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Management, diagnosis and follow-up of perioperative hypersensitivity reactions in Flanders

Published online: March 8, 2019

Despite numerous efforts to describe the clinical manifestations and the epidemiology of perioperative hypersensitivity reactions (POH), there remains room to increase awareness among anesthetists and allergist/immunologists.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Ebo et al. report their findings of a 17-year survey of suspected POH in Antwerp (Belgium). Clinical and diagnostic data from 715 patients referred because of a suspected POH, between January 1, 2001 and May 31, 2018 were analyzed. 456 patients demonstrating a POH could be queried about subsequent anaesthesia.

Finally, 608 cases formed the dataset; 208 had a non-life-threatening POH, 400 a life-threatening POH. In life-threatening reactions, hypotension was predominating. In the non-life-threatening reactions, 83.9% of the patients displayed cutaneous manifestations. In life-threatening reactions, intravenous adrenaline and fluids were administered in 75.7% and 31% of patients respectively. Forty-one percent of the patients had their intervention abandoned. Mast cell activation was mainly, but not exclusively, observed in severe grades but did not predict the mechanistic process nor the culprit. A cause was identified in 77.8% of severe and 48.6% of milder cases. The main culprits were neuromuscular blocking agents, latex, cefazolin and dyes. Following diagnostic evaluations, 156 had uneventful anaesthesia, except one patient who was inadvertently re-exposed to hidden chlorhexidine.

This study highlights that there is still room for improved acute management and an optimized diagnostic work-up that should not be restricted to patients with severe reactions and/or those with mast cell activation.  

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.