Classification of perioperative histamine-related reactions.
OBJECTIVE
Histamine release may cause anaphylactoid reactions. However, during anaesthesia and surgery especially cardiovascular effects may not be regarded as histamine-related. Therefore, we adapted the classical concept of histamine release reactions to the perioperative situation and validated the new paradigm.


METHODS
Elevated plasma histamine (diagnostic gold standard) was correlated to potentially related intraoperative signs and symptoms. The validity, repeatability and sensitivity of the 'gold standard' was tested by ROC analysis in volunteers, who also received H1-/H2-histamine antagonists. Additionally, a dose-response relationship was determined in dogs using the histamine releaser compound 48/80.


RESULTS
The 'gold standard' had a sensitivity of 96% (90%-100%) and a specificity of 93% (85%-100%). The reproducibility was proven by repeated injections of histamine. Skin reactions, tachycardia and hypertension were identified as histamine-related diagnostic variables. A dose-response curve of plasma histamine release was created.


CONCLUSIONS
The defined 'gold standard' is valid for the diagnosis of histamine-related reactions during anaesthesia and surgery. It may help to identify patients, who could benefit from pre-anaesthetic antihistamine prophylaxis.
Sitter
H
H
Institute of Theoretical Surgery, Philipps-University of Marburg, Baldingerstrasse, 35033, Marburg, Germany. sitter@mailer.uni-marburg.de
Torossian
A
A
Duda
D
D
Sattler
J
J
D000818:Animals; D003657:Decision Making; D003955:Diagnostic Tests, Routine / Q000592:standards*; D004305:Dose-Response Relationship, Drug; D006632:Histamine / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D006634:Histamine H1 Antagonists / Q000494:pharmacology; D006635:Histamine H2 Antagonists / Q000494:pharmacology; D006801:Humans; D006967:Hypersensitivity / Q000145:classification / Q000175:diagnosis*; D007267:Injections; D007407:Interviews as Topic; D019990:Perioperative Care; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists; D006632:Histamine