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. 2021 May;9(5):1980-1991.
doi: 10.1016/j.jaip.2020.11.025. Epub 2020 Nov 26.

Perioperative Allergic Reactions: Allergy Assessment and Subsequent Anesthesia

Aleena Banerji  1 , Gita Bhattacharya  2 , Emily Huebner  2 , Xiaoqing Fu  3 , Carlos A Camargo Jr  4 , Autumn Guyer  5 , James L Kuhlen Jr  6 , Kimberly G Blumenthal  7
Affiliations

Perioperative Allergic Reactions: Allergy Assessment and Subsequent Anesthesia

Aleena Banerji et al. J Allergy Clin Immunol Pract. 2021 May.

Abstract

Background: Evidence-based guidelines are needed in the United States to improve evaluation of perioperative allergic reactions including recommendations for subsequent anesthesia.

Objective: To identify causative agent(s) and evaluate patients' tolerability of subsequent anesthesia in patients evaluated by Allergy/Immunology (A/I) at Massachusetts General Hospital.

Methods: We performed a retrospective review of patients referred to the outpatient A/I clinic for perioperative allergic reactions between October 2003 and May 2017. Patient demographics, atopic history, and prior adverse drug reactions were reviewed. Patients underwent a comprehensive evaluation with testing including skin testing (ST), drug challenges (when appropriate), tryptase level measurement, and specific IgE to latex measurement. Tolerance of subsequent procedures requiring anesthesia was assessed.

Results: Of 123 patients referred, 74 (60%) were female and the mean age was 46 (±18) years. At least 1 causative agent was identified in 28 patients (24%, n = 28 of 118). Seventeen of 28 (61%) patients were ST positive to an antibiotic, including 13 (46%) positive to cefazolin; 3 patients (11%) had a positive latex specific IgE. Of 85 patients who had subsequent anesthesia with a known outcome, 78 (91%) did not have another perioperative allergic reaction. Two of 5 patients with an elevated baseline tryptase level did not tolerate subsequent anesthesia.

Conclusion: The majority of patients safely received subsequent anesthesia after comprehensive A/I evaluation for their perioperative allergic reactions; however, improved algorithmic care is needed in the United States. Among ST-positive patients (24%), antibiotics (especially cefazolin) were the most common culprits. An elevated baseline tryptase level was associated with an increased risk of recurrent perioperative allergic reactions.

Keywords: Allergy; Anaphylaxis; Drug allergy; Hypersensitivity; Latex; Operating room; Perioperative; Skin testing; Tryptase.

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