From the Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP (AGC, EK, PM, DL), Antibody in Therapy and Pathology, Pasteur Institute, UMR 1222 INSERM, Paris, France (AGC), Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (AGC), Pulmonology Department, Bichat Hospital, AP-HP, Paris University (CN), INSERM UMR 1152, Paris University, DHU FIRE, Paris (CN, PM), Anaesthesiology and Critical Care Medicine Department, Maison Blanche Hospital, Centre Hospitalier Universitaire de Reims, Reims (JM-M), Anaesthesiology and Critical Care Medicine Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (CT, PM-M), Paris University (PM, DL), EA 3072, Institut de Physiologie, FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg (PM-M) and INSERM1148, Paris, France (DL).
Eur J Anaesthesiol. 2021 Nov 1;38(11):1158-1167. doi: 10.1097/EJA.0000000000001536.
Acute hypersensitivity reactions to drugs occur infrequently during anaesthesia and the peri-operative period. When clinical presentation includes the classical triad, erythema, cardiovascular abnormalities and increased airway pressure, the diagnosis is evident and the challenge is to prescribe a therapeutic regimen according to guidelines and to manage refractory signs in a timely manner. In many situations, however, the initial clinical signs are isolated, such as increased airway pressure or arterial hypotension. Rendering a differential diagnosis with causes and mechanisms other than acute hypersensitivity reactions (AHRs) is difficult, delaying treatment with possible worsening of the clinical signs, and even death, in previously healthy individuals. In these difficult diagnostic situations, clinical reasoning is mandatory, and guidelines do not explicitly explain the elements on which clinical reasoning can be built. In this article, based on clinical evidence whenever available, experimental data and pathophysiology, we propose algorithms that have been evaluated by experts. The goal of these algorithms is to provide explicit elements on which the differential diagnosis of AHRs can be made, accelerating the implementation of adequate therapy.
麻醉和围手术期期间，药物急性过敏反应并不常见。当临床表现包括经典三联症（红斑、心血管异常和气道压力升高）时，诊断明确，挑战在于根据指南规定治疗方案，并及时处理难治性体征。然而，在许多情况下，最初的临床体征是孤立的，例如气道压力升高或动脉低血压。与药物急性过敏反应（AHR）以外的原因和机制进行鉴别诊断很困难，这会延迟治疗，导致原本健康的个体临床体征恶化，甚至死亡。在这些困难的诊断情况下，临床推理是必需的，而指南并未明确解释可以建立临床推理的要素。在本文中，我们基于临床证据（如有）、实验数据和病理生理学，提出了已由专家评估的算法。这些算法的目的是提供可用于药物急性过敏反应鉴别诊断的明确要素，从而加快实施适当的治疗。
