Antibiotics are a common cause of perioperative anaphylactic reactions.
According to scientists from the Cleveland Clinic (Ohio, USA), who were presented to the American College of Allergy, Asthma & Immunology - ACAAI at the annual scientific conference, the causes of perioperative anaphylaxis differ from the results of several European studies. Thus, it has been found that in the United States, antibiotics are the most common established cause of perioperative anaphylactic reactions.
During the study, 30 anaphylactic reactions that occurred in the clinic during the period from 2002 to 2013 were examined. During the work, skin tests and in vitro studies were carried out with inhibitors of neuromuscular transmission, drugs for the induction of anesthesia, analgesics (fentanyl), drugs antibacterials (cefuroxime, penicillin, penicilloyl polylysine, metronidazole) anesthetics (lidocaine), as well as povidone iodine, chlorhexidine and latex.
In 57% of cases, it was possible to determine the cause of the anaphylactic reactions, which were later classified as IgE-mediated. In the remaining 43% of cases, the cause of the hypersensitivity reactions has not been established and the researchers believe that these were non-IgE-mediated reactions using neuromuscular blockers.
The most common established causes of perioperative anaphylaxis were antibiotics (58%), less commonly seen reactions to neuromuscular blockers (23%) and latex (17%). Among antibacterial drugs, anaphylactic reactions have been caused by cefazolin (60%), penicillin (20%), cefuroxime (10%) and metronidazole (10%).
It should be noted that for more than 10 years in the clinic, there has not been a single fatal result due to the occurrence of anaphylactic reactions, however, hypotension was observed in 96.6% of cases and one cardiac arrest occurred in 23.3% of cases. Skin manifestations included hyperemia (33.3%), hives (16.7%) and angioedema (16.7%), bronchospasm (43.3%) and diarrhea (3, 3%) were also recorded.
All patients diagnosed with IgE-mediated reactions had elevated serum tryptase levels compared to 40% of patients with non-IgE-mediated reactions (p = 0.001). In addition, the mean serum tryptase level was higher in patients with IgE-mediated reactions (41.3 vs 23.8 μg / L, p = 0.096).
An interesting fact is that non-IgE mediated reactions occurred earlier than IgE mediated reactions (on average, 10 min. And 19.5 min.)
According to the authors of the work, the application of a systematic approach to the examination and management of patients with perioperative anaphylaxis, including the allergological and immunological examination, allows in certain cases to identify the cause an allergic reaction, which can affect subsequent management tactics and provide valuable information to the patient.
The difficulty in establishing the etiology of perioperative anaphylaxis is due to the fact that in the vast majority of cases, patients receive several drugs at the same time. The authors emphasize that skin tests should not be done before surgery for all patients without exception - this practice is only justified in people who have already had an episode of perioperative anaphylaxis.
When reviewing the proceedings at the conference, attention was drawn to the differences in the identified causes of perioperative anaphylaxis in different countries. In France, Norway, the United Kingdom and Australia, perioperative reactions were mainly caused by blockers of neuromuscular transmission, while in Denmark, the most common causes are chlorhexidine, antibacterial drugs and latex. This observation may be associated with various pepper drugs with which allergological tests are carried out. In addition, only intravenous drugs are often considered to be potential provocateurs of anaphylactic reactions, and antiseptics, drugs administered intramuscularly as premedication and other drugs are not considered.
The main conclusion of the work is recommendations that it is necessary to carefully study each case of perioperative anaphylaxis.