Intraoperative anaphylaxis: verba volant, scripta manent!
We describe a case of intraoperative gelatine-induced anaphylaxis whose diagnosis was delayed as the use of gelatine during surgical procedures was omitted for two times in patient's medical records. The subject is a 66-year old woman, with a negative medical history of atopy, food and drug allergy, with arterial hypertension on a course of beta-blockers and with bladder carcinoma requiring surgery. The patient had tolerated both general and local anaesthesia on several previous occasions. On the first occasion she experienced arterial fibrillation secondary to a severe episode of hypotension following local anaesthesia, while on a course of beta-blockers. On the second occasion she developed a very severe episode of hypotension followed by the outbreak of a generalised rash during general anaesthesia. The tryptase sera level was 109 mg/L one hour after the reaction had subsided, while the basal values were normal. On the third occasion the patient redeveloped severe hypotension and a generalised rash during general anaesthesia. The allergological work-up was negative, except for intradermal test with gelatine. A study of the intra-cellular cytokines in blood lymphocytes showed a production of IL4 from CD4+ lymphocytes after stimulation by gelatine. The patient underwent a successive surgical procedure without any adverse event.
Bilò
M B
MB
Department of Allergic and Respiratory Diseases, Ancona, Italy. b.bilo@ao-umbertoprimoi.marche.it
Cinti
B
B
Chiarello
M
M
Bonifazi
F
F
Moneret-Vautrin
D A
DA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000707:Anaphylaxis / Q000209:etiology*; D000768:Anesthesia, General / Q000009:adverse effects; D000777:Anesthetics / Q000009:adverse effects / Q000276:immunology; D004342:Drug Hypersensitivity; D005260:Female; D005780:Gelatin / Q000009:adverse effects* / Q000276:immunology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007022:Hypotension / Q000209:etiology; D007431:Intraoperative Complications / Q000209:etiology*; D011108:Polymers / Q000009:adverse effects*; D012697:Serine Endopeptidases / Q000097:blood; D053802:Tryptases; D001749:Urinary Bladder Neoplasms / Q000601:surgery
D000319:Adrenergic beta-Antagonists; D000777:Anesthetics; C115675:Hemaccel; D011108:Polymers; D005780:Gelatin; D012697:Serine Endopeptidases; D053802:Tryptases