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PERIOPERATIVE ALLERGIC REACTIONS: EXPERIENCE IN A FLEMISH REFERRAL CENTRE

João Antunes, A.-M. Kochuyt, J.L. Ceuppens

Clinical Department of Allergy and Clinical Immunology, University Hospital Gasthuisberg, KU Leuven, Belgium

Allergol Immunopathol (Madr). 2013 Oct 23. pii: S0301-0546(13)00237-1. doi: 10.1016/j.aller.2013.08.001.

Abstract
Background: The incidence of perioperative anaphylactic reactions is overall estimated to be 1per 10,000---20,000 anaesthetic procedures. We performed a retrospective analysis of patientsreferred to a University Allergy Centre in Belgium with the suspicion of an allergic reactionduring or shortly after general anaesthesia.
Objectives: Our aim was to assess the causes of perioperative allergic reactions, to evaluatecross-reactivity among neuromuscular blocking agents (NMBA) and to analyze the diagnosticrelevance of tryptase levels in the discrimination between IgE and non-IgE-mediated reactions.
Methods: A total of 119 patients, referred from 2007 to 2011 were included. The diagnosticprotocol consisted in case history, serum tryptase measurements, immunoassays and skin tests.
Results: A diagnosis of IgE-mediated reaction was established in 76 cases (63.9%). The mostcommon agents were NMBA (61.8%), antibiotics (14.5%), latex (9.2%) and chlorhexidine (5.2%).Rocuronium was the most frequently causative NMBA (48.9%). Vecuronium cross-reactivity wasestablished by skin testing in 47.6% of cases. Cisatracurium was the NMBA most frequently tol-erated (cross-reaction in 13.9%). In 23.4% of NMBA allergic patients, the reaction occurred onthe first exposure. Most IgE-mediated reactions occurred during the induction phase (72.4%).Latex-induced reactions occurred mainly during maintenance and recovery phases (71.4%;p < 0.02). Mean tryptase values were significantly higher in patients with IgE-mediated reactions(p = 0.0001), than in those with no identified cause.
Conclusions: NMBA, antibiotics, latex and chlorhexidine were the main culprits of IgE-mediatedperioperative reactions. Uncertainties remain concerning the specificity and sensitivity of skintesting. Tryptase assays can be useful in the discrimination of IgE and non-IgE-mediated reac-tions.

KEYWORDS: Anaesthesia; Drug allergy; Latex; Neuromuscular blocking agents; Tryptase