J Miller1, S B Clough1, R C Pollard2, S A Misbah3. 1. Department of Clinical Immunology, Oxford, UK. 2. Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 3. Department of Clinical Immunology, Oxford, UK. Electronic address: siraj.misbah@ouh.nhs.uk.
Abstract
BACKGROUND: Perioperative anaphylaxis (POA) is infrequent, but remains an important and potentially life-threatening complication of general anaesthesia. The diagnostic uncertainty surrounding the investigation of anaesthetic allergy poses numerous challenges. We aimed to inform practice by auditing the outcomes of repeat anaesthesia, after an investigation for previous POA. METHODS: One-hundred and seventy-four subjects were investigated after suspected POA between December 2002 and August 2015. Outcome data were obtained for a total of 70 patients who underwent repeat anaesthesia after investigation in the drug-allergy clinic. RESULTS: Sixty-seven out of the 70 patients studied underwent repeat anaesthesia without further complications. Three individuals experienced a further episode of anaphylaxis. In two cases, incomplete referral information led to the offending drugs being omitted from initial testing. The third was found to have underlying systemic mastocytosis (SM). CONCLUSIONS: In our cohort, the incidence of repeat anaphylaxis after a comprehensive assessment in the drug-allergy clinic for suspected POA was 4%. Important risk factors include the completeness of referral information provided to the assessor and the role of exacerbating disorders, particularly SM.
BACKGROUND: Perioperative anaphylaxis (POA) is infrequent, but remains an important and potentially life-threatening complication of general anaesthesia. The diagnostic uncertainty surrounding the investigation of anaesthetic allergy poses numerous challenges. We aimed to inform practice by auditing the outcomes of repeat anaesthesia, after an investigation for previous POA. METHODS: One-hundred and seventy-four subjects were investigated after suspected POA between December 2002 and August 2015. Outcome data were obtained for a total of 70 patients who underwent repeat anaesthesia after investigation in the drug-allergy clinic. RESULTS: Sixty-seven out of the 70 patients studied underwent repeat anaesthesia without further complications. Three individuals experienced a further episode of anaphylaxis. In two cases, incomplete referral information led to the offending drugs being omitted from initial testing. The third was found to have underlying systemic mastocytosis (SM). CONCLUSIONS: In our cohort, the incidence of repeat anaphylaxis after a comprehensive assessment in the drug-allergy clinic for suspected POA was 4%. Important risk factors include the completeness of referral information provided to the assessor and the role of exacerbating disorders, particularly SM.
Authors: Dirceu Solé; Maria Anita Costa Spindola; Marcelo Vivolo Aun; Liana Maria Tôrres de Araújo Azi; Luiz Antonio Guerra Bernd; Daniela Bianchi Garcia; Albertina Varandas Capelo; Débora de Oliveira Cumino; Alex Eustáquio Lacerda; Luciana Cavalcanti Lima; Edelton Flávio Morato; Rogean Rodrigues Nunes; Norma de Paula Motta Rubini; Jane da Silva; Maria Angela Tardelli; Alexandra Sayuri Watanabe; Erick Freitas Curi; Flavio Sano Journal: Braz J Anesthesiol Date: 2020-11-09