The investigation of bronchospasm during induction of anaesthesia.
BACKGROUND
The aim of this study was to ascertain whether anaesthetic induction-related anaphylactic bronchospasm could be distinguished from other types of bronchospasm by clinical features and response to treatment. Such features could then be used to identify a group of patients in whom skin testing is indicated.


METHODS
We retrospectively studied data from 183 patients referred to an anaesthetic allergy clinic because of bronchospasm during induction. For the analysis, the patients were divided into two groups depending on whether there was evidence suggesting immunological anaphylaxis.


RESULTS
When the patients in whom intradermal tests were positive were compared with those in whom intradermal tests were negative, the skin test-positive patients had significantly more severe reactions, and they were more commonly associated with other clinical signs. Mast cell tryptase (MCT) was an excellent discriminator between reactions likely to be allergic and those unlikely to be allergic.


CONCLUSIONS
Anaphylactic bronchospasm related to induction of anaesthesia is more likely to be severe than bronchospasm due to non-immune causes. An allergic cause is more likely if there are associated features of anaphylaxis (skin changes, hypotension, angioedema) or elevated MCT. Patients with any of these features should undergo immuno-allergolical investigation.
Fisher
M M
MM
Intensive Care Unit, Royal North Shore Hospital of Sydney, University of Sydney, Sydney, NSW, Australia. mfisher@med.usyd.edu.au
Ramakrishnan
N
N
Doig
G
G
Rose
M
M
Baldo
B
B
D000328:Adult; D000704:Analysis of Variance; D000707:Anaphylaxis / Q000175:diagnosis / Q000503:physiopathology*; D000758:Anesthesia / Q000009:adverse effects*; D001986:Bronchial Spasm / Q000139:chemically induced* / Q000145:classification; D015331:Cohort Studies; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006636:Histamine Release / Q000187:drug effects; D006801:Humans; D008297:Male; D008407:Mast Cells / Q000201:enzymology; D008875:Middle Aged; D012882:Skin Tests; D016896:Treatment Outcome; D053802:Tryptases / Q000378:metabolism
D053802:Tryptases