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Approach to Perioperative Anaphylaxis in 2020: Updates in Diagnosis and Management
Jerry Kalangara1,2, Kristine Vanijcharoenkarn3, Grant C Lynde4
1Division of Pain Medicine, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.
Current Allergy and Asthma Reports
|January 7, 2021
Summary
Perioperative anaphylaxis (POA) is reviewed, highlighting common causes like neuromuscular blocking agents and chlorhexidine. Accurate diagnosis relies on careful event analysis, as specific IgE tests have limited utility.
Area of Science:
- Anesthesiology
- Immunology
- Pharmacology
Background:
- Perioperative anaphylaxis (POA) is a rare but serious adverse event during anesthesia.
- Understanding the epidemiology, pathogenesis, and diagnosis of POA is crucial for patient safety.
Observation:
- Neuromuscular blocking agents (NMBAs) and chlorhexidine are frequently implicated in POA.
- Specific IgE testing shows limited diagnostic value for POA.
- Basophil activation testing and skin testing are valuable diagnostic tools.
Findings:
- There is an increasing incidence of suspected teicoplanin-induced allergic reactions in Europe.
- Accurate documentation and analysis of perioperative events are paramount for diagnosis.
- Multiple medication classes contribute to POA, necessitating a broad diagnostic approach.
Implications:
- Future research should focus on the pathophysiology of POA and novel therapeutic targets, such as MRGPRX2.
- Improved diagnostic strategies are needed to accurately identify causative agents of POA.
- Enhanced awareness and diagnostic capabilities can improve patient outcomes in perioperative settings.
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