title: Antibiotic-induced immediate type hypersensitivity is a risk factor for positive allergy skin tests for neuromuscular blocking agents.
abstract: BACKGROUND
  Skin tests for neuromuscular blocking agents (NMBAs) are not currently recommended for the general population undergoing general anaesthesia. In a previous study we have reported a high incidence of positive allergy tests for NMBAs in patients with a positive history of non-anaesthetic drug allergy, a larger prospective study being needed to confirm those preliminary results. The objective of this study was to compare the skin tests results for patients with a positive history of antibiotic-induced immediate type hypersensitivity reactions to those of controls without drug allergies.
  
  
  METHODS
  Ninety eight patients with previous antibiotic hypersensitivity and 72 controls were prospectively included. Skin tests were performed for atracurium, pancuronium, rocuronium, and suxamethonium.
  
  
  RESULTS
  We found 65 positive skin tests from the 392 tests performed in patients with a positive history of antibiotic hypersensitivity (1 6.58%) and 23 positive skin tests from the 288 performed in controls (7.98%), the two incidences showing significant statistical difference (p = 0.0011). The relative risk for having a positive skin test for NMBAs for patients versus controls was 1.77 (1.15-2.76). For atracurium, skin tests were more often positive in patients with a positive history of antibiotic hypersensitivity versus controls (p = 0.02). For pancuronium, rocuronium and suxamethonium the statistical difference was not attained (p-values 0.08 for pancuronium, 0.23 for rocuronium, and 0.26 for suxamethonium).
  
  
  CONCLUSIONS
  Patients with a positive history of antibiotic hypersensitivity seem to have a higher incidence of positive skin tests for NMBAs. They might represent a group at higher risk for developing intraoperative anaphylaxis compared to the general population.
authors.affiliation: Department of Anaesthesia and Intensive Care II, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania. Electronic address: hagaunatalia@gmail.com.
authors.forename: Natalia
authors.initials: N
authors.lastname: Hagau
authors.affiliation: Department of Allergology and Immunology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Nadia
authors.initials: N
authors.lastname: Gherman
authors.affiliation: Department of Anaesthesia and Intensive Care II, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Cocis
authors.affiliation: Department of Anaesthesia and Intensive Care II, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
authors.forename: Cristina
authors.initials: C
authors.lastname: Petrisor
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology*; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D012882:Skin Tests
chemical_list: D000900:Anti-Bacterial Agents; D009466:Neuromuscular Blocking Agents
keywords: Antibiotic; Drug hypersensitivity; Latent sensitization; Neuromuscular blocking agent; Skin tests