A US-Based Multicenter Retrospective Report of Perioperative Anaphylaxis, 2010-2021

被引：6

作者：

Gonzalez-Estrada, Alexei ^{[1
]}

Carrillo-Martin, Ismael ^{[1
]}

Morgenstern-Kaplan, Dan ^{[1
]}

Rukasin, Christine R. F. ^{[2
,3
]}

Rank, Matthew A. ^{[2
,3
]}

Park, Miguel A. ^{[4
]}

Yee, Claire I. ^{[5
]}

Volcheck, Gerald W. ^{[4
]}

机构：

[1] Mayo Clin, Dept Med, Div Pulm Allergy & Sleep Med, 4500 San Pablo Rd, Jacksonville, FL 32224 USA

[2] Mayo Clin, Dept Med, Div Allergy Asthma & Clin Immunol, Scottsdale, AZ USA

[3] Phoenix Childrens Hos pital, Div Pulm, Sect Allergy Immunol, Phoenix, AZ USA

[4] Mayo Clin, Dept Internal Med, Div Allerg Dis, Rochester, MN USA

[5] Mayo Clin, Div Clin Trials & Biostat, Scottsdale, AZ USA

来源：

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE | 2024年 / 12卷 / 06期

关键词：

Perioperative hypersensitivity; Perioperative anaphylaxis; Tryptase; Mast cell activation; N-Methyl histamine; Leukotriene E-4; Prostaglandin D-2; Urinary mast cell metabolite mediator; Drug hypersensitivity; PLATELET-ACTIVATING-FACTOR; PRACTICE PARAMETER UPDATE; MAST-CELL ACTIVATION; HYPERSENSITIVITY REACTIONS; ALLERGIC REACTIONS; PERIPROCEDURAL ANAPHYLAXIS; SERUM TRYPTASE; UNITED-STATES; RISK-FACTORS; ANESTHESIA;

D O I：

10.1016/j.jaip.2024.02.042

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

Background: US-based perioperative anaphylaxis (POA) studies are limited to single-center experiences. A recent report found that a serum acute tryptase (sAT) >9.8 ng/mL or mast cell activation (MCA) can predict POA causal agent identification. Urinary mast cell mediator metabolites (uMC) have not been studied in POA. Objective: To analyze the epidemiologic data of POA, to determine if sAT or MCA can predict suspected causal agent identification, and to evaluate uMC utility in POA. Methods: This study is a retrospective multicenter review of POA cases that were subcategorized by suspected causal agent identification status. sAT, MCA (defined as sAT >2 + 1.2 x serum baseline tryptase), and uMC (N-methylhistamine [N-MH], 11 beta-prostaglandin-F-2 alpha [11 beta-PGF(2 alpha)], leukotriene E-4 [LTE4]) were recorded. Results: Of 100 patients (mean age 52 [standard deviation 17] years, 94% adult, 50% female, 90% White, and 2% Hispanic) with POA, 73% had an sAT available, 41% had MCA, 16% had uMC available, and 50% had an identifiable suspected cause. POA cases with an identifiable suspected cause had a positive MCA status (100% vs 78%; P = .01) compared with POA with an unidentifiable cause. An elevated median sAT did not predict causal agent identification. Positive uMC were not associated with suspected causal agent identification during POA. Patients with positive uMC had a higher median sAT (30 vs 6.45 ng/mL; P = .001) and MCA status (96% vs 12%; P = .001) compared with negative uMC patients. Patients with POA had an elevated acute/baseline uMC ratios: 11 beta-PGF(2 alpha) ratio > 1.6, N-MH ratio >1.7, and LTE4 ratio >1.8. Conclusions: The presence of MCA in POA is associated with suspected causal agent identification. Positive uMC possibly correlate with a higher sAT level and MCA status but require further study. The authors suggest applying an acute/baseline uMC ratio (11 beta-PGF(2 alpha) ratio >1.6, N-MH ratio >1.7, and LTE4 ratio >1.87) in patients with POA for MCA when a tryptase level is inconclusive during POA evaluations. (c) 2024 American Academy of Allergy, Asthma & Immunology

引用

页码：1594 / 1602.e9

页数：18

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