Skin testing: A valuable screening tool to identify allergy to anesthetic agents

Abstract

Anaphylaxis is a rapid-onset, life-threatening allergic reaction that needs immediate medical intervention. Typically, immunoglobulin E (IgE) mediated, these reactions necessitate skin testing for assessing drug hypersensitivity. A 31-year-old woman with cervical carcinoma, scheduled for a total hysterectomy with bilateral salpingo-oophorectomy under general anesthesia (GA), experienced preoperative urticaria and palpitations, during a blood transfusion. Administering intravenous (IV) pheniramine, ranitidine, and dexamethasone resolved symptoms, allowing surgery under GA. However, post atracurium injection, she developed generalized urticaria and mild hypotension. IV pheniramine and hydrocortisone stabilized her, prompting surgery deferral for an allergology workup. The skin testing was performed, and all drugs tested negative. To prevent non-IgE-mediated reactions, a preoperative regimen of pheniramine 25 mg, prednisolone 50 mg, and famotidine 20 mg was recommended. Subsequently, surgery was performed under GA, using propofol and rocuronium, with the whole perioperative period remaining uneventful. This case underscores the imperative role of skin testing in elucidating perioperative drug usage amid suspected or encountered drug allergies.

Keywords

• anesthetic agents
• drug allergy
• skin testing