Scolaro R J, Crilly H M, Maycock E J, McAleer P T, Nicholls K A, Rose M A, The Rih
Member of Australiasian Society of Clinical Immunology and Allergy; European Academy of Allergy and Clinical Immunology.
Anaesth Intensive Care. 2017 Sep;45(5):543-555. doi: 10.1177/0310057X1704500504.
These guidelines are a consensus document developed by a working party of the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) to provide an approach to the investigation of perioperative anaphylaxis. They focus primarily on the use of skin testing as it is the investigation with the greatest clinical utility for the identification of the likely causative agent and potentially safer alternatives. The practicalities and process of skin testing, its limitations, and the place of other tests are discussed. These guidelines also address the roles of graded challenge and in vitro testing. The implications of anaphylaxis associated with neuromuscular blocking agents, beta-lactam antibiotics, local anaesthetic agents and chlorhexidine are discussed. Evidence for the recommendations is derived from literature searches using the words skin test, allergy, anaphylaxis, anaesthesia, and each of the individual agents listed in these guidelines. The individual articles were then reviewed for suitability for inclusion in these guidelines. Where evidence was not strong, as is the situation for many perioperative agents, expert consensus from the ANZAAG working party was used. These guidelines are intended for use by specialists involved in the investigation of perioperative allergy. They have been approved following peer review by members of ANZAAG and are available on the ANZAAG website: http://www.anzaag.com/anaphylaxis-management/testing-guidelines.pdf.
这些指南是由澳大利亚和新西兰麻醉过敏小组（ANZAAG）的一个工作小组制定的共识文件，旨在提供围手术期过敏反应的调查方法。它们主要侧重于皮肤试验的应用，因为皮肤试验是对确定可能的致病因素最具临床实用性且可能更安全的替代方法的调查。文中讨论了皮肤试验的实际操作和流程、其局限性以及其他检测方法的作用。这些指南还阐述了分级激发试验和体外检测的作用。文中讨论了与神经肌肉阻滞剂、β-内酰胺类抗生素、局部麻醉剂和洗必泰相关的过敏反应的影响。这些建议的证据来自于使用“皮肤试验”“过敏”“过敏反应”“麻醉”以及本指南中列出的每种单独药物等关键词进行的文献检索。然后对每篇文章进行审查，以确定其是否适合纳入本指南。在证据不足的情况下，就像许多围手术期药物的情况一样，则采用ANZAAG工作小组的专家共识。这些指南供参与围手术期过敏反应调查的专家使用。它们已经过ANZAAG成员的同行评审并获得批准，可在ANZAAG网站上获取：http://www.anzaag.com/anaphylaxis-management/testing-guidelines.pdf。
