Acute Management, Diagnosis, and Follow-Up of Suspected Perioperative Hypersensitivity Reactions in Flanders 2001-2018

被引：40
作者：
Ebo, Didier G. [1 ]
Van Gasse, Athina L. [1 ,2 ]
Decuyper, Ine I. [1 ,2 ]
Uyttebroek, Astrid [1 ]
Sermeus, Luc A. [3 ]
Elst, Jessy [1 ]
Bridts, Chris H. [1 ]
Mertens, Christel M. [1 ]
Faber, Margaretha A. [1 ]
Hagendorens, Margo M. [1 ,2 ]
De Clerck, Luc S. [1 ]
Sabato, Vito [1 ]
机构：
[1] Univ Antwerp, Univ Antwerp Hosp, Fac Med & Hlth Sci, Dept Immunol Allergol Rheumatol, Antwerp, Belgium
[2] Univ Antwerp, Univ Antwerp Hosp, Fac Med & Hlth Sci, Dept Paediat, Antwerp, Belgium
[3] Univ Antwerp, Univ Antwerp Hosp, Fac Med & Hlth Sci, Dept Anaesthet, Antwerp, Belgium
来源：
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE | 2019年 / 7卷 / 07期
关键词：
Epidemiology; Allergy; Perioperative hypersensitivity; Management; Diagnosis; MAST-CELL ACTIVATION; SUBSEQUENT GENERAL-ANESTHESIA; NEUROMUSCULAR BLOCKING-DRUGS; IMMUNOGLOBULIN-E ANTIBODIES; VITRO BASOPHIL ACTIVATION; AUDIT PROJECT NAP6; ALLERGIC REACTIONS; CROSS-REACTIVITY; ANAPHYLACTIC REACTIONS; PATENT BLUE;
D O I：
10.1016/j.jaip.2019.02.031
中图分类号：
R392 [医学免疫学];
学科分类号：
100102 ;
摘要：
BACKGROUND: Despite numerous efforts to describe the clinical manifestations and the epidemiology of perioperative hypersensitivity (POH), there remains room to increase awareness among anesthetists and immunologists/allergists. OBJECTIVE: To report the findings of a 17-year survey of suspected POH in Antwerp, Belgium. METHODS: We analyzed clinical and diagnostic data from 715 patients referred because of a suspected POH reaction, between January 1, 2001, and May 31, 2018. A total of 456 patients demonstrating a POH could be queried about subsequent anesthesia. RESULTS: A total of 608 cases formed the final dataset; 208 had a non-life-threatening reaction and 400 a life-threatening reaction. In life-threatening reactions, hypotension was predominating. In the non-life-threatening reactions, 83.9% of the patients displayed cutaneous manifestations. In life-threatening reactions, intravenous adrenaline and fluids were administered in 75.7% and 31%, respectively, and 41.3% had their intervention abandoned. Mast cell activation (MCA) was mainly, but not exclusively, observed in severe grades but did not predict the mechanistic process nor the culprit. A cause was identified in 77.8% of severe and 48.6% of milder cases. Main culprits were neuromuscular blocking agents, latex, cefazolin, and dyes. A total of 156 cases had uneventful anesthesia, except 1 patient who was inadvertently re-exposed to hidden chlorhexidine. CONCLUSIONS: This study highlights that there is room for an improved acute management and an optimized diagnostic workup that should not be restricted to patients with severe reactions and/or showing MCA. (C) 2019 American Academy of Allergy, Asthma & Immunology.
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页码：2194 / +
页数：18
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