title: Anesthesia in the patient with multiple drug allergies: are all allergies the same?
abstract: OBJECTIVE
  During the preoperative evaluation, patients frequently indicate 'multiple drug allergies', most of which have not been validated. Potential allergic cross-reactivity between drugs and foods is frequently considered as a risk factor for perioperative hypersensitivity. The aim of this review is to facilitate the recognition of risk factors for perioperative anaphylaxis and help the management of patients with 'multiple drug allergies' during the perioperative period.
  
  
  RESULTS
  Neuromuscular blocking agents (NMBAs) and antibiotics are the most common drugs triggering perioperative anaphylaxis. Quaternary ammonium ions have been suggested to be the allergenic determinant of NMBAs. Even though the 'pholcodine hypothesis' has been suggested to explain the occurrence of NMBA-induced allergy, this concept remains unclear. Although many practitioners believe that certain food allergies present an issue with the use of propofol, there is no role to contraindicate propofol in egg-allergic, soy-allergic or peanut-allergic patients. IgE-mediated hypersensitivity has been reported with seafood and iodinated drugs, IgE-mediated hypersensitivity has been reported with seafood and iodinated drugs, but there is no cross-reactivity between them. The allergenic determinants have been characterized for fish, shellfish and povidone iodine and remain unknown for contrast agents.
  
  
  CONCLUSIONS
  There are many false assumptions regarding drug allergies. The main goal of this article is to review the potential cross-reactivity among specific families of drugs and foods in order to facilitate the anesthetic management of patients with 'multiple drug allergies'.
authors.affiliation: Pôle d'Anesthésie-Réanimation, Hôpital Gabriel Montpied, Clermont-Ferrand, France. pascale.dewachter@yahoo.fr
authors.forename: Pascale
authors.initials: P
authors.lastname: Dewachter
authors.forename: Claudie
authors.initials: C
authors.lastname: Mouton-Faivre
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Castells
authors.forename: David L
authors.initials: DL
authors.lastname: Hepner
mesh_terms: D000700:Analgesics / Q000009:adverse effects / Q000276:immunology; D000707:Anaphylaxis / Q000628:therapy; D000758:Anesthesia / Q000009:adverse effects*; D000777:Anesthetics / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000276:immunology; D003061:Codeine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000276:immunology; D003287:Contrast Media / Q000009:adverse effects; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000503:physiopathology*; D021181:Egg Hypersensitivity / Q000276:immunology; D005399:Fishes; D005512:Food Hypersensitivity / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000503:physiopathology; D017613:Iodine Compounds / Q000009:adverse effects; D008460:Meat / Q000009:adverse effects; D009025:Morpholines / Q000009:adverse effects / Q000276:immunology; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects; D021183:Peanut Hypersensitivity / Q000150:complications; D059035:Perioperative Period; D015742:Propofol / Q000009:adverse effects; D012307:Risk Factors; D017747:Seafood / Q000009:adverse effects; D013025:Glycine max / Q000009:adverse effects
chemical_list: D000700:Analgesics; D000777:Anesthetics; D018686:Anesthetics, Intravenous; D000900:Anti-Bacterial Agents; D003287:Contrast Media; D017613:Iodine Compounds; D009025:Morpholines; D009466:Neuromuscular Blocking Agents; C008872:pholcodine; D003061:Codeine; D015742:Propofol