Clinical Immunology and Allergy Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Anaesthesia and Intensive Care Medicine, Royal United Hospital Bath NHS Trust, Bath, UK.
Clin Exp Allergy. 2017 Oct;47(10):1318-1330. doi: 10.1111/cea.12993. Epub 2017 Sep 7.
Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6 National Audit Project.
We compare self-declared UK practice in specialist perioperative allergy services with national recommendations.
A SurveyMonkey™ questionnaire was distributed to providers of allergy services in the UK. Responses were assessed for adherence to the best practice recommendations of the British Society for Allergy and Clinical Immunology (BSACI), the Association of Anaesthetists of Great Britain and Ireland and the National Institute for Health and Care Excellence (NICE) Guidance on Drug Allergy-CG183.
Over 1200 patients were evaluated in 44 centres annually. Variation in workload, waiting times, access, staffing and diagnostic approach was noted. Paediatric centres had the longest routine waiting times (most wait >13 weeks) in contrast to adult centres (most wait <12 weeks). Service leads are allergists/immunologists (91%) or anaesthetists (7%). Potentially important differences were seen in: testing repertoire [10/44 (23%) lacked BSACI compliant neuromuscular blocking agent (NMBA) panels and 17/44 (39%) lacked a NAP6-defined extended panel; many failed to screen all cases for chlorhexidine 19/44 (43%) or latex 21/44 (48%)], staffing [only 26/44 (59%) had specialist nurses and 18/44 (41%) an anaesthetist] and provision of information [18/44 (41%) gave immediate information in clinic and 5/44 (11%) sign-posted support groups]. Most centres were able to provide diagnostic challenges to antibiotics [40/44 (91%]) and local anaesthetics [41/44 (93%)].
Diagnostic testing is not harmonized, with marked variability in the NMBA panels used to identify safe alternatives. Chlorhexidine and latex are not part of routine testing in many centres. Poor access to services and patient information provision require attention. Harmonization of diagnostic approach is desirable, particularly with regard to a minimum NMBA panel for identification of safe alternatives.
现已有关于围手术期药物过敏调查的指南，但服务质量尚不清楚。皇家麻醉师学院 6 项国家审计项目对专科围手术期过敏服务进行了调查。
我们比较了英国专科围手术期过敏服务中自我宣称的做法与国家建议。
通过 SurveyMonkey™问卷向英国过敏服务提供者进行调查。评估结果是否符合英国过敏与临床免疫学学会（BSACI）、英国和爱尔兰麻醉师协会以及国家卫生与保健卓越研究所（NICE）药物过敏指南（CG183）的最佳实践建议。
44 个中心每年评估超过 1200 名患者。注意到工作量、等候时间、准入、人员配备和诊断方法存在差异。儿科中心的常规等候时间最长（大多数等待时间>13 周），而成人中心则较短（大多数等待时间<12 周）。服务负责人是过敏专家/免疫学家（91%）或麻醉师（7%）。在以下方面观察到潜在的重要差异：检测组合[44 个中心中有 10 个（23%）缺乏符合 BSACI 标准的神经肌肉阻滞剂（NMBA）检测板，17 个（39%）缺乏 NAP6 定义的扩展检测板；许多中心未能对所有病例进行氯己定 19/44（43%）或乳胶 21/44（48%）筛查]、人员配备[只有 26/44（59%）有专科护士，18/44（41%）有麻醉师]和信息提供[18/44（41%）在诊室内立即提供信息，5/44（11%）为患者提供支持小组的信息]。大多数中心能够提供抗生素[40/44（91%）]和局部麻醉剂[41/44（93%）]的诊断挑战。
诊断检测尚未实现协调，用于确定替代药物的 NMBA 检测板存在明显差异。许多中心未将氯己定和乳胶纳入常规检测。服务准入和患者信息提供存在问题，需要加以关注。有必要对诊断方法进行协调，特别是对 NMBA 检测板最低要求以确定替代药物。
