Paediatric perioperative hypersensitivity reactions: Analysis of the French GERAP network database

Perioperative hypersensitivity (POH) reactions are rare but potentially life-threatening and remain poorly characterised in children. We analysed the largest available French paediatric cohort to describe the epidemiology, causal agents, temporal trends and phenotypes.

We pooled data from paediatric patients (<18 years) included in six previously published GERAP surveys (1997-2012) and the GERAP computerised database (2017-2024), all evaluated in centres of the GERAP network according to current guidelines. The primary objective was to compare POH phenotypes with and without causal agent identification.

Of 4605 POH reactions recorded, 461 (10%) occurred in children (median age 14 [10-16] years; 47% female). Reactions were grade 1 in 50%, grade 2 in 23%, grade 3 in 26% and grade 4 in 1%. The causal agent was identified in 199 (43%) cases, mainly neuromuscular blocking agents (NMBAs) (31%), latex (30%) and antibiotics (16%). Identification was more frequent in anaphylaxis than in isolated cutaneous reactions (61% vs. 25%, p < .001). Latex-related reactions disappeared after 2017. Patients in whom a causal agent was identified had more severe reactions (grade 3-4: 46% vs. 13%; p < .001), more cardiovascular and respiratory involvement, and higher acute serum tryptase (median 16.0 vs. 4.0 μg/L; p < .001) than those without identification.

Paediatric POH are not uncommon and may be life-threatening. All suspected reactions, including isolated cutaneous signs, warrant referral to specialised allergy centres given the still low identification rate and the continuing burden of NMBA- and antibiotic-related reactions.