Orihara, Masaki; Saito, Yutaka; Sato, Nobukazu; Shiraishi, Toshie; Suzuki, Koji; Takahashi, Miyuki; Takahashi, Toshifumi; Tanabe, Kumiko; Tomioka, Akihiro; Tomita, Yukinari; Tsuji, Tatsuya; Watanabe, Ichiro; Yamada, Takashige; Yoshida, Nagahide; Yamaguchi, Masao; Saito, Shigeru

doi:10.1016/j.bja.2023.02.018

Cited by 23 publications

(8 citation statements)

References 30 publications

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“…Our patient had been exposed to common triggering agents and had encountered latex. 3,4 Unfortunately, measure tryptase level as this assay is not available at our institution.…”

Section: Discussionmentioning

confidence: 99%

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Tranexamic Acid in Cardiac Surgery: A Case Report of an Infrequent Adverse Reaction to a Common Medication.

Sanchez Salcedo,

Manuel Baloira,

Adrover

et al. 2023

A&A Practice

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Life-threatening anaphylaxis to tranexamic acid (TXA) is rare but critical in cardiac surgery. A 76-year-old patient undergoing elective ascending aorta replacement developed severe anaphylactic shock shortly after anesthesia induction. Subsequent skin prick tests confirmed a positive TXA reaction. While TXA and lysine derivatives were avoided in the second surgery, the patient experienced hyperfibrinolysis. Guided by rotational thromboelastometry, hemostatic therapy led to a successful outcome with minimal postoperative bleeding. This report emphasizes the importance of drug risk awareness and strategies to mitigate excessive bleeding in cardiac surgery.

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“…Our patient had been exposed to common triggering agents and had encountered latex. 3,4 Unfortunately, measure tryptase level as this assay is not available at our institution.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 While perioperative anaphylaxis is a rare event in the operating room, reported incidences range from 0.01% to 0.02% for all surgeries. 3,4 The most common culprits of perioperative anaphylaxis include antibiotics, neuromuscular blocking agents, and chlorhexidine. 3 Anaphylaxis to TXA during anesthesia is rarely reported.…”

mentioning

confidence: 99%

Tranexamic Acid in Cardiac Surgery: A Case Report of an Infrequent Adverse Reaction to a Common Medication.

Sanchez Salcedo,

Manuel Baloira,

Adrover

et al. 2023

A&A Practice

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“…Prompt recognition is central to the effective management of perioperative hypersensitivity reactions. However, there are several factors, which may contribute to delayed recognition [7,26]. The first is variability in clinical presentation.…”

Section: Managementmentioning

confidence: 99%

“…This variation is due in part to differences in reporting mechanisms, as well as nonstandardized diagnostic criteria both within and between countries. Population-level differences may exist in genetic susceptibility to such events, as well as in anaesthetic practices [1,6,7]. The most common causative agents are neuromuscular blocking agents (NMBAs) and antibiotics [1,8–15].…”

Section: Introductionmentioning

confidence: 99%

Management and treatment of perioperative hypersensitivity

Littlejohns,

Savic

2024

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Perioperative hypersensitivity reactions are rare but potentially catastrophic events. This review acts to summarize recent recommendations for both immediate and poststabilization management of suspected reactions, alongside practical advice for anaesthetists who may be faced with these events. Recent findings Prompt treatment is essential but may be hampered by delay in recognition. This can occur because there are multiple differential diagnoses for the observed clinical signs as well as variations in clinical presentation. Resuscitation is dependent on the use of adrenaline and fluids. Adrenaline should be administered in small, titrated intravenous boluses. Low-dose infusions should be commenced early if the response to boluses is poor. Large volume fluid resuscitation may be required to maintain adequate circulating volume. Chest compressions are recommended when there is evidence of inadequate perfusion, rather than waiting until cardiac arrest is confirmed. Antihistamines and corticosteroids are no longer recommended in the immediate management phase. Once the patient has been stabilized, it is important to obtain serial tryptase concentrations to aid the subsequent clinic investigation. The decision to proceed or abandon surgery will be based on an individual risk-benefit analysis. All cases of suspected perioperative hypersensitivity, including fatal cases, must be referred for formal investigation. Summary There have been recent updates to management guidelines in perioperative hypersensitivity. Treatment algorithms, treatment packs and referral packs can all help the anaesthetist manage these complex cases, aid the subsequent investigation and ensure patient safety in the future.

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“…The Japanese Epidemiological Study for Perioperative Anaphylaxis (JESPA), a recent large Japanese study, reported that of 43 cases diagnosed with anaphylaxis, the cause could not be identified in 11 cases. Among the 43 cases, while neither the skin test nor the basophil activation test could be performed in four of them, the cause could not be identified in seven of the remaining 39 patients (18%) despite performing at least one of the tests [ 4 ]. The reasons for not finding the cause of anaphylaxis could be that the patient was not anaphylactic or that the test was a false negative.…”

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confidence: 99%

Perioperative anaphylaxis with no identifiable cause

Horiuchi,

Takazawa

2024

JA Clin Rep

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The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: allergen exposure, epidemiology, and diagnosis of anaphylaxis during general anaesthesia

Cited by 23 publications

References 30 publications

Tranexamic Acid in Cardiac Surgery: A Case Report of an Infrequent Adverse Reaction to a Common Medication.

Tranexamic Acid in Cardiac Surgery: A Case Report of an Infrequent Adverse Reaction to a Common Medication.

Management and treatment of perioperative hypersensitivity

Perioperative anaphylaxis with no identifiable cause

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