Science & Research (Feb 2019)
THE MOST COMMONLY IDENTIFIED CAUSE OF PERIOPERATIVE HYPERSENSITIVITY REACTIONS
Abstract
Introduction. Perioperative anaphylaxis is a clinical condition that range from mild symptoms to life-threatening reactions. There is a geographic difference in the most frequent identified cause of perioperative drug hypersensitivity reactions. However, data from national surveys are lacking. The aim of this study was to evaluate the cause of perioperative drug hypersensitivity reactions among patients with a history of perioperative anaphylaxis. Materials and Methods. A total number of 195 patients [68(34.87%) men; mean age 57 years; SD 40.8; age range 10-79] with a history of perioperative anaphylaxis were included. All patients were referred in a specialized allergy centre for evaluation within at least six weeks of hypersensitivity reaction during anesthesia. Allergy evaluation included a detailed medical history, review of perioperative medical records and skin testing for all drugs and products administered during the anesthesia. Skin testing was performed with nonirritating concentrations. If the skin prick test was negative, intradermal test was performed, when available. Results: A culprit drug, defined as a positive skin test, was identified in 115(58.97%) patients. A total number of 111 patients had allergy to one agent and 4 – to two. The most common agents indentified were neuromuscular blocking agents (NMBAs)– 68 positive skin tests in 61 (53.04%) patients. Reactions were as followed: pipecuronium -25(36.76%), rocuronium - 25(36.76%), suxamethonium - 13(19.12%), atracurium -5 (7.35%). Four patients had allergy to two NMBAs. Other identified agents were: fentanyl 10(8.7%), ketamine 13(11.3%), midazolam 11(9.57%), propofol 18 (16.65%), latex 2(1.74%). Conclusions: The leading causes of perioperative anaphylaxis in our study population were NMBAs. More data from multicenter national surveys should be collected in future.
