Amedeo J, Occelli G, Pradier C, Grimaud D
Service du Pr J.-P. Cassuto-Hôpital de l'Archet 1, 151, route St Antoine de Ginestière, BP 3079, 06202 Nice.
Allerg Immunol (Paris). 2002 Oct;34(8):277-80.
What impact does the use of new drugs and latex gloves it have on the frequency and the severity of peri-anaesthetic anaphylactoid reactions? Does the evolution of in vitro techniques does represent a progress in the imputability of the substances at the origin of the shock?
They include the letter from the anaesthetic doctor, the questioning by the allergologist, skin tests (Pricks, IDR) with the anaesthetic substances and the latex according to the GERAP protocol and the biologic tests (Human Basophilic Degranulation test (TDBH), Radio ImmunoAssay (RIA), leukotrienes E4 assay (LTC4), Flow Cytometry (CMF)).
386 patients were explored (289 women and 88 men, mean age 41.5 years). The muscle relaxants are the first cause of anaphylaxis 77%. Muscle relaxants cross allergy is found in 55.1%. The Latex, tested since 1989 with Allerbio and Stallergenes extracts, is responsible for 25 shocks with one death and 15 with grade III or IV. Preventive antibiotherapy, since consensus meeting of 1992, seems responsible of 17 accidents. 116 TDBH, 216 RIA, 17LTC4 and 47CMF. TDBH are made concordant with skin tests in 48.2% against, 71.2% for the RIA.
The experience of 17 years of allergo-anaesthetic consultation confirms the first row for the muscles relaxants for the target of anaphylactic shock, but the imputability of Vecuronium and Rocuronium increases to the detriment of the Suxamethonium. The Latex is in the second row, but the target questioning, the systematic use of Prick tests and "latex free" surgery room limit its increase which should change down. The antibiotherapy occupies the third row and might increase. 54 accidents have remained unexplained.
使用新药和乳胶手套对围麻醉期类过敏反应的发生率和严重程度有何影响？体外技术的发展是否代表了对休克源物质归因的进步？
包括麻醉医生的信件、过敏科医生的询问、根据GERAP方案对麻醉物质和乳胶进行的皮肤试验（点刺试验、皮内反应试验）以及生物学试验（人嗜碱性粒细胞脱颗粒试验（TDBH）、放射免疫分析（RIA）、白三烯E4测定（LTC4）、流式细胞术（CMF））。
共检查了386例患者（289名女性和88名男性，平均年龄41.5岁）。肌肉松弛剂是过敏反应的首要原因，占77%。发现肌肉松弛剂交叉过敏的比例为55.1%。自1989年以来使用Allerbio和Stallergenes提取物检测乳胶，导致25例休克，1例死亡，15例为III级或IV级。自1992年共识会议以来，预防性抗生素治疗似乎导致了17起事故。进行了116次TDBH、216次RIA、17次LTC4和47次CMF。TDBH与皮肤试验的一致性为48.2%，而RIA为71.2%。
17年的过敏麻醉咨询经验证实，肌肉松弛剂是过敏性休克的首要靶点，但维库溴铵和罗库溴铵的归因增加，而琥珀胆碱的归因减少。乳胶排在第二位，但针对性询问、系统使用点刺试验和“无乳胶”手术室限制了其增加趋势，这种趋势应该会下降。抗生素治疗排在第三位，且可能会增加。有54起事故原因不明。
