The usefulness of plasma histamine and different tryptase cut‐off points in the diagnosis of peranaesthetic hypersensitivity reactions

Berroa, Felicia; Lafuente, Alberto; Javaloyes, Gracia; Ferrer, Marta; Moncada, Rafael; Goikoetxea, M. J.; Urbain, Claude M.; Sánz, M L; Gastaminza, Gabriel

doi:10.1111/cea.12237

Cited by 39 publications

(30 citation statements)

References 19 publications

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“…Blood should be taken during this stage in order to measure serum tryptase, an indicator of mast cell/basophil degranulation [63]. Other markers such as histamine and methyl-histamine in urine have been used, however these are not recommended in routine practice due to difficulties in measurement and low sensitivity [64].…”

Section: Actions After Treatmentmentioning

confidence: 99%

“…Moreover, the samples are less sensitive to environmental conditions, as determination is performed in serum. Different cut-offs have been considered, ranging from 8.23 μg/L to 11.4 μg/L [94][95][96], although the best criteria is a 2-fold or 2+1.2x increase above baseline levels (grade of recommendation, B) [63,133]. Tryptase levels are especially high in more severe reactions [134,135].…”

Section: This Determination Is Not Sufficiently Standardized For Diagmentioning

confidence: 99%

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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: Actions After Treatmentmentioning

confidence: 99%

Section: This Determination Is Not Sufficiently Standardized For Diagmentioning

confidence: 99%

Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna¹,

Archilla²,

Doña³

et al. 2018

J Investig Allergol Clin Immunol

105

View full text Add to dashboard Cite

show abstract

“…The presence of this enzyme is therefore a key element in diagnosing anaphylactic reactions [19]. However, the optimum number of Tryptase measurements and the best interpretative strategy has not yet been established in perioperative anaphylaxis [20][21][22]. Our internal protocol for Anaphylaxis in the perioperative period includes a proposal for Tryptase measurements.…”

Section: Discussionmentioning

confidence: 99%

Hypersensitivity Reactions During Anaesthesia Care: An 11-Year Experience From A Tertiary Hospital

Pereira¹,

Almeida²,

Frada³

et al. 2017

J Anesth Clin Res

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Introduction: Anaphylaxis during general anaesthesia is a rare but life-threatening clinical condition involving multiple organ systems, with a reported incidence of 1 in 4.000 to 25.000 anesthetic procedures. The objective of this study is to describe the experience of a Tertiary University Hospital with drug hypersensitivity reactions, including anaphylaxis, during anaesthesia care, their main causal agents, treatment and investigation.

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“…Moreover, skin testing was not done and serum tryptase levels were not assessed at the time of the IR to distinguish between IgE-mediated allergic reaction and cytokine-mediated IR. Ideally, serum tryptase levels >11.4ng/mL within 3 hours of the event, which is indicative of mast cell degranulation, may help to distinguish IgE-mediated allergic/anaphylactic reactions from non-IgE-mediated reactions [35,36]. …”

Section: Discussionmentioning

confidence: 99%

Incidence of infusion reactions to anti-neoplastic agents in early phase clinical trials: The MD Anderson Cancer Center experience

et al. 2016

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Background Infusion reactions (IRs) to anti-neoplastic agents require prompt recognition and immediate treatment to avert significant complications. Methods We conducted a retrospective review of the medical records of consecutive patients who received anti-neoplastic therapy in the outpatient treatment center of the Department of Investigational Cancer Therapeutics from January 1, 2013 to November 30, 2013. Results Of the 597 patients who received treatment, 9 (1.5%) had IRs (all ≤ grade 2). The most common IRs observed on first occurrence were chills (n=5), itching, rash, and facial flushing (n=3 each). There were no IR-related deaths. All the IRs were reversible with appropriate symptomatic treatment and the therapy was completed after temporary cessation of infusion in 7 of the 9 patients. The infusion was stopped in 2 patients due to symptoms suggestive of IgE-mediated allergic reaction and cytokine storm. Five of the 8 patients who were re-challenged with the same therapy developed a similar reaction. However, the infusion was completed in 4 of the 5 patients after administration of intravenous diphenhydramine and/or hydrocortisone, or slowing the rate of infusion and subsequently cycles with the same agents were uneventful. Conclusion IRs to anti-neoplastic agents are rare. Though the clinical presentations are overlapping, most IRs are not IgE-mediated allergic reactions. Appropriate premedication and slow rate of infusion facilitates uneventful administration of the anti-neoplastic agents in subsequent cycles. Further study in a larger cohort of patients to identify biomarkers of hypersensitivity is warranted.

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The usefulness of plasma histamine and different tryptase cut‐off points in the diagnosis of peranaesthetic hypersensitivity reactions

Abstract: The best criterion for discriminating IgE- and non IgE-mediated hypersensitivity reactions in anaesthesia was a tryptase value exceeding twice the basal one.

Cited by 39 publications

References 19 publications

Practical Guidelines for Perioperative Hypersensitivity Reactions

Practical Guidelines for Perioperative Hypersensitivity Reactions

Hypersensitivity Reactions During Anaesthesia Care: An 11-Year Experience From A Tertiary Hospital

Incidence of infusion reactions to anti-neoplastic agents in early phase clinical trials: The MD Anderson Cancer Center experience

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