Sugammadex-induced anaphylactic reaction: A systematic review

Area of Science:

• Anesthesiology
• Immunology
• Pharmacology

Background:

• Perioperative anaphylaxis is a rare, life-threatening hypersensitivity reaction during surgery.
• Sugammadex is a newer agent used to reverse neuromuscular blockade from specific anesthetics.
• Case reports suggest a potential link between sugammadex and anaphylaxis.

Purpose of the Study:

• To review existing literature and assess the association between sugammadex and anaphylaxis.
• To determine the incidence and characteristics of sugammadex-induced anaphylaxis.

Main Methods:

• A comprehensive literature search of PubMed, EMBASE, and Web of Science was performed.
• Studies were included if sugammadex was identified as a probable cause of anaphylaxis using World Allergy Organization criteria.
• Data from randomized controlled trials, observational studies, and case reports were analyzed.

Main Results:

• Four cases of anaphylaxis were identified across three randomized controlled trials (incidence 0.33% in one trial).
• Observational studies in Japan reported anaphylaxis incidence rates of 0.02% and 0.04%.
• Nineteen case reports/series confirmed 25 cases of sugammadex- or sugammadex-rocuronium complex-induced anaphylaxis, with common symptoms including hypotension and erythema.

Conclusions:

• Sugammadex is associated with a rare but serious risk of perioperative anaphylaxis, with an incidence of 0.02-0.04% in observational studies.
• The exact trigger (sugammadex alone or in complex with rocuronium) remains unclear.
• Further population studies and detailed allergy testing are needed to establish accurate global incidence rates and elucidate the mechanism of anaphylaxis.