Guyer Autumn C, Saff Rebecca R, Conroy Michelle, Blumenthal Kimberly G, Camargo Carlos A, Long Aidan A, Banerji Aleena
Division of Allergy and Inflammation, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):94-100. doi: 10.1016/j.jaip.2014.11.011. Epub 2014 Dec 2.
For patients with a history of drug hypersensitivity reaction (HSR) during anesthesia, strategies to minimize risk with subsequent anesthesia are unclear. Identification of the cause of HSR during anesthesia remains challenging.
To determine the success of a comprehensive allergy evaluation and management plan for patients with HSR during anesthesia, including identification of the causative agent and review of outcomes during subsequent anesthesia exposure.
We performed chart reviews of patients referred for the evaluation of HSR during anesthesia between 2003 and 2012. Data collection included patient characteristics, signs/symptoms of HSR during anesthesia, and subsequent outcomes. Patients underwent comprehensive allergy evaluation including skin testing for identifying potential culprit agents, and the results were used to provide recommendations for any subsequent anesthesia.
Over the 10-year study period, 73 patients with HSR during anesthesia were referred for further evaluation. Thirteen patients (18%) had positive skin test results to a drug received during anesthesia. One patient with a positive skin test result was diagnosed with mastocytosis. The causative agents identified in these 13 patients included latex, β-lactam antibiotics, neuromuscular blockers, tetracaine, odansetron, and fentanyl. On follow-up, 47 of the 73 patients (64%) subsequently underwent procedures requiring anesthesia. Using our recommendations from evaluation and testing, 45 of these 47 patients (96%) successfully tolerated subsequent anesthesia. The 2 patients who developed recurrent HSR during anesthesia were later diagnosed with mast cell disorders.
Our comprehensive evaluation and management plan minimizes risk with subsequent anesthesia even when the cause of HSR could not be identified. Baseline tryptase levels may be helpful in this patient population to diagnose mast cell disorders.
对于有麻醉期间药物过敏反应（HSR）病史的患者，降低后续麻醉风险的策略尚不清楚。确定麻醉期间HSR的病因仍然具有挑战性。
确定针对麻醉期间发生HSR的患者的综合过敏评估和管理计划的成效，包括确定致病因素并回顾后续麻醉暴露期间的结果。
我们对2003年至2012年间因麻醉期间HSR评估而转诊的患者进行了病历审查。数据收集包括患者特征、麻醉期间HSR的体征/症状以及后续结果。患者接受了全面的过敏评估，包括用于识别潜在致病因素的皮肤试验，结果用于为后续任何麻醉提供建议。
在10年的研究期间，73例麻醉期间发生HSR的患者被转诊进行进一步评估。13例患者（18%）对麻醉期间使用的药物皮肤试验结果呈阳性。1例皮肤试验结果呈阳性的患者被诊断为肥大细胞增多症。在这13例患者中确定的致病因素包括乳胶、β-内酰胺类抗生素、神经肌肉阻滞剂、丁卡因、奥丹西隆和芬太尼。随访时，73例患者中的47例（64%）随后接受了需要麻醉的手术。根据我们评估和检测的建议，这47例患者中的45例（96%）成功耐受了后续麻醉。2例在麻醉期间出现复发性HSR的患者后来被诊断为肥大细胞疾病。
即使无法确定HSR的病因，我们的综合评估和管理计划也能降低后续麻醉的风险。基线类胰蛋白酶水平可能有助于在这一患者群体中诊断肥大细胞疾病。
