title: Allergic reactions during anesthesia at a large United States referral center.
abstract: BACKGROUND
  The types of agents implicated to trigger intraoperative anaphylactic reactions vary among reports, and there are no recent series from the United States. In this retrospective study, we examined perioperative anaphylactic reactions that occurred at a major tertiary referral academic center.
  
  
  METHODS
  To characterize perioperative allergens associated with anaphylactic reactions, we reviewed the Mayo Clinic Division of Allergic Diseases skin test database between 1992 to 2010. The records of all patients who were tested for perioperative and anesthetic medications were reviewed. Charts that included a detailed history obtained by an allergist, skin test results, and tryptase measurements when available were reviewed and categorized.
  
  
  RESULTS
  Thirty-eight patients were found to have an anaphylactic reaction during anesthesia, of which 18 were immunoglobulin (Ig)E-mediated anaphylactic reactions (likely causative agent identified by skin test), 6 were non-IgE-mediated anaphylactic reactions (elevated tryptase levels and negative skin test), and 14 were probable non-IgE-mediated anaphylactic reactions (tryptase levels normal or not obtained and negative skin test). Of the IgE-mediated anaphylactic reactions, antibiotics were the most prevalent likely causative agent (50%) whereas neuromuscular blocking drugs were implicated as a likely causative agent in 11% of reactions.
  
  
  CONCLUSIONS
  Antibiotics were the most common likely causative agent associated with IgE-mediated anaphylactic reactions; however, for 52.6% of reactions, a causative agent could not be determined, suggesting a non-IgE-mediated anaphylactic reaction. The undiagnosed allergic reactions place patients at risk of a subsequent reexposure to the same allergen, or lead to unnecessary avoidance of needed medications.
authors.affiliation: Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
authors.forename: Carmelina
authors.initials: C
authors.lastname: Gurrieri
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.forename: David P
authors.initials: DP
authors.lastname: Martin
authors.forename: Nikola
authors.initials: N
authors.lastname: Babovic
authors.forename: Bradly J
authors.initials: BJ
authors.lastname: Narr
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Volcheck
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D000758:Anesthesia / Q000009:adverse effects*; D000777:Anesthetics / Q000009:adverse effects*; D002648:Child; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000209:etiology; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012189:Retrospective Studies; D012882:Skin Tests; D016896:Treatment Outcome; D053802:Tryptases / Q000097:blood; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000777:Anesthetics; D007073:Immunoglobulin E; D053802:Tryptases