Periprocedural allergy evaluation is safe and effective to guide subsequent anesthesia administration

There are limited data on allergy evaluation following suspected periprocedural hypersensitivity reactions, and skin testing for these reactions is not yet validated.

We sought to describe the epidemiology of periprocedural reactions and safety and effectiveness of allergy testing in a contemporary US patient cohort.

We performed a retrospective cohort study of adult patients evaluated at a tertiary-care academic center for presumed periprocedural hypersensitivity reaction from March 2013 to June 2023. We examined patient demographics, index reactions, tryptase levels, skin testing results, and tolerance of subsequent anesthesia.

Over 10 years, 74 patients underwent comprehensive allergy evaluation. Testing was positive in 30% (22/74). The most common culprits included antibiotics (10, 45%), local anesthetics (3, 14%), and neuromuscular blocking agents (3, 14%). Of 29 patients who received subsequent anesthesia, 28 (97%) didn't have reactions. Patients with perioperative anaphylaxis were more likely to have positive testing compared to patients with low-grade reactions (63% vs 9%, P < .001). Fifty-one percent (19/37) of patients tested within ≤6 months of index reaction had positive testing, versus 11% (4/38) tested at >6 months (P < .001).

Periprocedural allergy testing was safe and effective in preventing future reactions. Testing was more likely to be positive if performed within 6 months of hypersensitivity reaction and in patients with high-grade index reactions. Antibiotics were the most common culprits; emerging agents like chlorhexidine and sugammadex were also identified. The landscape of POA is evolving, and formal US guidelines are needed to guide clinicians in evaluation.