Perioperative anaphylactic reactions: Review and procedure protocol in paediatrics.
Perioperative anaphylactic reactions are immediate, hypersensitive reactions that are potentially life-threatening resulting from a sudden release of mediators from mast cells and basophiles, due to either immune (IgE or non-IgE mediated) or non-immune mechanisms. The most frequent causing agents are neuromuscular blocking agents (NMBAs), latex and antibiotics, with latex being the first cause in paediatrics. With regard to perioperative anaphylactic reactions, the usual early signs and symptoms of an anaphylactic reaction could be overlooked or erroneously interpreted and non-severe anaphylaxis could go undetected, with a risk of more severe reactions in the future. Using the data registered on the anaesthesia sheet, it is essential to establish a chronological relationship between drugs and/or substances administered and the reaction observed. An elevated level of tryptase confirms an anaphylactic reaction, but this does not usually increase in the absence of compromised circulation. An allergy study should be carried out preferably between 4 and 6 weeks after the reaction, using a combination of specific IgE, skin and controlled exposure tests (if indicated). Test sensitivity is good for NMBAs, latex, antibiotics, chlorhexidine, gelatine and povidone, and poor for barbiturates, opiates (these can give false positives since they are histamine releasers) and benzodiazepines. Special preventive measures should be taken, especially in the case of latex. We present the maximum concentrations recommended for skin tests, the recommended dosage to treat anaphylactic reactions in paediatrics and a procedure algorithm for the allergological study of these reactions.
Paediatric Allergy Unit, Hospital General de Castellón, Castellon, Spain. Electronic address: amichavila@gmail.com.
A V
AV
Michavila Gomez
Allergy Service, Hospital Infantil La Paz, Madrid, Spain.
M T
MT
Belver Gonzalez
Paediatric Allergy Unit, Hospital Mutua de Tarrasa, Barcelona, Spain.
N Cortés
NC
Alvarez
Paediatric Allergy Section, Hospital Sant Joan de Déu, Barcelona, Spain.
M T
MT
Giner Muñoz
Paediatric Allergy Unit, Virgen de la Arrixaca, Murcia, Spain.
V
V
Hernando Sastre
Paediatric Allergy Unit, Clínico Universitario, Santiago de Compostela, Spain.
J A
JA
Porto Arceo
Paediatric Allergy Unit, Hospital Vall d'Hebrón, Barcelona, Spain.
B Vila
BV
Induráin
D000465:Algorithms; D000707:Anaphylaxis / Q000209:etiology / Q000517:prevention & control*; D000818:Animals; D002648:Child; D004342:Drug Hypersensitivity / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D020315:Latex Hypersensitivity / Q000150:complications / Q000175:diagnosis*; D019990:Perioperative Care; D012882:Skin Tests; D013514:Surgical Procedures, Operative
Anaphylaxis; Childhood; Infancy; Latex; Neuromuscular Blockers; Perioperative; Prevention; Tryptase