Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.
Anaesth Intensive Care. 2021 Jan;49(1):44-51. doi: 10.1177/0310057X20964470. Epub 2021 Jan 20.
Making a diagnosis of perioperative anaphylaxis and identifying culprit drugs are diagnostic challenges. The aim of this study is to describe the perioperative presentation of anaphylaxis and results of patients who underwent allergy evaluation. This is a retrospective review of perioperative anaphylaxis of severity Grade 2 and above based on the Australian and New Zealand Anaesthetic Allergy Group criteria from 2015 to 2019 in a tertiary paediatric hospital. Data collected were demographics, clinical features, investigations and management. Of the 35,361 cases of paediatric anaesthesia, there were 15 cases of perioperative anaphylaxis, giving an incidence of four in 10,000. The median age was seven years (interquartile range four-15 years) with a male predominance of 86.7% (13/15). The severity of anaphylaxis was Grade 2 in 33.3% (5/15) and Grade 3 in 66.7% (10/15). The commonest presenting feature was hypotension (13/15, 86.7%) while the earliest symptom was respiratory change (9/15, 60.0%). Dynamic tryptase was raised in 75% (6/8) of the patients with adequate tryptase samples. Eight patients (53.3%) completed allergy testing, of whom five patients (62.5%) had IgE-mediated anaphylaxis with skin test positive to cefazolin ( = 3), atracurium ( = 1) and rocuronium ( = 1). Three patients (25.0%) had non-IgE-mediated reactions with negative skin tests. Although only half the patients completed allergy evaluation, a culprit drug could be identified in 62.5%, with antibiotics being the commonest. This emphasises the need for appropriate evaluation in cases of suspected perioperative anaphylaxis.
诊断围手术期过敏反应和确定致敏药物具有挑战性。本研究旨在描述过敏反应的围手术期表现以及接受过敏评估的患者的结果。这是 2015 年至 2019 年在一家三级儿科医院根据澳大利亚和新西兰麻醉过敏组标准对严重程度为 2 级及以上的围手术期过敏反应进行的回顾性研究。收集的数据包括人口统计学、临床特征、检查和管理。在 35361 例儿科麻醉中，有 15 例围手术期过敏反应，发病率为每 10000 例 4 例。中位年龄为 7 岁（四分位距为 4-15 岁），男性占 86.7%（13/15）。过敏反应严重程度为 2 级的占 33.3%（5/15），3 级的占 66.7%（10/15）。最常见的表现为低血压（13/15，86.7%），最早的症状是呼吸变化（9/15，60.0%）。有足够的类胰蛋白酶样本的患者中，75%（6/8）的动态类胰蛋白酶升高。8 例患者（53.3%）完成了过敏测试，其中 5 例（62.5%）对头孢唑啉（ = 3）、阿曲库铵（ = 1）和罗库溴铵（ = 1）皮试阳性，存在 IgE 介导的过敏反应。3 例（25.0%）为非 IgE 介导反应，皮试阴性。尽管只有一半的患者完成了过敏评估，但 62.5%的患者可以确定致敏药物，其中抗生素最为常见。这强调了在疑似围手术期过敏反应的情况下进行适当评估的必要性。
