Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.07.005
Brazilian Journal of Anesthesiology
Original Investigation

Evaluation of skin test indications for general anesthetics in real life: a prospective cohort study

Avaliação das indicações de testes cutâneos para anestésicos gerais na vida real: um estudo de coorte prospectivo

Sengul Beyaz; Raif Coskun; Nida Oztop; Evren Aygun; Mukadder Orhan Sungur; Tulay Ozkan Seyhan; Semra Demir; Muge Olgac; Derya Unal; Bahauddin Colakoglu; Suna Buyukozturk; Asli Gelincik

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Abstract

Background
In daily practice, atopic patients and those who have other drug allergies are referred to allergy clinics for evaluation of possible general anesthetic allergy despite the fact that it is not recommended in recent guidelines.

Objective
The aim of this prospective study is to determine the negative predictive value of skin tests for common general anesthetic drugs prior to general anesthesia in atopic patients and in patients who had drug allergies by including the data of those who had previously tolerated or reacted to general anesthesia.

Methods
A database program was constituted to collect the preoperative skin test data of patients referred to our clinic between 2013 and 2018. Demographic and clinical history, medications implemented during perioperative period, reactions, and results of skin tests performed with anesthetic drugs and latex were evaluated.

Results
Four hundred fifty-nine out of the total 1167 patients referred fulfilled the inclusion criteria for further evaluation. Nearly 75% of the patients were female and mean age was 46.3 ± 14.3 years. History of hypersensitivity reactions (HRs) due to NSAIDs and/or antibiotics, radiocontrast agents, local anesthetics, and food were present in the 53.1%, 4.1%, 1.5%, and 2.0%, respectively. The negative predictive values of skin tests for general anesthetics were in the range of 80–100%. Only 4 patients (0,87%) experienced HRs during operation.

Conclusion
These real-life data reveal high rates of negative predictive value of skin tests with general anesthetic drugs and a low reaction rate in atopic patients and in patients with allergy to other drugs.

Abbreviations
DSTDrug skin testEAACIEuropean Academy of Allergy and Clinical ImmunulogyEMAEuropean Medicines AgencyENDAEuropean Network on Drud AllergyHRsHypersensitivity reactionsIgEImmunoglobulin EMRGPRX2Mas-related G protein-coupled receptor-X2NMBAsNeuromuscular blocking agentsNPVNegative predictive valueNSAIDsNonsteroidal anti-inflammatory drugs

Keywords

Anesthetic agents;  Drug hypersensitivity;  Immunologic tests;  Predictive value of tests;  Skin tests

Resumo

Justificativa: Na prática diária, pacientes atópicos e alérgicos a outros medicamentos são encaminhados a clínicas de alergia para avaliação de possível alergia a anestésico geral, apesar de não ser recomendado em diretrizes recentes. Objetivo: O objetivo deste estudo prospectivo é determinar o valor preditivo negativo dos testes cutâneos para anestésicos gerais comuns antes da anestesia geral em pacientes atópicos e em pacientes com alergia a medicamentos, incluindo os dados daqueles que haviam tolerado ou reagido previamente a anestesia geral. Métodos: Foi constituído um programa de banco de dados para coletar os dados dos testes cutâneos pré-operatórios dos pacientes encaminhados ao nosso ambulatório entre 2013 e 2018. Foram analisados antecedentes demográficos e clínicos, medicações implementadas no perioperatório, reações e resultados dos testes cutâneos realizados com drogas anestésicas e látex foram avaliados. Resultados: Quatrocentos e cinquenta e nove do total de 1.167 pacientes encaminhados preencheram os critérios de inclusão para avaliação posterior. Quase 75% dos pacientes eram do sexo feminino e a média de idade foi de 46,3±14,3 anos. História de reações de hipersensibilidade (RHs) devido a AINEs e/ou antibióticos, agentes de radiocontraste, anestésicos locais e alimentos estavam presentes em 53,1%, 4,1%, 1,5% e 2,0%, respectivamente. Os valores preditivos negativos dos testes cutâneos para anestésicos gerais ficaram na faixa de 80 a 100%. Apenas 4 pacientes (0,87%) apresentaram RH durante a operação. Conclusão: Esses dados da vida real revelam altas taxas de valor preditivo negativo dos testes cutâneos com drogas anestésicas gerais e uma baixa taxa de reação em pacientes atópicos e em pacientes com alergia a outras drogas.

Palavras-chave

Agentes anestésicos; Hipersensibilidade a drogas; Testes imunológicos; Valor preditivo dos testes; Testes cutâneos

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