Pediatric perioperative hypersensitivity in Denmark: A 20 year retrospective analysis

Area of Science:

• Pediatric Anesthesiology
• Clinical Immunology
• Allergy Diagnostics

Background:

• Perioperative hypersensitivity (POH) is a rare but potentially life-threatening complication.
• Limited data exists on POH presentations and allergy investigations in pediatric populations.
• This study addresses the scarcity of information on POH in children in Denmark.

Purpose of the Study:

• To describe clinical presentations of suspected POH in children.
• To detail allergy investigation findings in pediatric POH cases.
• To evaluate a specific risk stratification algorithm for suspected POH in children.

Main Methods:

• Retrospective analysis of 70 children undergoing allergy investigations at a specialized Danish center.
• Comparison of children who tested positive versus negative for allergies.
• Calculation of diagnostic values (sensitivity, specificity, predictive values) for the risk stratification algorithm and symptom combinations.

Main Results:

• 24% of children tested positive for hypersensitivity.
• Chlorhexidine was the most frequent confirmed allergen, followed by neuromuscular blocking agents (NMBAs) and antibiotics.
• Skin symptoms were most common (94%); cardiovascular symptoms (CVS) were more frequent in the test-positive group and often the initial symptom (50%).
• The risk stratification algorithm showed high sensitivity (88%), but a combination of 'elevated tryptase or CVS or urticaria/angioedema' yielded higher sensitivity (94%).

Conclusions:

• Multiple allergens, including less obvious ones like chlorhexidine, were identified in pediatric POH.
• Highlights the importance of comprehensive allergen identification and specialized allergy center evaluations.
• Further research is needed to refine optimal risk stratification algorithms for pediatric POH.