title: Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic.
abstract: Our bi-specialty clinic was established to systematically investigate patients with suspected peri-operative hypersensitivity reactions. Four hundred and ten patients were studied; 316 following an intra-operative reaction ('postoperative' group) and 94 with a previous history of reaction, referred before undergoing anaesthesia ('pre-operative' group). In the postoperative group, 173 (54.7%) were diagnosed with IgE-mediated reactions: 65 (37.6%) to neuromuscular blocking drugs; 54 (31.2%) antibiotics; 15 (8.7%) chlorhexidine and 12 (6.9%) patent blue dye. Reactions were severe in 114 patients (65.9%). All reactions to patent blue dye were severe. We identified IgE sensitisation in 22 (13.2%) cases with isolated mucocutaneous reactions. Only 173 (54.7%) patients had serum tryptase samples taken. Referrers' suspected causal agent was confirmed in only 37.2% of patients. Of 94 patients reviewed 'pre-operatively', 29 (30.8%) were diagnosed with IgE-mediated hypersensitivity reactions, reinforcing the importance of investigating this group of patients. Knowledge of the range of causative agents identified in our study should guide the investigation of suspected peri-operative hypersensitivity reactions.
authors.affiliation: Department of Anaesthesia, Sandwell and West Birmingham Hospitals, Birmingham, UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Low
authors.affiliation: Department of Anaesthesia, Sandwell and West Birmingham Hospitals, Birmingham, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: McEwan
authors.affiliation: Department of Immunology, Sandwell and West Birmingham Hospitals, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Karanam
authors.affiliation: Department of Immunology, Sandwell and West Birmingham Hospitals, Birmingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: North
authors.affiliation: Department of Anaesthesia, Sandwell and West Birmingham Hospitals, Birmingham, UK.
authors.forename: K-L
authors.initials: KL
authors.lastname: Kong
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000209:etiology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008875:Middle Aged; D053802:Tryptases / Q000097:blood
chemical_list: D007073:Immunoglobulin E; D053802:Tryptases