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
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
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
References
1 S. Caimmi, D. Caimmi, R. Bernardini, et al. Perioperative anaphylaxis: epidemiology Int J Immunopathol Pharmacol, 24 (3 Suppl) (2011), pp. S21-S26
2 L.H. Garvey, D.G. Ebo, P.M. Mertes, et al. An EAACI position paper on the investigation of perioperative immediate hypersensitivity reactions Allergy, 74 (2019), pp. 1872-1884
3 B.D. McNeil, P. Pundir, S. Meeker, et al. Identification of a mast-cell-specific receptor crucial for pseudo-allergic drug reactions Nature, 519 (2015), pp. 237-241
4 P. Bonadonna, M. Pagani, W. Aberer, et al. Drug hypersensitivity in clonal mast cell disorders: ENDA/EAACI position paper Allergy, 70 (2015), pp. 755-763
5 P. Dewachter, M.C. Castells, D.L. Hepner, et al. Perioperative management of patients with mastocytosis Anesthesiology, 120 (2014), pp. 753-759
6 S.G. Johansson, J.O. Hourihane, J. Bousquet, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force Allergy, 56 (2001), pp. 813-824
7 C. Mirone, D. Preziosi, A. Mascheri, et al. Identification of risk factors of severe hypersensitivity reactions in general anaesthesia Clin Mol Allergy, 13 (2015), p. 11
8 H.I. Kemp, T.M. Cook, M. Thomas, et al. UK anaesthetists’ perspectives and experiences of severe perioperative anaphylaxis: NAP6 baseline survey Br J Anaesth, 119 (2017), pp. 132-139
9 P.M. Mertes, G.W. Volcheck, L.H. Garvey, et al. Epidemiology of perioperative anaphylaxis Presse Med, 45 (2016), pp. 758-767
10 L.C. Savic, V. Kaura, M. Yusaf, A.M. Hammond-Jones, R. Jackson, S. Howell, et al. Incidence of suspected perioperative anaphylaxis: a multicenter snapshot study J Allergy Clin Immunol Pract, 3 (2015) 454–5 e1
11 J.M. Malinovsky, S. Decagny, F. Wessel, et al. Systematic follow-up increases incidence of anaphylaxis during adverse reactions in anesthetized patients Acta Anaesthesiol Scand, 52 (2008), pp. 175-181
12 T. Lobera, M.T. Audicana, M.D. Pozo, et al. Study of hypersensitivity reactions and anaphylaxis during anesthesia in Spain J Investig Allergol Clin Immunol, 18 (2008), pp. 350-356
13 P.M. Mertes, F. Alla, P. Trechot, et al. Anaphylaxis during anesthesia in France: an 8-year national survey J Allergy Clin Immunol, 128 (2011), pp. 366-373
14 M.M. Fisher, G.S. Doig Prevention of anaphylactic reactions to anaesthetic drugs Drug Saf, 27 (2004), pp. 393-410
15 M. Kroigaard, L.H. Garvey, L. Gillberg, et al. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia Acta Anaesthesiol Scand, 51 (2007), pp. 655-670
16 M. Laforest, D. More, M. Fisher Predisposing factors in anaphylactoid reactions to anaesthetic drugs in an Australian population: the role of allergy, atopy and previous anaesthesia Anaesth Intensive Care, 8 (1980), pp. 454-459
17 M.C. Laxenaire, D.A. Moneret-Vautrin, D. Vervloet The French experience of anaphylactoid reactions Int Anesthesiol Clin, 23 (1985), pp. 145-160
18 M.M. Fisher, A. Outhred, C.J. Bowey Can clinical anaphylaxis to anaesthetic drugs be predicted from allergic history? Br J Anaesth, 59 (1987), pp. 690-692
19 N.J. Harper, T. Dixon, P. Dugue, et al. Suspected anaphylactic reactions associated with anaesthesia Anaesthesia, 64 (2009), pp. 199-211
20 K. Brockow, L.H. Garvey, W. Aberer, et al. Skin test concentrations for systemically administered drugs — an ENDA/EAACI Drug Allergy Interest Group position paper Allergy, 68 (2013), pp. 702-712
21 P.W. Ewan, P. Dugue, R. Mirakian, et al. BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia Clin Exp Allergy, 40 (2010), pp. 15-31
22 M.J. Torres, M. Blanca, J. Fernandez, et al. Diagnosis of immediate allergic reactions to beta-lactam antibiotics Allergy, 58 (2003), pp. 961-972
23 L. Heinzerling, A. Mari, K.C. Bergmann, et al. The skin prick test — European standards Clin Transl Allergy, 3 (2013), p. 3
24 P.M. Mertes, J.M. Malinovsky, L. Jouffroy, et al. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice J Investig Allergol Clin Immunol, 21 (2011), pp. 442-453
25 J. Ring, K. Messmer Incidence and severity of anaphylactoid reactions to colloid volume substitutes Lancet, 1 (1977), pp. 466-469
26 J.H. Levy Anaphylactic reactions during anesthesia Anesth Analg, 74 (1992), p. 167
27 W. Chen, M. Mempel, W. Schober, et al. Gender difference, sex hormones, and immediate type hypersensitivity reactions Allergy, 63 (2008), pp. 1418-1427
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