title: Failure to investigate anaesthetic anaphylaxis resulting in a preventable second anaphylactic reaction.
abstract: We present a case of anaphylaxis to suxamethonium and/or vecuronium in a patient who had previously suffered an anaphylactic reaction, presumably to rocuronium. The patient had not been referred for formal allergy testing after the first anaphylactic reaction. Subsequent formal allergy testing revealed sensitivities to suxamethonium, rocuronium and vecuronium. Her next anaesthetic, using cisatracurium, was uneventful. It is recommended that all patients with suspected perioperative anaphylaxis are referred for testing. This is the responsibility of the anaesthetist. Particular caution should be used with suspected neuromuscular blocking drug allergy as cross-reactivity is common and not predictable by drug structure.
authors.affiliation: Department of Anaesthesia, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: A F
authors.initials: AF
authors.lastname: Pedersen
authors.forename: S
authors.initials: S
authors.lastname: Green
authors.forename: M A
authors.initials: MA
authors.lastname: Rose
mesh_terms: D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced* / Q000276:immunology / Q000517:prevention & control; D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D001279:Atracurium / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D003429:Cross Reactions; D005260:Female; D006801:Humans; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D000077123:Rocuronium; D012882:Skin Tests; D013390:Succinylcholine / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology
chemical_list: D000732:Androstanols; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D014673:Vecuronium Bromide; D013390:Succinylcholine; C101584:cisatracurium; D000077123:Rocuronium