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

Area of Science:

• Anesthesiology
• Allergy and Immunology

Background:

• Limited data exist on allergy evaluation after periprocedural hypersensitivity reactions.
• Skin testing for these reactions lacks validation.

Purpose of the Study:

• To describe the epidemiology of periprocedural reactions.
• To assess the safety and effectiveness of allergy testing in a US patient cohort.

Main Methods:

• Retrospective cohort study of adult patients (March 2013-June 2023).
• Evaluation of demographics, index reactions, tryptase levels, skin testing, and subsequent anesthesia tolerance.
• Comprehensive allergy evaluation for presumed periprocedural hypersensitivity reactions.

Main Results:

• 74 patients underwent allergy evaluation; 30% tested positive.
• Common culprits: antibiotics (45%), local anesthetics (14%), neuromuscular blocking agents (14%).
• 97% of patients tolerated subsequent anesthesia; testing was more likely positive within 6 months (51%) and in high-grade reactions (63%).

Conclusions:

• Periprocedural allergy testing is safe and effective in preventing future reactions.
• Testing is more sensitive within 6 months of the reaction and for severe reactions.
• Formal US guidelines are needed for periprocedural allergy evaluation.