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Approach to Perioperative Anaphylaxis in 2020: Updates in Diagnosis and Management

  • Anaphylaxis and Drug Allergy (BT Kelly and M Castells, Section Editors)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of the paper is to review the epidemiology, pathogenesis, diagnosis, and manifestations of perioperative anaphylaxis (POA). We seek to review the most common culprits of POA and different diagnostic modalities for evaluation.

Recent Findings

Specific IgE testing has a limited role in POA evaluation due to lack of widespread availability and low sensitivity. Basophil activation testing is complementary to skin tests and can assist NMBA sensitivity diagnosis in complex cases. In the past years, there has been an exponential increase in suspected teicoplanin allergic reactions in the European Union. Chlorhexidine is also being increasingly implicated as a culprit in POA.

Summary

Multiple classes of perioperative medications cause POA. Diagnostic modalities available include skin testing with nonirritating concentrations, basophil activation tests, specific IgE, and drug provocation testing. An accurate record and critical analysis of perioperative events is more important than isolated test results. Future studies evaluating the pathophysiology of these reactions and other therapeutic strategies, such as targeting the MRGPRX2 receptor, are needed.

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Abbreviations

POA:

Perioperative anaphylaxis

NMBAs:

Neuromuscular blocking agents

NAP6:

National Audit Project of the Royal College of Anesthetists

MRGPRX2:

Mas-related G protein–coupled receptor X2

BAT:

Basophil activation testing

DPT:

Drug provocation testing

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Pain Medicine, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA

    Jerry Kalangara

  2. Atlanta VA Health Care System, Decatur, GA, USA

    Jerry Kalangara & Nichole McIntosh

  3. Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, GA, USA

    Kristine Vanijcharoenkarn & Merin Kuruvilla

  4. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA

    Grant C. Lynde & Nichole McIntosh

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  1. Jerry Kalangara
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  2. Kristine Vanijcharoenkarn
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  3. Grant C. Lynde
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  4. Nichole McIntosh
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  5. Merin Kuruvilla
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Correspondence to Merin Kuruvilla.

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Dr. Lynde reports personal fees from Merck Pharmacuticals. The other authors declare that they have no conflicts of interest relevant to this manuscript.

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Kalangara, J., Vanijcharoenkarn, K., Lynde, G.C. et al. Approach to Perioperative Anaphylaxis in 2020: Updates in Diagnosis and Management. Curr Allergy Asthma Rep 21, 4 (2021). https://doi.org/10.1007/s11882-020-00980-y

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