Risk factors and prevention for perioperative anaphylaxis: a nested case-control study

Area of Science:

• Anesthesiology
• Allergy and Immunology
• Surgical Safety

Background:

• Perioperative anaphylaxis, though rare, presents a significant clinical challenge due to its potential severity.
• Limited understanding exists regarding risk factors for perioperative anaphylaxis and the efficacy of anti-allergy premedication in prevention.
• Identifying high-risk patients and effective preventive strategies is crucial for improving surgical outcomes.

Purpose of the Study:

• To identify key risk factors associated with perioperative anaphylaxis.
• To evaluate the prophylactic effectiveness of anti-allergy premedication in preventing perioperative anaphylaxis.
• To explore factors influencing the choice of anti-allergy premedication in high-risk patients with prior anaphylaxis of unknown cause.

Main Methods:

• A retrospective nested case-control study was conducted on surgical patients from October 2012 to December 2017.
• Logistic regression analysis was employed to identify risk factors for perioperative anaphylaxis.
• A cohort of high-risk patients received tailored anti-allergy premedication, and outcomes were evaluated.

Main Results:

• A history of drug allergy (OR 6.78) and allergies to food or other substances (OR 40.56) were significantly associated with increased perioperative anaphylaxis risk.
• In high-risk patients, neither anaphylaxis recurrence nor adverse events occurred when culprit agents were avoided or anti-allergy premedication was administered.
• A history of grade II or III perioperative anaphylaxis (OR 9.09) was a significant factor in selecting anti-allergy premedication options.

Conclusions:

• History of drug allergy and food/other substance allergies are significant risk factors for perioperative anaphylaxis.
• Avoiding identified triggers and implementing rational anti-allergy premedication are critical preventive measures.
• These strategies are essential for mitigating perioperative anaphylaxis risk in susceptible surgical patients.