Epidemiology of perioperative anaphylaxis in France in 2017-2018: the 11th GERAP survey

Abstract

Background: Perioperative anaphylaxis is rare but is associated with significant morbidity. This complication has been well described in France by the GERAP (Groupe d'Etude des Réactions Anaphylactiques Périopératoires), a network focused on its study. The epidemiology of perioperative anaphylaxis is evolving, influenced by environmental factors and clinical practice. The aim of this study was to update the epidemiology of perioperative anaphylaxis in France.

Methods: This multicentre retrospective study was performed in 26 allergy clinics of the GERAP network in 2017-8.

Results: There were 765 patients with perioperative anaphylaxis included. Most cases were severe, with 428 (56%) reactions graded as 3 or 4 according to the Ring and Messmer classification. Skin test results were available for 676 patients, with a culprit agent identified in 471 cases (70%). Neuromuscular blocking agents were the main cause of perioperative anaphylaxis (n=281; 60%), followed by antibiotics (n=118; 25%) and patent blue dye (n=11; 2%). Cefazolin was the main antibiotic responsible for perioperative anaphylaxis (52% of antibiotic-related reactions). Suxamethonium and rocuronium were the main neuromuscular blocking agents responsible for perioperative anaphylaxis with 7.1 (6.1-8.4) and 5.6 (4.2-7.4) reactions per 100,000 vials sold, respectively, whereas cefazolin-related cases were estimated at 0.7 (0.5-0.9) reactions per 100,000 vials sold.

Conclusions: Our results confirm that most commonly identified triggering agents remain neuromuscular blocking agents. Reactions to antibiotics, particularly cefazolin, are becoming increasingly frequent. The origin of sensitisation to cefazolin is unknown, as no cross-sensitisation has been described, and it should be the subject of further study. Perioperative anaphylaxis should be followed over the years and understood given the changing triggers.

Clinical trial registration: ClinicalTrials.gov (NCT04654923).

Keywords: cefazolin; neuromuscular blocking agent; patent blue; perioperative anaphylaxis; tryptase.

Fig 1

Flow chart of the 11th GERAP survey. BAT, basophil activation test; CT, challenge test; ID group, identified culprit antigen; NMBA, neuromuscular blocking agent; sIgE, specific immunoglobulin E; ST, skin test; UNK group, unidentified culprit antigen. ∗IgE-mediated reactions in previous GERAP surveys. ^†Non-IgE-mediated reactions in previous GERAP surveys. ^‡The sum of patients with each factor is higher than the total of patients with at least one other factor in favour of a potential culprit, as some patients had two or more factors.