Allergic reactions in anaesthesia: are suspected causes confirmed on subsequent testing?
BACKGROUND
The aim of this retrospective survey of possible allergic reactions during anaesthesia was to investigate whether the cause suspected by anaesthetists involved corresponded with the cause found on subsequent investigation in the Danish Anaesthesia Allergy Centre (DAAC).


METHODS
Case notes and anaesthetic charts from 111 reactions in 107 patients investigated in the DAAC were scrutinized for either suspicions of or warnings against specific substances stated to be the cause of the supposed allergic reaction.


RESULTS
In 67 cases, one or more substances were suspected. In 49 of these (73%) the suspected cause did not match the results of subsequent investigation, either a different substance being the cause or no cause being found. Only five cases (7%) showed a complete match between suspected cause and investigation result. In the remaining 13 cases (19%) there was a partial match, the right substance being suspected, but investigations showed an additional allergen or several substances, including the right substance being suspected.


CONCLUSIONS
An informed guess is not a reliable way of determining the cause of a supposed allergic reaction during anaesthesia and may put a significant number of patients at unnecessary risk. Some patients may be labelled with a wrong allergy, leading to unnecessary warnings against harmless substances, and some patients may be put at risk of subsequent re-exposure to the real allergen. Patients with suspected allergic reactions during anaesthesia should be referred for investigation in specialist centres whenever possible.
Krøigaard
M
M
Danish Anaesthesia Allergy Centre, Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Gentofte University Hospital, Copenhagen. daac@rh.dk
Garvey
L H
LH
Menné
T
T
Husum
B
B
D000485:Allergens / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects; D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis; D000758:Anesthesia / Q000009:adverse effects*; D000777:Anesthetics / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D003951:Diagnostic Errors; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012882:Skin Tests
D000485:Allergens; D000701:Analgesics, Opioid; D000777:Anesthetics; D000900:Anti-Bacterial Agents; D009466:Neuromuscular Blocking Agents