Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.
Medical School, The University of Western Australia, Perth, WA, Australia.
Anaesthesia. 2019 Oct;74(10):1252-1259. doi: 10.1111/anae.14693. Epub 2019 May 11.
Propofol is the most commonly administered intravenous agent for anaesthesia in children. However, there are concerns that the emulsified preparation may not be safe in children with an allergy to egg, peanut, soybean or other legumes. We conducted a retrospective study of children with immunologically confirmed egg, peanut, soybean or legume allergy and who underwent general anaesthesia at Princess Margaret Hospital for Children between 2005 and 2015. We extracted details regarding allergy diagnosis, each anaesthetic administered and any adverse events or signs of an allergic reaction in the peri-operative period. A convenience sample of patients without any known food allergies was identified from our prospective anaesthesia research database and acted as a control group. We identified 304 food-allergic children and 649 procedures where propofol was administered. Of these, 201 (66%) had an egg allergy, 226 (74%) had a peanut allergy, 28 (9%) had a soybean allergy and 12 (4%) had a legume allergy. These were compared with 892 allergy-free patients who were exposed to propofol. In 10 (3%) allergy patients and 124 (14%) allergy-free patients, criteria for a possible allergic reaction were met. In nine of the food-allergic children and in all the controls valid non-allergic explanations for the clinical symptoms were found. One likely mild allergic reaction was experienced by a child with a previous history of intralipid allergy. We conclude that genuine serious allergic reaction to propofol is rare and is not reliably predicted by a history of food allergy.
异丙酚是儿童麻醉中最常用的静脉给药药物。然而，人们担心对于鸡蛋、花生、大豆或其他豆类过敏的儿童，使用乳剂制剂可能不安全。我们对 2005 年至 2015 年间在玛格丽特公主医院接受全身麻醉的、免疫确诊为鸡蛋、花生、大豆或豆类过敏的儿童进行了回顾性研究。我们提取了过敏诊断、每次麻醉以及围手术期任何不良事件或过敏反应迹象的详细信息。从我们的前瞻性麻醉研究数据库中随机选择了一组无已知食物过敏的患者作为对照组。我们共确定了 304 例食物过敏儿童和 649 例使用异丙酚的手术。其中，201 例（66%）有鸡蛋过敏，226 例（74%）有花生过敏，28 例（9%）有大豆过敏，12 例（4%）有豆类过敏。这些与 892 例暴露于异丙酚的无过敏患者进行了比较。在 10 例（3%）过敏患者和 124 例（14%）无过敏患者中，符合可能过敏反应的标准。在 9 例食物过敏儿童和所有对照组中，都发现了临床症状的非过敏原因。一名曾有脂肪乳剂过敏史的患儿出现了一次可能的轻度过敏反应。我们的结论是，对异丙酚的真正严重过敏反应罕见，且不能通过食物过敏史可靠地预测。
