Abstract
Anaphylaxis in the setting of general anesthesia is a rare but potentially lethal event. The investigation of severe reactions is important for confirming the clinical diagnosis and identifying likely causative agents and safe agents that may be used in the future. Many comprehensive reports have described the testing protocol of individual specialized units, whereas there has been no standardization of testing techniques or formal assessment of these tests’ diagnostic accuracy. We review the literature with reference to the recently published standards for reporting of diagnostic accuracy (STARD) and make recommendations for future studies of diagnostic accuracy in the field.
Similar content being viewed by others
References and Recommended Reading
Ebo DG, Fisher MM, Hagendorens MM, et al.: Anaphylaxis during anaesthesia: diagnostic approach. Allergy 2007, 62:471–487.
Fisher M: Intradermal testing after anaphylactoid reaction to anaesthetic drugs: practical aspects of performance and interpretation. Anaesth Intensive Care 1984, 12:115–120.
Thong BY, Yeow-Chan: Anaphylaxis during surgical and interventional procedures. Ann Allergy Asthma Immunol 2004, 92:619–628.
Bossuyt PM, Reitsma JB, Bruns DE, et al.: The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem 2003, 49:7–18.
Murat I: Anaphylactic reactions during paediatric anaesthesia; results of the survey of the French Society of Paediatric Anaesthetists (ADARPEF). Paediatr Anaesth 1993, 3:339–343.
Fisher MM, Baldo BA: The incidence and clinical features of anaphylactic reactions during anesthesia in Australia. Ann Fr Anesth Reanim 1993, 12:97–104.
Laxenaire MC, Mertes PM: Anaphylaxis during anaesthesia. Results of a two-year survey in France. Br J Anaesth 2001, 87:549–558.
Karila C, Brunet-Langot D, Labbez F, et al.: Anaphylaxis during anesthesia: results of a 12-year survey at a French pediatric center. Allergy 2005, 60:828–834.
Levy JH, Gottge M, Szlam F, et al.: Weal and flare responses to intradermal rocuronium and cisatracurium in humans. Br J Anaesth 2000, 85:844–849.
Fisher M, Baldo BA: Anaphylaxis during anaesthesia: current aspects of diagnosis and prevention. Eur J Anaesthesiol 1994, 11:263–284.
Chacko T, Ledford D: Peri-anesthetic anaphylaxis. Immunol Allergy Clin North Am 2007, 27:213–230.
Laxenaire MC, Mouton DC, Moneret-Vautrin DA, et al.: Drugs and another agents involved in anaphylactic shock during anesthesia: a French multicenter epidemiological inquiry. Ann Fr Anesth Reanim 1993, 12:91–96.
Simon MR: Anaphylaxis associated with relative bradycardia. Ann Allergy 1989, 62:495–497.
Currie M, Kerridge RK, Bacon AK, Williamson JA: Crisis management during anaesthesia: anaphylaxis and allergy. Qual Saf Health Care 2005, 14:e19.
Fisher MM, Bowey CJ: Intradermal compared with prick testing in the diagnosis of anaesthetic allergy. Br J Anaesth 1997, 79:59–63.
Garvey LH, Roed-Petersen J, Menné T, Husum B.: Danish Anaesthesia Allergy Centre—preliminary results. Acta Anaesthesiol Scand 2001, 45:1204–1209.
Thacker MA, Davis FM: Subsequent general anaesthesia in patients with a history of previous anaphylactoid/anaphylactic reaction to muscle relaxant. Anaesth Intensive Care 1999, 27:190–193.
Pepys J, Pepys EO, Baldo BA, Whitwam JG: Anaphylactic/anaphylactoid reactions to anaesthetic and associated agents. Skin prick tests in aetiological diagnosis. Anaesthesia 1994, 49:470–475.
Rose M, Fisher M: Rocuronium: high risk for anaphylaxis? Br J Anaesth 2001, 86:678–682.
Harboe T, Guttormsen AB, Irgens A, et al.: Anaphylaxis during anesthesia in Norway: a 6-year single-center follow-up study. Anesthesiology 2005, 102:897–903.
Deville WL, Bezemer PD, Bouter LM: Publications on diagnostic test evaluation in family medicine journals: an optimal search strategy. J Clin Epidemiol 2000, 53:65–69.
Moscicki RA, Sockin SM, Corsello BF, et al.: Anaphylaxis during induction of general anesthesia: subsequent evaluation and management. J Allergy Clin Immunol 1990, 86:325–332.
Fisher MM, Baldo BA: Mast cell tryptase in anaesthetic anaphylactoid reactions. Br J Anaesth 1998, 80:26–29.
Brown SG, Blackman KE, Heddle RJ: Can serum mast cell tryptase help diagnose anaphylaxis? Emerg Med 2004, 16:120–124.
Tamayo E, Perez M, Gomez JI, Alvarez FJ: Allergy of anaesthetizing agents in Spain. Br J Anaesth 1999, 83:336–337.
Mertes PM, Laxenair MC, Lienhart A, et al.: Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice. J Investig Allergol Clin Immunol 2005, 15:91–101.
Edwards R, Aronson JK: Adverse drug reactions: definitions, diagnosis, and management. Lancet 2000, 356:1255–1259.
Kroigaard M, Garvey LH, Gillberg L, et al.: Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol Scand 2007, 51:655–670.
Aberer W, Bircher A, Romano A, et al.: Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy 2003, 58:854–863.
Messaad D, Sahla H, Benahmed S, et al.: Drug provocation testing in patients with a history suggesting an immediate drug hypersensitivity reaction. Ann Intern Med 2004, 140:1001–1007.
Macy E, Mangat R, Burchette RJ: Penicillin skin testing in advance of need: multiyear follow-up in 568 test result-negative subjects exposed to oral penicillins. J Allergy Clin Immunol 2003, 111:1111–1115.
Torres MJ, Mayorga C, Leyva L, et al.: Controlled administration of penicillin to patients with a positive history but negative skin and specific serum IgE tests. Clin Exp Allergy 2002, 32:270–276.
Brockow K, Romano A, Blanca M, et al.: General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy 2002, 57:45–51.
Wöhrl S, Vigl K, Stingl G: Patients with drug reactions—is it worth testing? Allergy 2006, 61:928–934.
Schatz M: Skin testing and incremental challenge in the evaluation of adverse reactions to local anesthetics. J Allergy Clin Immunol 1984, 74:606–616.
Wasserfallen JB, Frei PC: Long-term evaluation of usefulness of skin and incremental challenge tests in patients with history of adverse reaction to local anesthetics. Allergy 1995, 50:162–165.
Nelson H: Variables in allergy skin testing. Immunol Allergy Clin North Am 2001, 21:281–290.
Vervloet D, Nizankowska E, Araud A, et al.: Adverse reactions to suxamethonium and other muscle relaxants under general anesthesia. J Allergy Clin Immunol 1983, 71:552–559.
Van der Schouw YT, Verbeek AL, Ruijs JH: ROC curves for the initial assessment of new diagnostic tests. Fam Pract 1992, 9:506–511.
McCann WA, Ownby DR: The reproducibility of the allergy skin test scoring and interpretation by board-certified/board-eligible allergists. Ann Allergy Asthma Immunol 2002, 89:368–371.
Turkeltaub P: Performance standards for allergen skin testing: an approach to proficiency testing. Immunol Allergy Clin North Am 2001, 21:321–328.
Mailing HJ: Methods of skin testing. Allergy 1993, 48:s14.
Laroche D, Malzac L, Nicaise-Roland P, et al.: Assessment of a new commercial IgE test for diagnosing allergy to neuromuscular blocking agents [abstract]. Anesthesiology 2008, 109:A1143.
Mertes PM, Laxenaire M, Alla F: Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999–2000. Anesthesiology 2003, 99:521–523.
Bernstein D, Wanner M, Borish L, Liss G: Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990–2001 J Allergy Clin Immunol 2004, 113:1129–1136.
Assem E: Anaphylactic anaesthetic reactions. The value of paper radioallergosorbent tests for IgE antibodies to muscle relaxants and thiopentone. Anaesthesia 1990, 45:1032–1038.
Hamilton R, Rossil CE, Yeang HY, et al.: Latex specific IgE assay sensitivity enhanced using Hev b5 enriched latex allergosorbent. Available at http://deptmed. med.som.jhmi.edu/research/2003/Abstracts/hamilton.html. Accessed July 8, 2008.
Brown RH, Schauble JA, Hamilton RG: Prevalence of latex allergy in occupationally exposed healthcare workers: identification of sensitized but non-symptomatic latex allergic anesthesiologists. Anesthesiology 1998, 89:292–299.
Fisher MM, Baldo BA: Immunoassays in the diagnosis of anaphylaxis to neuromuscular blocking drugs: the value of morphine for the detection of IgE antibodies in allergic subjects. Anaesth Intensive Care 2000, 28:167–170.
Fisher MM, Merefield D, Baldo B: Failure to prevent an anaphylactic reaction to a second neuromuscular blocking drug during anaesthesia. Br J Anaesth 1999, 82:770–773.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bleasel, K.E., Donnan, G. & Unglik, G.A. General anesthetic allergy testing. Curr Allergy Asthma Rep 9, 50–56 (2009). https://doi.org/10.1007/s11882-009-0008-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11882-009-0008-3