Sex-based differences in perioperative hypersensitivity: A systematic review and meta-analysis

Area of Science:

• Immunology
• Anesthesiology
• Pharmacology

Background:

• Perioperative hypersensitivity (POH) is a rare but severe immediate hypersensitivity reaction.
• Perioperative anaphylaxis, a severe form of POH, carries a significant mortality rate of 2%.
• The influence of sex on immune responses suggests potential sex-based disparities in POH, which remain under-explored.

Purpose of the Study:

• To systematically evaluate sex-based differences in the incidence of perioperative hypersensitivity.
• To investigate how age, specific drugs, and reaction severity correlate with sex-based POH proportions.

Main Methods:

• A comprehensive systematic literature search was performed across major databases (MEDLINE, EMBASE, Scopus, Web of Science).
• Included studies reported the female-to-male ratio in perioperative hypersensitivity patients.
• Proportional meta-analysis with subgroup analyses by age, drug, and severity was employed to determine pooled sex proportions.

Main Results:

• The meta-analysis included 62 studies with 19,944 patients, revealing a 63% female predominance in POH.
• The overall pooled female-to-male ratio for POH was 0.60, indicating a higher proportion of females.
• While adults showed a female predominance (0.59), males were more represented in pediatric studies (0.41).

Conclusions:

• Perioperative hypersensitivity exhibits an overall female predominance, with notable exceptions in pediatric populations.
• Chromosomal factors may explain the higher male proportion in children, while hormonal influences could contribute to female predominance in adults.
• Further research is warranted to elucidate the underlying biological mechanisms driving these observed sex-based differences in POH.