Anaphylaxis during surgical and interventional procedures.
OBJECTIVE
To describe the current evidence-based knowledge of the causes, diagnostic evaluation, and treatment of patients with anaphylaxis associated with surgical and interventional procedures.


METHODS
Articles published between 1966 and 2003 were identified in MEDLINE using the keywords anaphylactoid, anaphylaxis, anesthetics, antibiotics, cephalosporins, contrast media, colloids, flow cytometry, hypersensitivity, latex, neuromuscular depolarizing agents, neuromuscular nondepolarizing agents, penicillins, radioallergosorbent test, skin test, and vancomycin. Additional studies were identified from article reference lists.


METHODS
Relevant, peer-reviewed original research articles and reviews.


RESULTS
Neuromuscular blocking agents, natural rubber latex, antibiotics, and induction agents are the most common causes of anaphylaxis during surgical and interventional procedures. Colloids, opioids, and radiocontrast media probably account for less than 10% of all reactions. Newer agents implicated in anaphylaxis include isosulphan blue and chlorhexidine. Skin tests are useful for evaluating allergic reactions to anesthetic agents and penicillins and for selecting alternative agents. Skin testing and specific IgE measurements for latex vary in allergen standardization and sensitivity and specificity, respectively. Flow cytometric allergen stimulation tests show promise in differentiating allergic from idiosyncratic ("pseudoallergic") reactions. Drug desensitization has been shown to be useful for penicillin anaphylaxis. Premedication with histamine receptor antagonists and corticosteroids helps prevent or attenuate radiocontrast media reactions.


CONCLUSIONS
Anaphylaxis during surgical and interventional procedures may be difficult to evaluate because of the rapid, successive use of multiple drugs or diagnostic agents. Careful analysis of anesthetic records and diagnostic tests for all the putative agents are necessary to ensure a complete evaluation.
Thong
Bernard Yu-Hor
BY
Department of Rheumatology, Allergy, and Immunology, Tan Tock Seng Hospital, Singapore. bernard_thong@ttsh.com.sg
Yeow-Chan
D000707:Anaphylaxis / Q000453:epidemiology* / Q000209:etiology*; D000777:Anesthetics / Q000009:adverse effects / Q000276:immunology; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000276:immunology; D019937:Diagnostic Techniques and Procedures / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000150:complications; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis*; D020315:Latex Hypersensitivity / Q000150:complications; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000276:immunology
D000777:Anesthetics; D000900:Anti-Bacterial Agents; D009465:Neuromuscular Agents