Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

P M Hopkins¹, P J Cooke², R C Clarke³, A B Guttormsen⁴, P R Platt³, P Dewachter⁵, D G Ebo⁶, T Garcez⁷, L H Garvey⁸, D L Hepner⁹, D A Khan¹⁰, H Kolawole¹¹, P Kopac¹², M Krøigaard¹³, J J Laguna¹⁴, S D Marshall¹¹, P M Mertes¹⁵, M A Rose¹⁶, V Sabato⁶, L C Savic¹⁷, S Savic¹⁸, T Takazawa¹⁹, G W Volcheck²⁰, S Voltolini²¹, P H M Sadleir²²

Affiliations

¹ Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: p.m.hopkins@leeds.ac.uk.
² Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
³ Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia.
⁴ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁵ Service d'Anesthésie-Réanimation, Groupe Hospitalier de Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris 13, Sorbonne-Paris-Cité, Paris, France.
⁶ Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
⁷ Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
⁸ Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁹ Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA.
¹⁰ Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹¹ Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia.
¹² University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
¹³ Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark.
¹⁴ Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X. El Sabio University, ARADyAL, Madrid, Spain.
¹⁵ Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
¹⁶ Department of Anaesthesia, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia.
¹⁷ Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁸ Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁹ Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan.
²⁰ Division of Allergic Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
²¹ Allergy Unit, Policlinic Hospital San Martino, Genoa, Italy.
²² Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia; Department of Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.

PMID: 31029409
DOI: 10.1016/j.bja.2019.02.029

Free article

Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

P M Hopkins et al. Br J Anaesth. 2019 Jul.

Free article

. 2019 Jul;123(1):e29-e37.

doi: 10.1016/j.bja.2019.02.029. Epub 2019 Apr 24.

Authors

Affiliations

¹ Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: p.m.hopkins@leeds.ac.uk.
² Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
³ Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia.
⁴ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁵ Service d'Anesthésie-Réanimation, Groupe Hospitalier de Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris 13, Sorbonne-Paris-Cité, Paris, France.
⁶ Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
⁷ Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
⁸ Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁹ Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA.
¹⁰ Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹¹ Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia.
¹² University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
¹³ Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark.
¹⁴ Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X. El Sabio University, ARADyAL, Madrid, Spain.
¹⁵ Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
¹⁶ Department of Anaesthesia, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia.
¹⁷ Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁸ Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁹ Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan.
²⁰ Division of Allergic Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
²¹ Allergy Unit, Policlinic Hospital San Martino, Genoa, Italy.
²² Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia; Department of Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.

PMID: 31029409
DOI: 10.1016/j.bja.2019.02.029

Abstract

Background: Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents.

Methods: We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1-9) and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated.

Results: Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more) and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase.

Conclusion: We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.

Keywords: allergy; anaesthesia; anaphylaxis; drug hypersensitivity; perioperative period; surgery.

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Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

Affiliations

Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions

Authors

Affiliations

Abstract

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical