Epidemiology of perioperative anaphylaxis

Anaphylactic reactions may be either of immune (allergy, usually IgE-mediated, sometimes IgG-mediated) or non-immune origin. The incidence of anaphylactic reactions during anaesthesia varies between countries ranging from 1/1250 to 1/18,600 per procedure. In France, the estimated incidence of allergic reactions is 100.6 [76.2-125.3]/million procedure with a high female predominance (male: 55.4 [42.0-69.0], female: 154.9 [117.2-193.1]). The proportion of IgE-mediated allergic reactions seems to be relatively similar between countries, ranging from 50 to 60%. Substantial geographical variability regarding the different drugs or substances involved is reported. Reactions involving neuromuscular blocking agents are a major cause in several countries but are less frequently reported in the United States or Denmark. Reactions involving antibiotics, dyes or chlorhexidine are reported with a high and sometimes increasing frequency in most series. Reactions to latex are rapidly decreasing as a result of primary and secondary prevention policy. Regional differences are a strong incentive for repeated epidemiological surveys in different countries.