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Multicentre retrospective analysis of anaphylaxis during general anaesthesia in the UK: aetiology and diagnostic performance of acute serum tryptase.
MedLine Citation:
PMID:  25070464     Owner:  NLM     Status:  Publisher    
BACKGROUND: This is the first multi-centre retrospective survey from UK to evaluate the aetiology and diagnostic performance of tryptase in anaphylaxis during general anaesthesia (GA).
METHODS: Data was retrospectively collected (2005-12) from 161 patients [mean ± SD, 50 ± 15 years] referred to 4 regional UK centres. Receiver Operating Characteristic curves (ROC) were constructed to assess utility of tryptase measurements in the diagnosis of IgE mediated anaphylaxis and the performance of percentage change from baseline (PC) and absolute tryptase (AT) quantitation.
RESULTS: An IgE mediated cause was identified in 103 patients (64%); neuromuscular blocking agents (NMBA) constituted the leading cause (38%) followed by antibiotics (8%), patent blue dye (6%), chlorhexidine (5%), and other agents (7%). In contrast to previous reports, latex-induced anaphylaxis was rare (0.6%). A non-IgE mediated cause was attributed in 10 patients (6%) and no cause could be established in 48 cases (30%). Three serial tryptase measurements were available in 34% of patients and a ROC analysis of area under curve (AUC) showed comparable performance for PC and AT. A ≥ 80% PPV for identifying an IgE mediated anaphylaxis was achieved with a PC of >141% or an AT of >15.7 mcg/l.
CONCLUSION: NMBAs were the leading cause of anaphylaxis, followed by antibiotics with latex allergy being uncommon. Chlorhexidine and patent blue dye are emerging important healthcare associated allergens that may lead to anaphylaxis. An elevated acute serum tryptase (PC >141% ,AT >15.7 mcg/l) is highly predictive of IgE mediated anaphylaxis and both methods of interpretation are comparable.
Mamidipudi T Krishna; Melanie York; Tak Chin; Gnanasegaram Gnanakumaran; Jane Heslegrave; Cathryn Derbridge; Aarnoud Huissoon; Lavanya Diwakar; Efrem Eren; Richard J Crossman; Nasreen Khan; Anthony P Williams
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-7-29
Journal Detail:
Title:  Clinical and experimental immunology     Volume:  -     ISSN:  1365-2249     ISO Abbreviation:  Clin. Exp. Immunol.     Publication Date:  2014 Jul 
Date Detail:
Created Date:  2014-7-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0057202     Medline TA:  Clin Exp Immunol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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This article is protected by copyright. All rights reserved.
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