Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Clin Exp Allergy. 2018 Jul;48(7):846-861. doi: 10.1111/cea.13180. Epub 2018 Jun 19.
The Royal College of Anaesthetists 6th National Audit Project examined Grade 3-5 perioperative anaphylaxis for 1 year in the UK.
To describe the causes and investigation of anaphylaxis in the NAP6 cohort, in relation to published guidance and previous baseline survey results.
We used a secure registry to gather details of Grade 3-5 perioperative anaphylaxis. Anonymous reports were aggregated for analysis and reviewed in detail. Panel consensus diagnosis, reaction grade, review of investigations and clinic assessment are reported and compared to the prior NAP6 baseline clinic survey.
A total of 266 cases met inclusion criteria between November 2015 and 2016, detailing reactions and investigations. One hundred and ninety-two of 266 (72%) had anaphylaxis with a trigger identified, of which 140/192 (75%) met NAP6 criteria for IgE-mediated allergic anaphylaxis, 13% lacking evidence of positive IgE tests were labelled "non-allergic anaphylaxis". 3% were non-IgE-mediated anaphylaxis. Adherence to guidance was similar to the baseline survey for waiting time for clinic assessment. However, lack of testing for chlorhexidine and latex, non-harmonized testing practices and poor coverage of all possible culprits was confirmed. Challenge testing may be underused and many have unacceptably delayed assessments, even in urgent cases. Communication or information provision for patients was insufficient, especially for avoidance advice and communication of test results. Insufficient detail regarding skin test methods was available to draw conclusions regarding techniques.
Current clinical assessment in the UK is effective but harmonization of approach to testing, access to services and MHRA reporting is needed. Expert anaesthetist involvement should increase to optimize diagnostic yield and advice for future anaesthesia. Dynamic tryptase evaluation improves detection of tryptase release where peak tryptase is <14 μg/L and should be adopted. Standardized clinic reports containing appropriate details of tests, conclusions, avoidance, cross-reactivity and suitable alternatives are required to ensure effective, safe future management options.
皇家麻醉师学院第 6 次国家审计项目在英国对 1 年内的 3-5 级围手术期过敏反应进行了研究。
根据已发布的指南和之前的基线调查结果，描述 NAP6 队列中过敏反应的原因和检查。
我们使用安全登记处收集 3-5 级围手术期过敏反应的详细信息。对匿名报告进行汇总分析，并进行详细审查。报告并比较了专家组诊断、反应等级、检查回顾和临床评估，与之前的 NAP6 临床基线调查结果进行比较。
2015 年 11 月至 2016 年间，共有 266 例符合纳入标准的病例，详细描述了反应和检查情况。266 例中有 192 例（72%）确定了过敏反应的诱因，其中 140/192 例（75%）符合 NAP6 对 IgE 介导的过敏反应的标准，13%缺乏阳性 IgE 检测证据的病例被标记为“非过敏反应”。3%为非 IgE 介导的过敏反应。对指南的遵循与基线调查中对临床评估的等待时间相似。然而，仍存在氯己定和乳胶检测缺乏、检测方法不统一以及未能全面检查所有可能的罪魁祸首等问题。挑战测试可能使用不足，许多病例的评估都被延迟，即使是紧急情况。对患者的沟通或信息提供也不足，特别是在避免建议和测试结果的沟通方面。关于皮肤测试方法的详细信息不足，无法得出有关技术的结论。
目前英国的临床评估是有效的，但需要对测试方法、服务的可及性和 MHRA 报告进行协调。应增加专家麻醉师的参与度，以优化诊断效果和未来麻醉的建议。动态类胰蛋白酶评估可提高检测到类胰蛋白酶释放的灵敏度，特别是当峰值类胰蛋白酶<14μg/L 时，应采用该方法。需要标准化的临床报告，其中包含测试、结论、避免、交叉反应和适当替代方案的适当详细信息，以确保有效的、安全的未来管理选择。
