Clinical characteristics and allergen detection of perioperative anaphylaxis: a 12-year retrospective analysis from an anesthesia clinic in China

Xiaowen Liu,Jing Zhao,Xin Xin,Ruisong Gong

doi:10.1186/s13741-021-00234-z

Abstract

BackgroundAnaphylaxis during anesthesia is a rare but often a potentially life-threatening event for patients. Identifying culprit agents responsible for anaphylaxis is of great important for avoiding potential re-exposure to allergens, but it poses great challenge for anesthetists. This retrospective study aimed to analyze the culprits of patients with a history of perioperative anaphylaxis referred to an anesthesia allergy clinic in China, and to evaluate the role of allergy diagnostic tests in clinical practice.MethodsA total of 145 patients (102 female/43 male) who attended the Anesthesia Allergy Clinic for allergen detection between 1 January 2009 and 31 December 2020 were reviewed retrospectively. Clinical characteristics, results of allergy diagnostic tests including skin, and/or basophil activation tests, and the incidence of repeat anaphylaxis after use of recommended alternative anesthetics were obtained.ResultsOf these 145 patients, 109 patients (75.2%, 74 females/35 males) were determined to experience perioperative anaphylaxis. The most common presenting clinical feature was cardiovascular manifestations (n = 63, 57.8%). According to diagnostic work up, the most common causative agents for perioperative anaphylaxis were neuromuscular blocking agents (n = 35, 32.1%). After diagnostic work up, 52 patients underwent repeat anesthesia. None of these patients experienced recurrent anaphylaxis.ConclusionsThis study suggests that neuromuscular blocking agents are the main cause of perioperative anaphylaxis. For patients with perioperative anaphylaxis, allergy diagnostic tests are essential to identify causative agents, and to find suitable alternative drugs for the future planning of subsequent anesthetics.

Highlights

Anaphylaxis during anesthesia is a rare but often a potentially life-threatening event for patients
Available literature from European and Australian populations suggests that neuromuscular blocking agents (NMBAs) are the most common cause of Perioperative anaphylaxis (POA) (Mertes et al 2016)
Our aims were to describe the clinical characteristics of POA and results of diagnostic tests, and to review the incidence of repeat anaphylaxis for patients referred to our clinic after suspected POA and recommended alternative drugs

Summary

Introduction

Anaphylaxis during anesthesia is a rare but often a potentially life-threatening event for patients. Identifying culprit agents responsible for anaphylaxis is of great important for avoiding potential reexposure to allergens, but it poses great challenge for anesthetists. This retrospective study aimed to analyze the culprits of patients with a history of perioperative anaphylaxis referred to an anesthesia allergy clinic in China, and to evaluate the role of allergy diagnostic tests in clinical practice. Identification of causative agents responsible for anaphylaxis is important to avoid potential re-exposure to allergens, but it poses a great challenge for anesthetists (Orihara et al 2020). The effectiveness of diagnostic tests in identifying alternative agents for repeat anesthesia need to be further proved

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