Repeated perioperative hypersensitivity reactions and positive challenge testing strongly suggest sevoflurane...

A 75-year-old man repeatedly developed immediate hypersensitivity reactions during general anesthesia. Because sevoflurane was suspected as the causative agent based on reproducible reactions during multiple anesthetic procedures, further diagnostic evaluation was performed. Skin testing for other perioperative agents was negative. A sevoflurane challenge test reproduced similar clinical symptoms. Basophil activation testing (BAT) showed basophil activation following sevoflurane exposure. Although methodological limitations were present, the combined clinical reproducibility, positive challenge testing, and supportive BAT findings strongly suggested sevoflurane hypersensitivity. This case suggests that BAT may provide supportive additional information when evaluating suspected hypersensitivity reactions to volatile anesthetics.