Early testing for suspected perioperative hypersensitivity

Published: November 09, 2021

Anesthetized patients are exposed to a variety of medications. Allergic reactions to anesthetic agents can be life-threatening. Therefore, it is of utmost importance to correctly identify the culprit drug(s), to avoid dangerous re-exposure during subsequent anesthesia. It has been recommended one should wait at least 6 weeks to start allergy investigations. However, this claim has never been clearly substantiated and there are occasions where urgent repeat anesthesia is required, e.g. after interruption of life-saving surgery.

In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice by van der Poorten et al., the authors investigated whether it is really essential to delay allergic work-up for 6 weeks after the suspected perioperative hypersensitivity reaction. Patients who were referred to our hospital, were stratified over three time epochs. An early timing group, with investigations performed within 6 weeks post event; a recommended timing group, with tests performed between 6 weeks and 6 months; a late timing group, tested later than 6 months, respectively.

A total of 677 patients were included. A causative drug was found in 74.2% of the early timing group, in 62.6% of the recommended timing group and in 50% of the late timing group, respectively.

This observation challenges the dogma to postpone diagnostic work-up for suspected perioperative hypersensitivity. When needed, early testing should not be excluded.
   
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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