Malinovsky J-M, Decagny S, Wessel F, Guilloux L, Mertes P M
Departments of Anesthesia and Intensive Care, Hôtel-Dieu, Nantes, France.
Acta Anaesthesiol Scand. 2008 Feb;52(2):175-81. doi: 10.1111/j.1399-6576.2007.01489.x. Epub 2007 Nov 13.
The incidence of hypersensitivity reactions during anesthesia is underestimated because clinical symptoms may vary and diagnosis is not obvious. Our aim was to investigate the consequences of a systematic follow-up of patients on the estimated incidence of allergic reactions during anesthesia.
We conducted a prospective study over a 2-year period (70,000 anesthesias). When patients were suspected with hypersensitivity reactions or with unexplained adverse reactions during anesthesia, blood was sampled to measure histamine and tryptase, and then skin tests were performed 4-6 weeks later.
During the studied period, 39 patients were enrolled in the database. Eight were excluded because of lack of skin tests. Twenty-two patients had clinical features compatible with immediate hypersensitivity reaction, and nine had reactions rated as 'unexplained' by the attending physician. Following systematic investigation, we found 22 hypersensitivity reactions (15 patients with obvious and seven with unexplained reactions) during anesthesia. This increases the estimated incidence of hypersensitivity reactions from 1 : 4667 to 1 : 3180 anesthesias. Tryptase concentrations were increased in only 50% of these patients. In our series, positive and negative predictive values of tryptase at T(0) for the diagnosis of anaphylaxis were 100% and 60%, respectively. Latex was the major causative agent, followed by neuromuscular blocking agents and antibiotics.
Systematic follow-up of patients with unexplained reactions during anesthesia increases the estimated incidence of IgE-mediated hypersensitivity reactions during anesthesia by 50%.
麻醉期间过敏反应的发生率被低估，因为临床症状可能各异且诊断并不明显。我们的目的是研究对患者进行系统随访对麻醉期间过敏反应估计发生率的影响。
我们进行了一项为期2年的前瞻性研究（70000例麻醉）。当患者在麻醉期间疑似发生过敏反应或出现不明原因的不良反应时，采集血液样本检测组胺和类胰蛋白酶，然后在4 - 6周后进行皮肤试验。
在研究期间，39例患者被纳入数据库。8例因未进行皮肤试验而被排除。22例患者具有与速发型过敏反应相符的临床特征，9例患者的反应被主治医生评定为“不明原因”。经过系统调查，我们在麻醉期间发现了22例过敏反应（15例有明显反应，7例反应不明原因）。这使得过敏反应的估计发生率从1 : 4667增加到1 : 3180麻醉例数。这些患者中只有50%的类胰蛋白酶浓度升高。在我们的系列研究中，T(0)时类胰蛋白酶对过敏反应诊断的阳性预测值和阴性预测值分别为100%和60%。乳胶是主要致病因素，其次是神经肌肉阻滞剂和抗生素。
对麻醉期间有不明原因反应的患者进行系统随访可使麻醉期间IgE介导的过敏反应估计发生率增加50%。
