Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
Anesth Analg. 2011 Nov;113(5):1202-12. doi: 10.1213/ANE.0b013e31822d45ac. Epub 2011 Aug 24.
The types of agents implicated to trigger intraoperative anaphylactic reactions vary among reports, and there are no recent series from the United States. In this retrospective study, we examined perioperative anaphylactic reactions that occurred at a major tertiary referral academic center.
To characterize perioperative allergens associated with anaphylactic reactions, we reviewed the Mayo Clinic Division of Allergic Diseases skin test database between 1992 to 2010. The records of all patients who were tested for perioperative and anesthetic medications were reviewed. Charts that included a detailed history obtained by an allergist, skin test results, and tryptase measurements when available were reviewed and categorized.
Thirty-eight patients were found to have an anaphylactic reaction during anesthesia, of which 18 were immunoglobulin (Ig)E-mediated anaphylactic reactions (likely causative agent identified by skin test), 6 were non-IgE-mediated anaphylactic reactions (elevated tryptase levels and negative skin test), and 14 were probable non-IgE-mediated anaphylactic reactions (tryptase levels normal or not obtained and negative skin test). Of the IgE-mediated anaphylactic reactions, antibiotics were the most prevalent likely causative agent (50%) whereas neuromuscular blocking drugs were implicated as a likely causative agent in 11% of reactions.
Antibiotics were the most common likely causative agent associated with IgE-mediated anaphylactic reactions; however, for 52.6% of reactions, a causative agent could not be determined, suggesting a non-IgE-mediated anaphylactic reaction. The undiagnosed allergic reactions place patients at risk of a subsequent reexposure to the same allergen, or lead to unnecessary avoidance of needed medications.
引发术中过敏反应的药物种类在不同的报告中有所不同，且目前尚无来自美国的最新系列报道。在这项回顾性研究中，我们检查了一家主要的三级转诊学术中心发生的围手术期过敏反应。
为了确定与过敏反应相关的围手术期过敏原，我们回顾了 1992 年至 2010 年期间梅奥诊所过敏科的皮肤试验数据库。回顾并分类了所有接受围手术期和麻醉药物皮试的患者的记录。这些记录包括过敏症专家详细的病史、皮肤试验结果和可用的类胰蛋白酶测量结果。
发现 38 例患者在麻醉期间发生过敏反应，其中 18 例为免疫球蛋白（IgE）介导的过敏反应（通过皮肤试验确定的可能致病原），6 例为非 IgE 介导的过敏反应（类胰蛋白酶水平升高和皮肤试验阴性），14 例为可能的非 IgE 介导的过敏反应（类胰蛋白酶水平正常或未获得且皮肤试验阴性）。在 IgE 介导的过敏反应中，抗生素是最常见的可能致病原（50%），而神经肌肉阻滞剂则被认为是 11%反应的可能致病原。
抗生素是与 IgE 介导的过敏反应最相关的常见可能致病原；然而，52.6%的反应无法确定致病原，提示为非 IgE 介导的过敏反应。未诊断的过敏反应使患者面临再次暴露于同一过敏原的风险，或导致不必要地避免使用所需药物。
