Multiple drug allergies: Recommendations for perioperative management

Area of Science:

• Anesthesiology
• Clinical Immunology
• Pharmacology

Background:

• Hypersensitivity reactions pose significant risks during perioperative periods.
• Patients with a history of allergy, atopy, or asthma are at higher risk.
• Multiple drug allergies (MDA) are a critical concern for anesthesiologists.

Purpose of the Study:

• To outline the pathophysiology of multiple drug allergies (MDA).
• To guide preoperative evaluation and anesthesia considerations for patients with MDA.
• To provide recommendations for preventing and managing allergic reactions in anesthetized patients with MDA.

Main Methods:

• Review of current literature on drug hypersensitivity in perioperative settings.
• Analysis of the incidence and common causes of perioperative anaphylaxis.
• Discussion of diagnostic and management strategies for patients with known drug allergies.

Main Results:

• Neuromuscular blocking agents are the most frequent cause of perioperative anaphylaxis (50%-70%).
• Antibiotics and latex are other common allergens.
• Allergic reactions to propofol are rare (1:60,000).
• Intraoperative anaphylaxis contributes to 4.3% of general anesthesia deaths.

Conclusions:

• Allergological assessment is essential for patients with MDA before surgery.
• Proactive management strategies can mitigate risks associated with perioperative allergic reactions.
• Understanding drug allergy mechanisms is key to patient safety in anesthesia.