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SELECTED ARTICLES FROM THE RECENT LITERATURE 2008
4/1/08
The Workup of a Patient Experiencing an Anaphylactic Reaction During a Surgical Procedure
Summary
Allergists are often asked to see patients who have experienced anaphylaxis during a surgical procedure. The object of the visit is to identify the responsible agent so that further surgery can be done without a repeat event. This is oftentimes a difficult consultation because it requires meticulous review of the records (some of which are difficult to interpret), and because tests have not been well standardized. Therefore it would be extremely useful to have a resource to consult regarding concentrations of test to employ, historical features to note, and availability of in vitro tests to help confirm the correct choice of the responsible drug.
Fortunately, there are two recent articles which deal in detail with these issues. One of these is a consensus guideline published via the imprimatur of the Scandinavian Clinical Practice Guidelines. It is a practical and concise guideline to the approach to the patient seen in your office after such a reaction has occurred.
The other is a superbly written review article by Chacko and Ledford published in Immunology and Allergy Clinics of North America.
Using these two resources can be extremely valuable in the approach to a patient with a previous anaphylactic event occurring during surgery. Potentially responsible drugs are discussed in detail and test protocols are set forth. In addition, availability of in vitro tests for IgE antibody against potential responsible agents is also noted.
Reference
1. Chacko T and Ledford D. Peri-anesthetic anaphylaxis. In: Immunology and Allergy Clinics of North America 2007; 27:213-230.
2. Kroigaard M, et al. Scandinavian Clinical Practice Guidelines on the diagnosis, management, and follow-up of anaphylaxis during anesthesia. ACTA Anaesthesiol Scandinavia 2007; 51:655-670.
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