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Intraoperative anaphylaxis: verba volant, scripta manent!
M B Bilò1, B Cinti, M Chiarello
1Department of Allergic and Respiratory Diseases, Ancona, Italy. b.bilo@ao-umbertoprimoi.marche.it
European Annals of Allergy and Clinical Immunology
|February 4, 2006
Summary
Delayed diagnosis of gelatine-induced anaphylaxis occurred due to medical record omissions. Allergy testing revealed specific sensitivity to gelatine, confirmed by cytokine analysis.
Area of Science:
- Anesthesiology
- Immunology
- Allergology
Background:
- A 66-year-old woman with hypertension and bladder carcinoma underwent multiple surgeries.
- Previous anesthesias were complicated by hypotension and rash, initially attributed to other factors.
Observation:
- The patient experienced severe hypotension and rash during general anesthesia on two separate occasions.
- Initial workup for anaphylaxis was negative, but tryptase levels were elevated post-reaction.
- A subsequent allergological evaluation identified a specific allergy to gelatine via intradermal testing.
Findings:
- Intracellular cytokine analysis demonstrated Interleukin-4 (IL-4) production by CD4+ lymphocytes upon gelatine stimulation.
- This confirmed gelatine as the causative agent for the patient's anaphylactic reactions.
Implications:
- Highlights the importance of thorough patient history, including potential exposure to less commonly recognized allergens like gelatine.
- Underscores the utility of advanced immunologic testing in diagnosing challenging cases of anaphylaxis.
- Suggests careful consideration of gelatine-containing materials in patients with unexplained perioperative reactions.