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

Area of Science:

• Anesthesiology
• Allergy and Immunology
• Pharmacology

Background:

• Limited data exist on allergy evaluation after periprocedural hypersensitivity reactions.
• Skin testing for these reactions is not yet validated.
• Contemporary US patient data on periprocedural reactions and allergy testing are scarce.

Purpose of the Study:

• To describe the epidemiology of periprocedural hypersensitivity reactions.
• To assess the safety and effectiveness of allergy testing in a US patient cohort.
• To identify common culprits and influencing factors for positive allergy testing.

Main Methods:

• Retrospective cohort study of adult patients evaluated for presumed periprocedural hypersensitivity reactions (March 2013-June 2023).
• Analysis of patient demographics, index reactions, tryptase levels, skin testing results, and subsequent anesthesia tolerance.
• Evaluation of timing of testing relative to the index reaction.

Main Results:

• 74 patients underwent allergy evaluation; 30% tested positive.
• Common culprits included antibiotics (45%), local anesthetics (14%), and neuromuscular blocking agents (14%).
• Testing within 6 months of the reaction (51% positive) and high-grade index reactions (63% positive) were associated with higher positive test rates.

Conclusions:

• Periprocedural allergy testing is safe and effective in preventing recurrent reactions.
• Testing is more likely to be positive within 6 months of the reaction and in patients with severe reactions.
• Formal US guidelines are needed to standardize the evaluation of periprocedural hypersensitivity reactions.