The Case of Ketamine Allergy

Area of Science:

• Pediatric Anesthesiology
• Clinical Toxicology
• Immunology

Background:

• Ketamine is a widely used anesthetic agent for pediatric procedural sedation.
• It is generally considered safe with a low incidence of adverse events.
• Allergic reactions, including anaphylaxis, are exceptionally rare with ketamine use.

Observation:

• A 3-year-old female patient developed acute symptoms immediately after intramuscular ketamine administration.
• The patient presented with facial edema, urticarial rash, wheezing, and oxygen desaturation.
• These symptoms are clinically consistent with anaphylaxis.

Findings:

• The patient's symptoms resolved after treatment with epinephrine, dexamethasone, and diphenhydramine.
• This case suggests a potential for histamine release-mediated anaphylaxis following ketamine.
• It is the first reported instance of an allergic reaction to intramuscular ketamine alone.

Implications:

• Clinicians should be aware of the rare possibility of anaphylaxis with ketamine, even when administered alone.
• Further investigation may be needed to understand the mechanisms of ketamine-induced allergic reactions.
• This case underscores the importance of monitoring for allergic responses during and after ketamine sedation in children.