Allergic reactions occurring during anaesthesia: diagnostic approach

Area of Science:

• Anesthesiology
• Allergy and Immunology
• Critical Care Medicine

Background:

• Perioperative anaphylaxis and anaphylactoid reactions have increased over the last 30 years.
• Hypersensitivity reactions during anesthesia range from 1/1,000 to 1/25,0000 procedures, with muscle relaxants implicated in nearly 75% of cases.
• Mortality rates for these reactions are between 3-6%, and natural rubber latex is a significant cause, especially in children.

Purpose of the Study:

• To review the diagnosis and management of perioperative hypersensitivity reactions.
• To highlight the importance of identifying causative agents and avoiding them in future procedures.
• To discuss diagnostic tools, including skin testing and in vitro methods.

Main Methods:

• Review of clinical manifestations and diagnostic challenges in differentiating IgE-mediated anaphylaxis from non-specific mediator release.
• Emphasis on a multidisciplinary approach involving anesthesiologists and allergists.
• Evaluation of diagnostic techniques, including anesthetic report review, in vitro tests, and in vivo allergy tests (skin tests).

Main Results:

• Skin tests are considered the gold standard for diagnosing muscle relaxant-induced perioperative hypersensitivity reactions.
• Skin tests possess a good negative predictive value, assisting in selecting appropriate therapeutic alternatives.
• Diagnosis for agents other than muscle relaxants is more challenging, though in vitro activated basophil analysis shows promise.

Conclusions:

• Prompt recognition and management by anesthesiologists are crucial for acute events.
• Accurate identification of the responsible agent(s) by allergists, utilizing skin tests and other methods, is vital for preventing future reactions.
• Multidisciplinary collaboration and appropriate diagnostic testing are essential for managing patients with perioperative hypersensitivity.