The epidemiology of anaesthetic anaphylactoid reactions in Australasia

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165 patients with a history of a lifethreatening reaction to anaesthetic drugs have been studied prospectively in Australasia. The increase in the incidence of such reactions seen in other countries also occurred in this geographic area. Investigations have consisted of the taking of a detailed history, review of previous and subsequent anaesthetics, and intradermal testing, sequential complement measurements, and passive transfer testing. 116 patients had lifethreatening reactions to drugs in the perioperative period with four deaths. In 101 patients the agent responsible was determined. The majority of patients who reacted to induction agents had received the drug before, and the majority of patients who reacted to muscle relaxant drugs had not. The incidence of allergy, atopy, eczema and previous reactions was greater than in patients having uneventful anaesthesia. The increased incidence was not sufficiently great to make pretreatment of an at risk group a valid manouever. Premedication with steroids and antihistamines alone did not prevent reactions. Reactions occurred in spite of test doses. The majority of reactions occurred during induction and the most lifethreatening feature was cardiovascular collapse. Cross sensitivity occurred between d-tubocurarine and alcuronium, gallamine and suxamethonium, alfathesin and propanidid, and local anaesthetics. 13 patients had had second lifethreatening reactions prior to referral. The most valuable method of making a diagnosis was intradermal testing and the addition of sequential complement measurements in the 24 h post reaction increased reliability of diagnosis. With adequate investigation, explanation, and communication, subsequent anaesthesia is safe in this group. 106 of the 165 patients referred have had subsequent uneventful anaesthesia.