Circulating microbiome analysis in patients with perioperative anaphylaxis

Area of Science:

• Immunology
• Microbiology
• Anesthesiology

Background:

• Perioperative anaphylaxis is a rare, acute reaction to anesthesia, often caused by neuromuscular blocking agents (NMBAs) and antibiotics.
• Mechanisms of drug sensitization and risk factors for anaphylaxis remain unclear.
• Emerging evidence links allergies to microbiota composition, but its role in perioperative anaphylaxis is unexplored.

Purpose of the Study:

• To investigate the association between circulating microbiota and perioperative anaphylaxis.
• To compare microbiota richness and composition in patients experiencing anaphylaxis versus matched controls.

Main Methods:

• Serum samples from 20 patients with IgE-mediated NMBA-related anaphylaxis and 20 matched controls were analyzed.
• Circulating 16S rDNA was sequenced to assess microbiota composition.
• Bioinformatic analysis identified microbial taxa and correlated them with clinical and biological data.

Main Results:

• Anaphylaxis patients exhibited a trend towards richer circulating microbiota compared to controls.
• No significant global differences in microbiota composition were detected using standard diversity indexes.
• Specific taxa, including Saprospiraceae, Enterobacteriaceae, and Escherichia-Shigella, showed altered relative abundance in patients. Some taxa correlated with mast cell tryptase and specific IgE levels.

Conclusions:

• While global microbiota composition did not differ significantly, specific bacterial taxa were associated with perioperative anaphylaxis.
• These findings suggest a potential role for certain microbial communities in anaphylaxis.
• Further validation in diverse settings is crucial to understand anaphylaxis pathophysiology and identify potential biomarkers.