The Journal of Allergy and Clinical Immunology: In Practice
Original ArticleAntibiotics Are the Most Commonly Identified Cause of Perioperative Hypersensitivity Reactions
Section snippets
Study design
We performed a prospective cohort study of all patients at Massachusetts General Hospital who were referred to Allergy and/or Immunology for a perioperative HSR between November 2013 and March 2015. These patients were evaluated using a standardized protocol.6
Patients were identified based on referral information provided by a central patient scheduler. Patients who had an HSR during induction or maintenance of anesthesia, or during the immediate postoperative recovery period, were included.
Results
Over the 17-month period, 30 patients with an HSR during anesthesia were referred to the allergy practice; 25 were included in the analysis. Five patients were excluded because of the following: below the age of 18 at the time of evaluation (n = 1), declined participation in the comprehensive evaluation (n = 2), or did not complete comprehensive allergy evaluation (n = 2).
Discussion
Twenty-five patients completed a prospective comprehensive evaluation after the perioperative HSR, and a suspected IgE-mediated cause, with positive skin testing, was found in 36%, higher than 18% in a previously published study.6 We identified antibiotics as the most commonly identified cause of perioperative HSRs by skin testing, with cefazolin having the most frequently observed positive skin testing. Tryptase levels, obtained during HSRs, aid in the evaluation of perioperative anaphylaxis.
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No funding was received for this work.
Conflicts of interest: D. S. Balekian has received research support from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (Award Number NIAID T32 HL116275); has received travel support from the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology. K. G. Blumenthal has received research support from the National Institutes of Health (T32HL116275). A. Guyer served as an Expert Medical Witness for Western Litigation on drug allergy; has received lecture fees from MetroWest Medical Center; has received payment for manuscript preparation from First Consult; and receives royalties from UpToDate. A. Long receives royalties from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest.