Perioperative hypersensitivity reactions: a retrospective study (2018-2023) in a Lebanese tertiary clinic

Perioperative hypersensitivity (POH) reactions are of significant concern for anesthesiologists and allergologists, often leading to surgery delays, extended hospital stays, and increased morbidity and mortality. The main objective of this study was to provide an overview of POH reactions in Lebanon and their evaluation.

A 5-year retrospective review was conducted at a tertiary allergy clinic in Lebanon, involving patients with a history of POH reactions or preoperative evaluations due to atopy or known drug, respiratory and/or food allergies. All patients underwent skin prick tests (SPTs) for several perioperative agents.

A total of 255 patients were included in this study. Among them, 124 patients (48.6%) were referred to the clinic with a history of POH reactions, mostly immediate, with symptoms ranging from mucocutaneous manifestations to cardiopulmonary arrest. SPTs were conducted for all 255 patients, focusing on opioids, neuromuscular blocking agents (NMBAs), hypnotics, local anesthetics, latex and patent blue. Of these, 97.3% (n = 248) demonstrated a positive reaction to at least one substance. The most frequent sensitizations were to morphine (59.7%, n = 148), rocuronium (54%, n = 134), and latex (48%, n = 119), while sensitizations to hypnotics (19%, n = 47) and local anesthetics (8.5%, n = 21) were less common. We assessed co-sensitization within the same drug class, identifying rocuronium and cisatracurium as the NMBAs with the highest co-sensitization, while morphine and pethidine showed the highest co-sensitization among opioids. Among the 124 patients with a history of POH reactions, SPTs results identified the causative agent, primarily morphine, fentanyl or rocuronium, in 38 patients.

This study provides valuable insights into the clinical characteristics of POH reactions in Lebanon and highlights the role of SPTs in identifying causative agents thus allowing to suggest alternative perioperative options.