Pediatric perioperative hypersensitivity in Denmark: A 20 year retrospective analysis

Perioperative hypersensitivity (POH) is rare but potentially life-threatening, and data on POH in children are sparse. This single-center study aimed to describe clinical presentations and allergy investigations in children with suspected POH in Denmark, and to evaluate a risk stratification algorithm used for suspected POH (elevated tryptase, 2 or more organ systems involved and urticaria/angioedema).

Retrospective data from 70 children who had undergone allergy investigations at the specialized Danish Anaesthesia Allergy Centre were included. Children were divided into a test positive and test negative group based on results from allergy investigations, and the groups were compared. Sensitivities, specificities, positive and negative predictive values were calculated for the risk stratification algorithm for suspected POH and for different combinations of symptoms.

24% of the children tested positive. The most confirmed allergen was chlorhexidine (n = 3), followed by NMBAs (n = 2) and antibiotics (n = 2). Skin symptoms were most common (94%), and cardiovascular symptoms (CVS) appeared as the first symptom in 50% of the test positive children. CVS were more common in the test positive group. The risk stratification algorithm had a high sensitivity (88%) but a higher sensitivity (94%) was seen in the combination "elevated tryptase or CVS or urticaria/angioedema".

Several different allergens were confirmed in this study, including hidden allergens like chlorhexidine. This emphasizes the need to identify all potential allergens and the need for investigation at a specialized allergy center. More data are needed to make recommendations on the optimal risk stratification algorithm in children with suspected POH.