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Perioperative hypersensitivity in children: A prospective multidisciplinary study
Sezin Aydemir1, Hatice Betul Gemici Karaaslan1, Ulviye Mustu1
1Department of Pediatric Allergy and Immunology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Insights
Perioperative hypersensitivity reactions in children are rare but serious. This study found an incidence of 0.03%, confirming anaphylaxis in one case and highlighting the need for expert evaluation of suspected allergic reactions.
Area of Science:
- Pediatric Anesthesiology
- Allergy and Immunology
- Pediatric Surgery
Background:
- Perioperative hypersensitivity reactions (PHRs) in children are underdiagnosed due to recognition challenges.
- Anaphylaxis and urticaria can be missed in unconscious or draped patients, respectively.
- Limited studies exist on PHRs in pediatric surgical patients.
Purpose of the Study:
- To prospectively evaluate the incidence and characteristics of perioperative hypersensitivity reactions in children.
- To assess the diagnostic methods and confirmation criteria for PHRs in a pediatric surgical setting.
Main Methods:
- Prospective investigation of children (0-18 years) with suspected PHRs undergoing surgery (2019-2021).
- Reactions graded using the Ring and Messmer scale; confirmed via specific IgE, basophil activation tests, and serum tryptase levels.
- Patients underwent follow-up examinations 4-6 weeks post-reaction.
Main Results:
- 29 patients with suspected intraoperative reactions were analyzed; 1 patient had a confirmed PHR.
- The incidence of PHRs was 0.03% (1/2861).
- Anaphylaxis was confirmed in 1 patient, with 5 additional possible anaphylaxis cases.
Conclusions:
- Perioperative hypersensitivity reactions are potentially life-threatening and can recur.
- Collaboration among pediatric surgeons, anesthesiologists, and allergists is crucial for prevention.
- Prompt evaluation by an allergist is recommended for all suspected PHR cases.
Background:
There are few studies of perioperative hypersensitivity reactions in children. The diagnosis of perioperative hypersensitivity reactions may be under estimated because it is difficult to recognize the reactions. Anaphylaxis may go unnoticed because of patient unconsciousness. Urticaria may be missed due to sterile drapes. The aim of this study was to prospectively evaluate perioperative hypersensitivity reactions.
Methods:
In this prospective study, patients with suspected perioperative hypersensitivity reactions aged 0-18 years who underwent surgery at the Department of Pediatric Surgery, Cerrahpasa Faculty of Medicine, between 2019 and 2021 were investigated. Suspected reactions in the perioperative period were graded according to the Ring and Messmer scale. Patients with suspected reactions were examined 4-6 weeks after the reaction. If necessary, specific IgE and basophil activation tests were performed. Reactions of grades III-IV were considered anaphylaxis. If one test modality was strongly positive and there was a relevant time point or repeated allergic reactions, or at least two test modalities were positive, hypersensitivity was confirmed. In all patients, serum tryptase levels were analyzed at the time of the reaction, 2 h after the reaction, and 4-6 weeks after the reaction as part of the allergic evaluation.
Results:
A total of 29 patients (8 female, 21 male) suspected of having an intraoperative reaction during the study were included in the analysis. Perioperative hypersensitivity reactions were noted in 1 patient. The incidence of perioperative hypersensitivity reactions was reported to be 0.03% (n = 1/2861). While anaphylaxis was confirmed in 1 patient, 5 patients were considered possible anaphylaxis cases.
Conclusion:
Perioperative hypersensitivity reactions can be life-threatening and may recur with further administration. Collaboration between pediatric surgeons, anesthesiologists, and allergists can prevent further reactions. All suspected cases should be evaluated by an experienced allergist soon after the initial reaction.
