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01.01.2021 | Anaphylaxis and Drug Allergy (BT Kelly and M Castells, Section Editors) | Ausgabe 1/2021

Current Allergy and Asthma Reports 1/2021

Approach to Perioperative Anaphylaxis in 2020: Updates in Diagnosis and Management

Current Allergy and Asthma Reports > Ausgabe 1/2021
Jerry Kalangara, Kristine Vanijcharoenkarn, Grant C. Lynde, Nichole McIntosh, Merin Kuruvilla
Wichtige Hinweise
This article is part of the Topical Collection on Anaphylaxis and Drug Allergy

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Purpose of Review

The goal of the paper is to review the epidemiology, pathogenesis, diagnosis, and manifestations of perioperative anaphylaxis (POA). We seek to review the most common culprits of POA and different diagnostic modalities for evaluation.

Recent Findings

Specific IgE testing has a limited role in POA evaluation due to lack of widespread availability and low sensitivity. Basophil activation testing is complementary to skin tests and can assist NMBA sensitivity diagnosis in complex cases. In the past years, there has been an exponential increase in suspected teicoplanin allergic reactions in the European Union. Chlorhexidine is also being increasingly implicated as a culprit in POA.


Multiple classes of perioperative medications cause POA. Diagnostic modalities available include skin testing with nonirritating concentrations, basophil activation tests, specific IgE, and drug provocation testing. An accurate record and critical analysis of perioperative events is more important than isolated test results. Future studies evaluating the pathophysiology of these reactions and other therapeutic strategies, such as targeting the MRGPRX2 receptor, are needed.

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