[Allergic risk during paediatric anaesthesia].
OBJECTIVE
To propose the different modalities of management of the allergic risk occurring during paediatric anaesthesia.


METHODS
Literature analysis.


METHODS
Literature research using the Medline((R)) database and MeSH format according to keywords, including publications in French and English since 1982.


RESULTS
The overall incidence for anaphylactic reactions was estimated at one in 7741 anaesthetic procedures during paediatric anaesthesia. Latex anaphylaxis was mostly involved with an incidence at one in 10,159 anesthetic procedures. The risk factors of latex sensitization are known. Primary latex prophylaxis is efficient in patients at risk of latex sensitization. In contrast to adults, neuromuscular blocking agents (NMBAs) are rarely involved in children, with an incidence at 1 in 81,275 anaesthetic procedures. The Ring and Messmer clinical scale allows quantifying the severity and helps managing the care of immediate hypersensitivity reactions. Clinical symptoms associate cardiovascular, respiratory and cutaneous-mucous signs according to different severity grades. Epinephrine associated to fluid loading, remains the first-line agent in case of severe reactions. The allergological assessment is key to the management of these reactions and is required in order to identify the mechanism of the reaction and the culprit drug or substance involved.


CONCLUSIONS
Allergic reactions to NMBAs occurring during paediatric anaesthesia are rare whereas those with latex are more frequent. Therefore, the reduction of the allergic risk during paediatric anaesthesia essentially requires a latex-free environment.
Inserm U970, service d'anesthésie-réanimation chirurgicale, Samu de Paris, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75743 Paris cedex 15, France. pascale.dewachter@yahoo.fr
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Mouton-Faivre
D000293:Adolescent; D000367:Age Factors; D000485:Allergens / Q000737:chemistry / Q000276:immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D000758:Anesthesia / Q000009:adverse effects*; D001986:Bronchial Spasm / Q000188:drug therapy / Q000209:etiology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006969:Hypersensitivity, Immediate / Q000453:epidemiology; D007223:Infant; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D020315:Latex Hypersensitivity / Q000453:epidemiology; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D012307:Risk Factors; D055815:Young Adult
D000485:Allergens; D001993:Bronchodilator Agents; D009466:Neuromuscular Blocking Agents; D004837:Epinephrine