Department of Pediatrics, University of Verona, Verona, Italy.
Int J Immunopathol Pharmacol. 2011 Jul-Sep;24(3 Suppl):S35-46. doi: 10.1177/03946320110240s306.
The most common agents that are responsible for intraoperative anaphylaxis are muscle relaxants. In fact, neuromuscular blocking agents (NMBAs) contribute to 50-70 percent of allergic reactions during anaesthesia. The main mechanism of hypersensitivity reactions to NMBAs is represented by acute type I allergic reactions and the most severe form is anaphylaxis. The rate of non IgE mediated immediate hypersensitivity reactions usually varies between 20 percent and 35 percent of the reported cases in most large series. In a recent report, non allergic suspected reactions to NMBAs occurred with almost the same frequency as did those with an allergic component. Although the precise mechanisms of these reactions remain difficult to ascertain, they usually result from direct non specific mast cell and basophil activation. After diagnostic procedures, regardless of the specific IgE results, NMBAs are contraindicated if the skin tests were positive. In view of the constantly evolving anesthesiologic practices, and of the complexity of allergy investigation, an active policy to identify patients at risk and to provide any necessary support to anaesthetists and allergologists should be promoted. The high frequency of IgE anaphylactic reactions and the feasibility of skin tests in children justify systematic allergy testing whenever hypersensitivity reaction occurs during general anaesthesia.
引起术中过敏反应最常见的药物是肌松药。事实上，在麻醉期间，神经肌肉阻滞剂（NMBA）导致 50-70%的过敏反应。对 NMBA 产生超敏反应的主要机制是急性 I 型过敏反应，最严重的形式是过敏反应。非 IgE 介导的即刻超敏反应的发生率通常在大多数大系列报告的病例中占 20%至 35%。在最近的一份报告中，非过敏疑似 NMBA 反应的发生频率与具有过敏成分的反应几乎相同。尽管这些反应的确切机制仍然难以确定，但它们通常是由于直接的非特异性肥大细胞和嗜碱性粒细胞激活引起的。在诊断程序后，无论特定 IgE 结果如何，如果皮肤测试呈阳性，则 NMBA 是禁忌的。鉴于麻醉实践的不断发展和过敏反应研究的复杂性，应积极识别有风险的患者，并为麻醉师和过敏科医生提供任何必要的支持。由于 IgE 过敏反应的高频率以及儿童皮肤试验的可行性，因此在全身麻醉期间发生过敏反应时，应进行系统的过敏测试。
