[Perioperative aspects of anaphylaxis]

Area of Science:

• Anesthesiology
• Allergy and Immunology

Context:

• Anaphylaxis is a severe, life-threatening systemic reaction, often triggered by allergens like drugs, insect stings, or foods.
• Mediators such as histamine, released from mast cells, play a central role in anaphylaxis.
• Incidence varies, with approximately 1 in 10,000 anesthesias affected, and specific causative agents differ geographically.

Purpose:

• To highlight the critical importance of immediate recognition and swift, specific treatment for anaphylaxis.
• To review common triggers and incidence rates of anaphylaxis, particularly in anesthetic settings.
• To emphasize factors influencing clinical presentation and the role of preoperative allergy assessment.

Summary:

• Antibiotics are identified as a leading cause of anaphylaxis in England, followed by neuromuscular blocking drugs, chlorhexidine, and Patent Blue dye.
• Most anaphylactic reactions occur rapidly, within 5-10 minutes of exposure.
• Antibiotic allergy, especially to teicoplanin and co-amoxiclav, is a growing concern.

Impact:

• Effective management hinges on rapid diagnosis and intervention, regardless of the allergic or non-allergic origin of severe reactions.
• Patient factors like anesthesia classification, physical condition, and concurrent medications (beta-blockers, ACE inhibitors) can modify clinical characteristics.
• Proactive measures, including detailed preoperative allergy history, can significantly mitigate the risk and incidence of anaphylaxis.