title: Perioperative anaphylaxis.
abstract: Perioperative anaphylaxis is a life-threatening condition with an estimated prevalence of 1:3,500 to 1:20,000 procedures and a mortality rate of up to 9 %. Clinical presentation involves signs such as skin rash, urticaria, angioedema, bronchospasm, tachycardia, bradycardia, and hypotension. Prompt recognition and treatment is of utmost importance to the patient's prognosis, since clinical deterioration can develop rapidly. Epinephrine is the main treatment drug, and its use should not be postponed, since delayed administration is associated with increased mortality. Elevated levels of serum tryptase help to confirm the diagnosis. The main agents involved in IgE-mediated perioperative anaphylaxis are neuromuscular blocking agents, latex, antibiotics, hypnotics, opioids, and colloids. Specific investigation should be conducted 4 to 6 weeks after the reaction and relies on skin tests, serum-specific IgE, and challenge procedures. This review aims to discuss the main aspects of perioperative anaphylaxis: risk factors, diagnosis, treatment, culprit agents, specific investigation, and preventive measures.
authors.affiliation: Division of Clinical Immunology and Allergy, University of São Paulo Medical School, Rua Doutor Bacelar, 747 ap 81, Vila Clementino, 04026-001, São Paulo, SP, Brazil, vgalvao@usp.br.
authors.forename: Violeta Régnier
authors.initials: VR
authors.lastname: Galvão
authors.forename: Pedro
authors.initials: P
authors.lastname: Giavina-Bianchi
authors.forename: Mariana
authors.initials: M
authors.lastname: Castells
mesh_terms: D000707:Anaphylaxis / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D019990:Perioperative Care; D012307:Risk Factors; D012882:Skin Tests / Q000009:adverse effects; D053802:Tryptases / Q000097:blood
chemical_list: D007073:Immunoglobulin E; D053802:Tryptases