Allergic reactions during anaesthesia: diagnosis and treatment

Filiep M. Soetens¹ and Marcel P. Vercauteren²
1. Sint-Elisabeth Hospital, Turnhout
2. Antwerp University Hospital, Belgium

Abstract

Allergic reactions during anaesthesia are rare, but potentially life-threatening allergic events. The worst manifestations are cardiovascular collaps, bronchospasm and laryngeal oedema. Anaphylactic and anaphylactoid reactions are clinically indistinguishable. The most incriminated agents are neuromuscular blocking drugs and latex. Treatment consists of instant interruption of contact with possible antigens, 100% oxygen, endotracheal intubation, lower limb elevation, adrenaline and volume expansion. Cross-reactivity between neuromuscular blocking drugs occurs frequently. It is unclear which neuromuscular blocking agent is actually the safest. Further in vivo and in vitro investigation is mandatory to find the responsible drug and to make future anaesthesia safe. Diagnosis is made with intra-operative tests (mainly mast cell tryptase) and postoperative tests (skin tests and RASTs for specific IgE antibodies). If time permits postoperative testing should be delayed until 4-6 weeks after the treated event.
The installation of a national database may allow to determine the exact and objective incidence of allergic reactions to different substances in relationship with their market share before straightforward conclusions may be drawn or comparisons with other countries performed.

Key words. Allergy, anaesthesia, anaphylaxis