title: Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom: aetiology and diagnostic performance of acute serum tryptase.
abstract: This is the first multi-centre retrospective survey from the United Kingdom to evaluate the aetiology and diagnostic performance of tryptase in anaphylaxis during general anaesthesia (GA). Data were collected retrospectively (2005-12) from 161 patients [mean ± standard deviation (s.d.), 50 ± 15 years] referred to four regional UK centres. Receiver operating characteristic curves (ROC) were constructed to assess the utility of tryptase measurements in the diagnosis of immunoglobulin (Ig)E-mediated anaphylaxis and the performance of percentage change from baseline [percentage change (PC)] and absolute tryptase (AT) quantitation. An IgE-mediated cause was identified in 103 patients (64%); neuromuscular blocking agents (NMBA) constituted the leading cause (38%) followed by antibiotics (8%), patent blue dye (6%), chlorhexidine (5%) and other agents (7%). In contrast to previous reports, latex-induced anaphylaxis was rare (0·6%). A non-IgE-mediated cause was attributed in 10 patients (6%) and no cause could be established in 48 cases (30%). Three serial tryptase measurements were available in 34% of patients and a ROC analysis of area under the curve (AUC) showed comparable performance for PC and AT. A ≥ 80% PPV for identifying an IgE-mediated anaphylaxis was achieved with a PC of >141% or an AT of >15·7 mg/l. NMBAs were the leading cause of anaphylaxis, followed by antibiotics, with latex allergy being uncommon. Chlorhexidine and patent blue dye are emerging important health-care-associated allergens that may lead to anaphylaxis. An elevated acute serum tryptase (PC >141%, AT >15·7 mg/l) is highly predictive of IgE-mediated anaphylaxis, and both methods of interpretation are comparable.
authors: Birmingham Heartlands Hospital, Birmingham, UK; University of Birmingham, Birmingham, UK; Warwick Medical School, Warwick, UK.
authors: M T
authors: MT
authors: Krishna
authors: M
authors: M
authors: York
authors: T
authors: T
authors: Chin
authors: G
authors: G
authors: Gnanakumaran
authors: J
authors: J
authors: Heslegrave
authors: C
authors: C
authors: Derbridge
authors: A
authors: A
authors: Huissoon
authors: L
authors: L
authors: Diwakar
authors: E
authors: E
authors: Eren
authors: R J
authors: RJ
authors: Crossman
authors: N
authors: N
authors: Khan
authors: A P
authors: AP
authors: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000175:diagnosis* / Q000209:etiology*; D000768:Anesthesia, General / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012882:Skin Tests; D053802:Tryptases / Q000097:blood; D006113:United Kingdom
chemical_list: D007073:Immunoglobulin E; D053802:Tryptases
keywords: anaphylaxis; general anaesthesia; neuromuscular blocking agents; patent blue dye; tryptase