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Perioperative anaphylaxis in a 44-year-old man
Jeffrey A Culp1, Ross I Palis, Mariana C Castells
1Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, VA 22908, USA. jc5yd@virginia.edu
Allergy and Asthma Proceedings
|November 24, 2007
Summary
Perioperative anaphylaxis, a rare but serious reaction, can occur even in patients without prior allergies. This case highlights cefazolin as a potential trigger, emphasizing the need for thorough investigation to prevent future occurrences.
Area of Science:
- Anesthesiology
- Immunology
- Pharmacology
Background:
- Perioperative anaphylaxis is a critical event during surgery.
- Cephalosporins, including cefazolin, are commonly used for surgical prophylaxis.
- Anaphylaxis to cephalosporins is considered rare but possible.
Observation:
- A 44-year-old male experienced anaphylaxis during cervical spine surgery under general anesthesia.
- Symptoms included hypotension, tachycardia, bronchospasm, and erythema.
- Markedly elevated serum tryptase confirmed anaphylaxis.
Findings:
- Initial allergy tests for penicillin and cefazolin were negative.
- Repeat skin testing for cefazolin six weeks post-reaction was positive.
- This suggests cefazolin as the likely causative agent.
Implications:
- Cephalosporin-induced anaphylaxis should be considered in perioperative allergic reactions.
- Comprehensive workup is essential to identify triggers and guide future anesthetic management.
- Available skin testing protocols can aid in diagnosing drug-induced anaphylaxis.
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