Diagnostic procedure after an immediate hypersensitivity reaction in the operating room

Area of Science:

• Anesthesiology
• Allergy and Immunology

Background:

• Perioperative allergic reactions pose significant risks during surgery.
• Accurate diagnosis is crucial for patient safety and future anesthetic management.

Purpose of the Study:

• To outline a comprehensive diagnostic and management strategy for perioperative allergic reactions.
• To emphasize the importance of timely diagnosis and appropriate follow-up investigations.

Main Methods:

• Clinical evaluation of reaction features and timeline.
• Measurement of serum histamine and tryptase levels post-reaction.
• Allergy assessments including skin tests, specific IgE, and provocation tests.
• Exclusion of alternative diagnoses.

Main Results:

• Diagnosis relies on clinical presentation, exclusion of other causes, elevated degranulation markers, and positive allergy tests.
• Serial blood sampling for histamine and tryptase aids in validating immediate hypersensitivity.
• Delayed tryptase measurement helps rule out mastocytosis.

Conclusions:

• Anesthesiologists must meticulously document reaction details and collaborate with allergists.
• Informed patient consent and adherence to guidelines are essential for investigations and future anesthesia planning.
• Patients should be informed and carry an allergy alert card.