title: Is a positive history of non-anaesthetic drug allergy a predictive factor for positive allergy tests to anaesthetics?
abstract: OBJECTIVE
  International recommendations stipulate not performing screening skin tests to a drug in the absence of a clinical history consistent with that specific drug allergy. Nevertheless, two publications showed that a positive history of non-anaesthetic drug allergy was the only predictive factor for a positive skin test when screening for allergy to anaesthetic drugs was done. We selected from a surgical population 40 volunteers with a prior history of allergy to non-anaesthetic drugs in order to analyse the prevalence of positive allergy tests to anaesthetics.
  
  
  METHODS
  The selected adult patients were tested for 11 anaesthetic drugs using in vivo tests: skin prick (SPT) and intradermal (IDT) tests and in vitro tests: the basophil activation test (BAT) and detection of drug-specific immunoglobulin E (IgE).
  
  
  RESULTS
  The prevalence for the positive SPT and IDT was 1.6% and 5.8% respectively. The result of flow cytometry agreed with the SPT in five out of seven positive SPT (71%). IgEs confirmed two positive SPT with corresponding positive BAT. Ten per cent of the patients had a positive prick test to neuromuscular blocking agents (NMBA). For midazolam none of the SPT was positive, but 11 patients had positive IDT nonconfirmed by BAT.
  
  
  CONCLUSIONS
  The prevalence of positive in vivo and in vitro allergy tests to NMBAs is higher in our study population. This could be an argument for pre-operative SPT to NMBAs for the surgical population with reported non-anaesthetic drug allergies. A larger prospective study is needed to validate changes in clinical practice.
authors: Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy 'Iuliu Hatieganu' Cluj-Napoca, Romania. hagaunatalia@gmail.com
authors: Natalia
authors: N
authors: Hagau
authors: Nadia
authors: N
authors: Gherman-Ionica
authors: Denisa
authors: D
authors: Hagau
authors: Sebastian
authors: S
authors: Tranca
authors: Manuela
authors: M
authors: Sfichi
authors: Dan
authors: D
authors: Longrois
mesh_terms: D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D000777:Anesthetics / Q000276:immunology*; D015549:Basophil Degranulation Test / Q000379:methods / Q000592:standards; D004342:Drug Hypersensitivity / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects / Q000276:immunology*; D011237:Predictive Value of Tests; D012882:Skin Tests / Q000379:methods; D055815:Young Adult
chemical_list: D000485:Allergens; D000777:Anesthetics; D009466:Neuromuscular Blocking Agents; D007073:Immunoglobulin E