Timing of skin testing after a suspected anaphylactic reaction during anaesthesia

A delay of 4 to 6 weeks after a suspected anaphylactic reaction has commonly been recommended before performing skin testing. However, sometimes surgery cannot be delayed, and investigation must be done earlier. Recent recommendations suggest that skin testing can be performed immediately after a reaction.

We describe three cases in which skin testing was performed within 3 weeks after the suspected anaphylactic reaction. A literature review was undertaken to evaluate cases where skin testing was performed within 3 weeks of a suspected anaphylactic reaction during anaesthesia.

Review of the literature did not give a definite answer to the optimal timing of skin testing after a suspected anaphylactic reaction during anaesthesia.

Only positive skin tests can be taken into account, and there is little safety data to provide confidence in early skin testing. A protocol of how to act if urgent surgery is necessary is suggested.