Perioperative anaphylactic reactions: Review and procedure protocol in paediatrics

Area of Science:

• Anesthesiology
• Allergology
• Immunology

Background:

• Perioperative anaphylaxis presents immediate, potentially fatal hypersensitivity reactions.
• Common triggers include neuromuscular blocking agents (NMBAs), latex, and antibiotics, with latex prevalent in pediatric cases.
• Subtle signs can lead to underdiagnosis, increasing future risk.

Purpose of the Study:

• To review the diagnosis and management of perioperative anaphylactic reactions.
• To highlight diagnostic challenges and the importance of allergy testing.
• To provide guidance on preventive measures and diagnostic algorithms.

Main Methods:

• Analysis of anesthesia records to establish temporal links between exposures and reactions.
• Measurement of serum tryptase levels to confirm anaphylaxis.
• Allergy investigations including specific IgE, skin tests, and controlled exposure tests 4-6 weeks post-reaction.

Main Results:

• An elevated tryptase level supports anaphylaxis diagnosis, though it may be absent with circulatory compromise.
• Allergy testing shows good sensitivity for NMBAs, latex, antibiotics, chlorhexidine, gelatin, and povidone.
• Testing sensitivity is poor for barbiturates, opiates, and benzodiazepines, with potential for false positives.

Conclusions:

• Accurate diagnosis of perioperative anaphylaxis requires careful review of anesthesia records and timely allergy testing.
• Specific preventive strategies are essential, particularly for latex allergy.
• The study provides recommendations for skin test concentrations, pediatric treatment dosages, and an allergological study algorithm.