Department of Clinical Immunology, Oxford, UK.
Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Br J Anaesth. 2018 Jun;120(6):1195-1201. doi: 10.1016/j.bja.2018.02.033. Epub 2018 Apr 10.
Perioperative anaphylaxis (POA) is infrequent, but remains an important and potentially life-threatening complication of general anaesthesia. The diagnostic uncertainty surrounding the investigation of anaesthetic allergy poses numerous challenges. We aimed to inform practice by auditing the outcomes of repeat anaesthesia, after an investigation for previous POA.
One-hundred and seventy-four subjects were investigated after suspected POA between December 2002 and August 2015. Outcome data were obtained for a total of 70 patients who underwent repeat anaesthesia after investigation in the drug-allergy clinic.
Sixty-seven out of the 70 patients studied underwent repeat anaesthesia without further complications. Three individuals experienced a further episode of anaphylaxis. In two cases, incomplete referral information led to the offending drugs being omitted from initial testing. The third was found to have underlying systemic mastocytosis (SM).
In our cohort, the incidence of repeat anaphylaxis after a comprehensive assessment in the drug-allergy clinic for suspected POA was 4%. Important risk factors include the completeness of referral information provided to the assessor and the role of exacerbating disorders, particularly SM.
围手术期过敏反应（POA）虽不常见，但仍是全身麻醉的一种重要且潜在威胁生命的并发症。由于对麻醉过敏的调查存在诊断不确定性，因此带来了诸多挑战。我们旨在通过对先前 POA 调查后的重复麻醉结果进行审核，为实践提供信息。
2002 年 12 月至 2015 年 8 月期间，我们对疑似 POA 的 174 名患者进行了调查。对在药物过敏诊所进行调查后接受重复麻醉的 70 名患者共获得了 70 名患者的结果数据。
在研究的 70 名患者中，有 67 名患者在没有进一步并发症的情况下接受了重复麻醉。有 3 人出现了进一步的过敏反应。在两例中，由于不完全的转诊信息导致最初的测试中遗漏了可疑药物。第三例被发现患有潜在的系统性肥大细胞增多症（SM）。
在我们的队列中，对疑似 POA 进行全面药物过敏评估后，重复发生过敏反应的发生率为 4%。重要的危险因素包括向评估者提供的转诊信息的完整性以及加重性疾病的作用，特别是 SM。
