title: Anaphylaxis during anesthesia in France: an 8-year national survey.
abstract: BACKGROUND
  More attention should be paid to rare serious adverse events such as anaphylaxis to increase the safety of anesthesia.
  
  
  OBJECTIVE
  To report the results of an 8-year survey of anaphylaxis during anesthesia in France.
  
  
  METHODS
  Data from patients who experienced anaphylaxis between January 1, 1997, and December 31, 2004, were analyzed. Estimated incidences were obtained by combining this database with data from the French pharmacovigilance system by using a capture-recapture method. The number of patients exposed to the offending agents was obtained from data collected during the national survey of anesthesia practice.
  
  
  RESULTS
  A total of 2516 patients was included. A diagnosis of IgE-mediated reaction was established in 1816 cases (72.18%). The most common causes were neuromuscular blocking agents ([NMBAs]; n = 1067; 58.08%), latex (n = 361; 19.65%), and antibiotics (n = 236; 12.85%). The median annual incidence per million procedures was higher for females 154.9 (5th-95th percentile, 117.2-193.1) than for males 55.4 (5th-95th percentile, 42.0-68.0). It reached 250.9 (5th-95th percentile, 189.8-312.9) for women in cases of allergic reactions to NMBAs. In children, a diagnosis of IgE-mediated reactions was obtained in 122 cases (45.9%). The most common causes were latex (n = 51; 41.8%), NMBAs (n = 39; 31.97%), and antibiotics (n = 11; 9.02%). In contrast with adults, no female predominance was observed.
  
  
  CONCLUSIONS
  The incidence of allergic reactions during anesthesia, estimated on a national basis, is higher than previously estimated. These results should be taken into account in the evaluation of the benefit-to-risk ratio of the various anesthetic techniques in individuals. The similar incidence of reactions according to sex before adolescence suggests a role for sex hormones in the increase of anaphylaxis observed in women.
authors.affiliation: Service d'Anesthésie Réanimation Chirurgicale, Hôpital Central, CHU de Nancy, INSERM U911-Groupe Choc, Nancy, France. pm.mertes@chu-nancy.fr
authors.forename: Paul Michel
authors.initials: PM
authors.lastname: Mertes
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.forename: Philippe
authors.initials: P
authors.lastname: Tréchot
authors.forename: Yves
authors.initials: Y
authors.lastname: Auroy
authors.forename: Eric
authors.initials: E
authors.lastname: Jougla
mesh_terms: D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D000758:Anesthesia / Q000009:adverse effects*; D000777:Anesthetics; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D015994:Incidence; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects*; D017678:Sex Distribution; D012737:Sex Factors
chemical_list: D000777:Anesthetics; D000900:Anti-Bacterial Agents; D009466:Neuromuscular Blocking Agents; D007073:Immunoglobulin E