Guidelines: Diagnosis and management of perioperative immediate hypersensitivity reactions 2025

The French Society of Anaesthesia and Intensive Care (SFAR) and the French Society of Allergology (SFA) have collaborated to propose guidelines for the diagnosis and management of perioperative immediate hypersensitivity reactions (IHR).

A group of 23 French experts from the SFAR and the SFA was assembled. Any potential conflicts of interest were officially declared at the outset of the recommendations development process, which was conducted independently of any industry funding. The authors used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to assess the level of evidence in the literature.

4 fields were defined: 1) Diagnostic assessment of perioperative IHR reactions; 2) Risk factors for perioperative IHR reactions; 3) Treatment in scheduled and emergency situations and; 4) Treatment of perioperative IHR reactions. For each field, the aim of the recommendations was to answer questions formulated by the experts according to the PICO model ("Population, Intervention, Comparison, Outcome"). Based on these questions, an extensive literature search covering the last 24 years was carried out using predefined keywords according to the PRISMA recommendations. The level of evidence was analysed using the GRADE method. The recommendations were formulated using the GRADE method, then voted on by all the experts using the GRADE grid method.

The experts' summary work and the application of the GRADE method resulted in 70 recommendations concerning 31 questions. After 3 rounds of voting and several amendments, strong agreement was reached on 70 recommendations. Of these recommendations, 6 have a high level of evidence (6 GRADE 1), 16 have a low level of evidence (16 GRADE 2) and 48 are expert opinions. Finally, for 1 question, no recommendation could be made.

There was strong agreement among the experts to formulate recommendations aimed at providing a benchmark for the diagnosis and management of perioperative IHR.