Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2021 May;9(5):1980-1991. doi: 10.1016/j.jaip.2020.11.025. Epub 2020 Nov 26.
Evidence-based guidelines are needed in the United States to improve evaluation of perioperative allergic reactions including recommendations for subsequent anesthesia.
To identify causative agent(s) and evaluate patients' tolerability of subsequent anesthesia in patients evaluated by Allergy/Immunology (A/I) at Massachusetts General Hospital.
We performed a retrospective review of patients referred to the outpatient A/I clinic for perioperative allergic reactions between October 2003 and May 2017. Patient demographics, atopic history, and prior adverse drug reactions were reviewed. Patients underwent a comprehensive evaluation with testing including skin testing (ST), drug challenges (when appropriate), tryptase level measurement, and specific IgE to latex measurement. Tolerance of subsequent procedures requiring anesthesia was assessed.
Of 123 patients referred, 74 (60%) were female and the mean age was 46 (±18) years. At least 1 causative agent was identified in 28 patients (24%, n = 28 of 118). Seventeen of 28 (61%) patients were ST positive to an antibiotic, including 13 (46%) positive to cefazolin; 3 patients (11%) had a positive latex specific IgE. Of 85 patients who had subsequent anesthesia with a known outcome, 78 (91%) did not have another perioperative allergic reaction. Two of 5 patients with an elevated baseline tryptase level did not tolerate subsequent anesthesia.
The majority of patients safely received subsequent anesthesia after comprehensive A/I evaluation for their perioperative allergic reactions; however, improved algorithmic care is needed in the United States. Among ST-positive patients (24%), antibiotics (especially cefazolin) were the most common culprits. An elevated baseline tryptase level was associated with an increased risk of recurrent perioperative allergic reactions.
美国需要循证指南来改进围手术期过敏反应的评估，包括对后续麻醉的建议。
确定过敏/免疫科（A/I）评估的患者围手术期过敏反应的致病因素，并评估患者对后续麻醉的耐受性。
我们对 2003 年 10 月至 2017 年 5 月期间因围手术期过敏反应而转至门诊 A/I 诊所的患者进行了回顾性研究。回顾了患者的人口统计学、特应性病史和既往药物不良反应。对患者进行了包括皮肤点刺试验（ST）、药物挑战（如适用）、类胰蛋白酶水平测量和乳胶特异性 IgE 测量在内的综合评估。评估了需要麻醉的后续手术的耐受性。
在 123 例转诊患者中，74 例（60%）为女性，平均年龄为 46（±18）岁。在 28 例患者（24%，n=28 of 118）中至少确定了 1 种致病因素。17 例（61%）患者对 1 种抗生素的 ST 阳性，包括 13 例（46%）对头孢唑啉阳性；3 例（11%）对乳胶特异性 IgE 阳性。在 85 例已知结果的患者中接受后续麻醉，78 例（91%）未发生围手术期过敏反应。2 例基础类胰蛋白酶水平升高的患者未耐受后续麻醉。
在对围手术期过敏反应进行全面的 A/I 评估后，大多数患者安全地接受了后续麻醉；然而，美国需要改进算法式护理。在 ST 阳性患者中（24%），抗生素（尤其是头孢唑啉）是最常见的罪魁祸首。基础类胰蛋白酶水平升高与围手术期过敏反应复发的风险增加有关。
