[Impact of the development of anesthesia protocols on the incidence of peri-anesthetic anaphylactoid reactions].
BACKGROUND
What impact does the use of new drugs and latex gloves it have on the frequency and the severity of peri-anaesthetic anaphylactoid reactions? Does the evolution of in vitro techniques does represent a progress in the imputability of the substances at the origin of the shock?
They include the letter from the anaesthetic doctor, the questioning by the allergologist, skin tests (Pricks, IDR) with the anaesthetic substances and the latex according to the GERAP protocol and the biologic tests (Human Basophilic Degranulation test (TDBH), Radio ImmunoAssay (RIA), leukotrienes E4 assay (LTC4), Flow Cytometry (CMF)).


RESULTS
386 patients were explored (289 women and 88 men, mean age 41.5 years). The muscle relaxants are the first cause of anaphylaxis 77%. Muscle relaxants cross allergy is found in 55.1%. The Latex, tested since 1989 with Allerbio and Stallergenes extracts, is responsible for 25 shocks with one death and 15 with grade III or IV. Preventive antibiotherapy, since consensus meeting of 1992, seems responsible of 17 accidents. 116 TDBH, 216 RIA, 17LTC4 and 47CMF. TDBH are made concordant with skin tests in 48.2% against, 71.2% for the RIA.


CONCLUSIONS
The experience of 17 years of allergo-anaesthetic consultation confirms the first row for the muscles relaxants for the target of anaphylactic shock, but the imputability of Vecuronium and Rocuronium increases to the detriment of the Suxamethonium. The Latex is in the second row, but the target questioning, the systematic use of Prick tests and "latex free" surgery room limit its increase which should change down. The antibiotherapy occupies the third row and might increase. 54 accidents have remained unexplained.
Amedeo
J
J
Service du Pr J.-P. Cassuto-Hôpital de l'Archet 1, 151, route St Antoine de Ginestière, BP 3079, 06202 Nice.
Occelli
G
G
Pradier
C
C
Grimaud
D
D
D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced*; D000776:Anesthesiology / Q000639:trends*; D000777:Anesthetics / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D006636:Histamine Release; D006801:Humans; D020315:Latex Hypersensitivity / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011229:Preanesthetic Medication; D012882:Skin Tests; D013523:Surgical Equipment / Q000009:adverse effects*
D000777:Anesthetics; D000900:Anti-Bacterial Agents