Background
Methods
Patients
Patients with perioperative hypersensitivity reactions
In vivo tests
Skin tests procedures
Available agents
|
Skin Prick Test
|
Intradermal Tests
| |||
---|---|---|---|---|---|
mg/mL | Dilution | mg/mL | Dilution | mcg/mL | |
Atracurium | 10 | 1/10 | 1 | 1/1000 | 10 |
Cisatracurium | 2 | Undiluted | 2 | 1/100 | 20 |
Mivacurium | 2 | 1/10 | 0.2 | 1/1000 | 2 |
Pancuronium*
| 2 | Undiluted | 2 | 1/10 | 200 |
Rocuronium | 10 | Undiluted | 10 | 1/200 | 50 |
Succinylcholine | 50 | Undiluted | 50 | 1/500 | 100 |
Vecuronium | 4 | Undiluted | 4 | 1/10 | 400 |
Midazolam | 5 | Undiluted | 5 | 1/10 | 500 |
Propofol | 10 | Undiluted | 10 | 1/10 | 1000 |
Thiopental | 25 | Undiluted | 25 | 1/10 | 2500 |
Ketamine | 10 | 1/10 | 10 | 1/10 | 1000 |
Fentanyl | 0.05 | Undiluted | 0.05 | 1/10 | 5 |
In vitro tests
Tryptase
Serum specific IgE
Diagnosis and severity grading
Statistical analysis
Results
Patients
n
|
%
| |
---|---|---|
No. of patients
| 193 | |
Age (y), mean (range)
| 37.5 (2–84) | |
Sex (F/M)
| 122/71 | |
Personal history of allergic disease
| 84 | 43.52 |
Severity of reaction
| ||
Grade I (F/M) | 100 (61/39) | 51.81 |
Grade II (F/M) | 32 (20/12) | 16.58 |
Grade III (F/M) | 55 (35/20) | 28.49 |
Grade IV (F/M) | 6 (6/0) | 3.10 |
Concomitant diseases
| ||
Asthma | 37 | 19.17 |
Other respiratory diseases | 10 | 5.18 |
Hypertension | 30 | 15.54 |
Thyroid diseases | 13 | 6.73 |
Chronic urticaria | 13 | 6.73 |
Anti-hypertensive agents
| ||
ACE-inhibitors | 14 | 7.25 |
ARBs | 9 | 4.66 |
Beta-blockers | 13 | 6.73 |
NMBAs
|
Patients exposed during anaesthesia (F/M)
|
Positivity to skin test in patients exposed (F/M)
|
---|---|---|
Vecuronium
| 22 (13/9) | 4 (3/1) |
Atracurium
| 18 (12/6) | 3 (2/1) |
Cisatracurium
| 23 (13/10) | 1 (1/0) |
Rocuronium
| 19 (15/4) | 1 (1/0) |
Mivacurium
| 8 (4/4) | 0 |
Pancuronium
| 3 (2/1) | 0 |
Succinylcholine
| 15 (11/4) | 0 |
Drugs
|
Positive skin tests (%)
|
No. of patients tested
|
---|---|---|
Beta-lactams
| 4 (8.16) | 49 |
Penicillin
| 1 (2.04) | |
Cephalosporin
| 3 (6.12) | |
Hypnotics
| 8 | |
Ketamine
| 3 (37.50) | |
Others
| 87 | |
Atropine
| 1 (1.14) | |
Latex
| 6 (3.10) | 193 |
Allergic diagnostic work-up
Symptoms group
|
IgE-mediated hypersensitivity
|
No. of patients
|
P value
| |
---|---|---|---|---|
Mucocutaneous
|
0
|
1
| ||
0
| 35 (25.36%) | 18 (32.72%) | 53 | 0.372 |
1
| 103 (74.63%) | 37 (67.27%) | 140 | |
Cardiovascular
|
0
|
1
| ||
0
| 124 (89.86%) | 40 (72.73%) | 164 | 0.006 |
1
| 14 (10.14%) | 15 (27.27%) | 29 | |
Bronchospasm
|
0
|
1
| ||
0
| 97 (70.29%) | 34 (61.82%) | 131 | 0.010 |
1
| 41 (29.71%) | 21 (38.18%) | 62 | |
No. of patients
|
138
|
55
|
193
|