title: Anaphylaxis during general anaesthesia: one-year survey from a British allergy clinic.
abstract: BACKGROUND
  Anaphylaxis during general anaesthesia is a major concern. Early recognition and management of anaphylaxis, as well as its future prevention, remain a challenge for the anaesthetists, while for the allergists, the elucidation of the causal agents may be difficult. We aimed to describe our experience in our drug allergy clinic.
  
  
  METHODS
  We retrospectively reviewed 23 consecutive adult patients who presented with anaphylaxis during anaesthesia from March 1, 2005 to February 28, 2006.
  
  
  RESULTS
  Out of the 23 patients (12 females, 11 males) with mean age (+/- SD) of 53.1 +/- 15.8 years, 15 patients were found to have a positive skin test to at least one neuromuscular blocking agent (NMBA); all of them showed cross-sensitivity with one or more NMBA(s). Three patients had a positive skin test to opioids, two patients to gelofusine, two patients to penicillin, and one patient each to povidone-iodine and chlorhexidine. Two patients had negative test results to agents used during their anaesthesia. Four patients had double positive skin tests to different families of drugs/agents. 18 patients had severe reaction-grade 3, and 15 of them tested positive for NMBA(s). Serum tryptase levels were known in nine patients. We did not encounter any latex or hypnotics sensitisation.
  
  
  CONCLUSIONS
  NMBA was the commonest cause of anaphylaxis during general anaesthesia, occurring in 65% in our series.
authors.affiliation: Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Chong
authors.forename: M R
authors.initials: MR
authors.lastname: Caballero
authors.forename: J
authors.initials: J
authors.lastname: Lukawska
authors.forename: P
authors.initials: P
authors.lastname: Dugué
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D000707:Anaphylaxis / Q000209:etiology*; D000768:Anesthesia, General; D004342:Drug Hypersensitivity / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D009466:Neuromuscular Blocking Agents