Document Detail

Review of procedures for investigation of anaesthesia-associated anaphylaxis in Newcastle, Australia.
MedLine Citation:
PMID:  18361011     Owner:  NLM     Status:  MEDLINE    
The procedures, results and outcomes of investigation of 50 patients with clinical episodes of anaesthesia-associated anaphylaxis were retrospectively reviewed. Assessment was performed by measurement of serum tryptase and specific IgE and a combination of skin prick and intradermal skin testing. Testing was performed both for agents received during the anaesthetic and for agents the patient may encounter in future procedures. Twenty of 50 patients underwent a subsequent procedure after assessment. Sensitisation to neuromuscular blocking agents was identified in 18 patients (36%). Sensitisation to propofol (14 patients; 28%) and latex (four patients; 8%) was also frequently identified. No precise cause was identified in 11 cases (22%). Reactivity to more than one agent was identified in 14 patients (28%). Serum tryptase was measured within six hours of the episode in only 28 of the 50 cases. All the patients with elevated serum tryptase had clinically severe reactions. One patient initially found to be sensitised to propofol had another reaction during a second procedure, prompting further assessment where chlorhexidine reactivity was identified. Subsequent surgery in that patient and in 19 other patients where agents implicated in the testing were avoided, proceeded without incident. The results reaffirm that neuromuscular blocking agents are the most common cause of anaphylaxis during anaesthesia. The importance of serum tryptase measurement at the time of the acute episode needs to be emphasised. Investigation should include screening for chlorhexidine and latex in all patients, as exposure to both these agents is common and may be overlooked.
O McNeill; R K Kerridge; M J Boyle
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anaesthesia and intensive care     Volume:  36     ISSN:  0310-057X     ISO Abbreviation:  Anaesth Intensive Care     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-25     Completed Date:  2008-05-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0342017     Medline TA:  Anaesth Intensive Care     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  201-7     Citation Subset:  IM    
Department of Immunology, John Hunter Hospital, Newcastle, New South Wales, Australia.
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MeSH Terms
Aged, 80 and over
Anaphylaxis / diagnosis*,  etiology*,  immunology
Anesthesia, General / adverse effects*
Anesthetics / adverse effects*
Anesthetics, Intravenous / adverse effects
Antiemetics / adverse effects
Cross Reactions
Drug Hypersensitivity / diagnosis*,  immunology
Latex Hypersensitivity / diagnosis
Middle Aged
Neuromuscular Blocking Agents / adverse effects
Ondansetron / adverse effects
Propofol / adverse effects
Retrospective Studies
Skin Tests
Treatment Outcome
Tryptases / blood
Reg. No./Substance:
0/Anesthetics; 0/Anesthetics, Intravenous; 0/Antiemetics; 0/Neuromuscular Blocking Agents; 2078-54-8/Propofol; 99614-02-5/Ondansetron; EC

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