Recognition, treatment, and prevention of perioperative anaphylaxis: a narrative review

Erin Long; Juan Camilo Ruiz; Julena Foglia; Kamen Valchanov; Andrew Meikle; Erin Long; Juan Camilo Ruiz; Julena Foglia; Kamen Valchanov; Andrew Meikle

doi:10.3934/medsci.2022005

AIMS Medical Science

2022, Volume 9, Issue 1: 32-50. doi: 10.3934/medsci.2022005

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Recognition, treatment, and prevention of perioperative anaphylaxis: a narrative review

1.
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
2.
Department of Allergy & Immunology, Vancouver General Hospital, Vancouver, British Columbia, Canada
3.
Department of Anesthesiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
4.
Department of Anesthesia, Royal Columbian Hospital, New Westminster, British Columbia, Canada

Received: 20 December 2021 Revised: 21 February 2022 Accepted: 07 March 2022 Published: 15 March 2022

Perioperative anaphylaxis events are allergic reactions which occur in the perioperative period when patients are exposed to a multitude of agents, received anesthesia, and undergo a procedure. These reactions are rare and can be life-threatening, with the common signs being hypotension, hypoxia, elevated airway pressures and urticaria. Perioperative anaphylaxis can be mediated by immunoglobulin E (IgE) or non-IgE mechanisms. Globally, the incidence of reactions and frequency of specific triggers varies considerably. Perioperative anaphylaxis events often result in discontinuation of surgery, extended hospital stays, unanticipated intensive care admissions and increased morbidity and mortality. Common causative agents include neuromuscular blocking agents (NMBA's), beta-lactam antibiotics, chlorhexidine, and latex. The primary treatment of perioperative anaphylaxis is removal of the offending agent, epinephrine, and adequate fluid resuscitation. Post-operative workup involves serial serum tryptase measurements, skin testing, in-vitro testing and challenges to determine the culprit agent. Several countries including the UK, Spain, France, Australia, and New Zealand have established guidelines, reporting systems, and specialized clinics dedicated to perioperative hypersensitivity reactions. Future efforts should address diagnostic challenges as well as increasing awareness of other perioperative anaphylaxis triggers. This narrative review will provide an overview of the epidemiology, diagnosis, management, and prevention of perioperative anaphylaxis events.
- perioperative,
- anaphylaxis,
- hypersensitivity,
- allergy,
- anesthesia
Citation: Erin Long, Juan Camilo Ruiz, Julena Foglia, Kamen Valchanov, Andrew Meikle. Recognition, treatment, and prevention of perioperative anaphylaxis: a narrative review[J]. AIMS Medical Science, 2022, 9(1): 32-50. doi: 10.3934/medsci.2022005

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Abstract

Perioperative anaphylaxis events are allergic reactions which occur in the perioperative period when patients are exposed to a multitude of agents, received anesthesia, and undergo a procedure. These reactions are rare and can be life-threatening, with the common signs being hypotension, hypoxia, elevated airway pressures and urticaria. Perioperative anaphylaxis can be mediated by immunoglobulin E (IgE) or non-IgE mechanisms. Globally, the incidence of reactions and frequency of specific triggers varies considerably. Perioperative anaphylaxis events often result in discontinuation of surgery, extended hospital stays, unanticipated intensive care admissions and increased morbidity and mortality. Common causative agents include neuromuscular blocking agents (NMBA's), beta-lactam antibiotics, chlorhexidine, and latex. The primary treatment of perioperative anaphylaxis is removal of the offending agent, epinephrine, and adequate fluid resuscitation. Post-operative workup involves serial serum tryptase measurements, skin testing, in-vitro testing and challenges to determine the culprit agent. Several countries including the UK, Spain, France, Australia, and New Zealand have established guidelines, reporting systems, and specialized clinics dedicated to perioperative hypersensitivity reactions. Future efforts should address diagnostic challenges as well as increasing awareness of other perioperative anaphylaxis triggers. This narrative review will provide an overview of the epidemiology, diagnosis, management, and prevention of perioperative anaphylaxis events.

Abbreviations

ACE

Angiotensin converting enzyme

ACLS

Advanced cardiovascular life support

ANZAAG

Australian & New Zealand Anaesthetic Allergy Group

ICU

Intensive care unit

IgE

Immunoglobulin E

Intramuscular

Intravenous

GERAP

Groupe d'etude des reactions anaphylactoides peranesthesiques

MRGPRX2

Mas-related G-protein coupled receptor member X2

NAP6

6th National Audit Project

NMBA

Neuromuscular blocking agents

T_H2

T helper 2

Acknowledgments

The authors did not receive funding for this project.

Conflicts of interest

All authors declare no conflicts of interest in this paper.

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