title: General anaesthesia-induced anaphylaxis: impact of allergy testing on subsequent anaesthesia.
abstract: BACKGROUND
  Immunoglobulin E-mediated allergy to drugs and substances used during general anaesthesia as well as non-allergic drug hypersensitivity reactions may account for anaesthesia-induced anaphylaxis. As IgE-mediated anaphylaxis is a potentially life-threatening reaction, identification of the culprit allergen is essential to avoid anaphylaxis recurrence during subsequent general anaesthesia.
  
  
  OBJECTIVE
  To study whether preventive recommendations derived from allergy testing after intraoperative anaphylaxis were followed in subsequent general anaesthesia.
  
  
  METHODS
  Results of standardized allergy testing after anaesthesia-induced anaphylaxis and outcome of subsequent general anaesthesia were analysed retrospectively.
  
  
  RESULTS
  Fifty-three of 107 patients were diagnosed with IgE-mediated allergy to a drug or substance used during general anaesthesia, and 54 patients were test negative. Twenty-eight of 29 allergy patients tolerated subsequent general anaesthesia uneventfully. One patient with cefazolin allergy suffered from anaphylaxis recurrence due to accidental reapplication of cefazolin. Twenty-two of 24 test-negative patients tolerated subsequent general anaesthesia, whereas two patients again developed anaphylaxis despite pre-medication regimens.
  
  
  CONCLUSIONS
  Our results confirm the practical impact of allergy testing in general anaesthesia-induced anaphylaxis. By identification of the allergen, it is possible to avoid allergic anaphylaxis during subsequent anaesthesia. In most cases, recommended pre-medication seems to prevent the recurrence of non-allergic drug hypersensitivity reactions.
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Trautmann
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Seidl
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Stoevesandt
authors.affiliation: Department of Dermatology and Allergy, University Hospital Göttingen, Göttingen, Germany.
authors.forename: C S
authors.initials: CS
authors.lastname: Seitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000485:Allergens / Q000276:immunology; D000707:Anaphylaxis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D000768:Anesthesia, General / Q000009:adverse effects*; D000918:Antibody Specificity / Q000276:immunology; D001491:Basophils / Q000276:immunology / Q000378:metabolism; D002648:Child; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000276:immunology; D005260:Female; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012882:Skin Tests; D053802:Tryptases / Q000097:blood; D057188:Workflow; D055815:Young Adult
chemical_list: D000485:Allergens; D007073:Immunoglobulin E; D053802:Tryptases
keywords: allergic hypersensitivity; cephalosporin; drug allergy; drug hypersensitivity; intraoperative anaphylaxis; neuromuscular-blocking agent; non-allergic hypersensitivity; penicillin