Kwok Fan-Yin, Hui Mun-Tsong, Thomas Joseph Cindy, Hanim Binti Mohamad Arfah, Bakhtiar Mohammed-Faizal
Anaesthetic Allergy Clinic, Department of Anaesthesiology and Critical Care, Kuala Lumpur Hospital, Ministry of Health, Kuala Lumpur, Malaysia.
Department of Anaesthesia, Thomson Hospital, Kota Damansara, Malaysia.
Anaesth Intensive Care. 2025 May;53(3):171-180. doi: 10.1177/0310057X241284655. Epub 2025 Feb 4.
Diagnosis of perioperative anaphylaxis (POA) and identification of causative agents remain challenging. This study aimed to describe the estimated incidence, characteristics and causative agents of POA in Malaysia. This is a retrospective review of all cases of suspected POA referred to the only anaesthetic allergy centre in Malaysia from March 2014 to December 2022. One hundred and ninety patients with suspected POA of Grade 2 and above were included. Data on clinical presentation, severity, management, serum tryptase and subsequent allergy workup (including skin and serum testing results) of these patients were extracted from the database. Dynamic tryptase was elevated in half of the cases where tryptase results were available and skin tests were positive in 96% of these cases. Skin testing was positive in 113 patients (60%) overall, and more than 70% of Grades 3 and 4 anaphylaxis cases. Neuromuscular blocking agents (NMBAs) and antibiotics were the most commonly identified causative agents (27.4% and 23% respectively). The commonest NMBAs were rocuronium and atracurium, both commonly cross-reacting with cisatracurium. The overall cross-reactivity rate among NMBAs was 58%. For antibiotics, the commonest causative agents were cefuroxime, ceftriaxone and amoxicillin/clavulanic acid. Using these data, the estimated incidence of Grades 2-4 POA over this period in Malaysia was approximately 1 in 30,000 anaesthetics. However, owing to the voluntary nature of reporting, it is possible that this is an underestimate, particularly in relation to some milder Grade 2 cases which may have gone unrecognised or unreported.
围手术期过敏反应（POA）的诊断及致病因素的识别仍然具有挑战性。本研究旨在描述马来西亚POA的估计发病率、特征及致病因素。这是一项对2014年3月至2022年12月转诊至马来西亚唯一一家麻醉过敏中心的所有疑似POA病例的回顾性研究。纳入了190例2级及以上疑似POA患者。从数据库中提取了这些患者的临床表现、严重程度、治疗、血清类胰蛋白酶以及后续过敏检查（包括皮肤和血清检测结果）的数据。在可获得类胰蛋白酶结果的病例中，半数患者的动态类胰蛋白酶升高，其中96%的病例皮肤试验呈阳性。总体而言，113例患者（60%）皮肤试验呈阳性，3级和4级过敏反应病例中超过70%呈阳性。神经肌肉阻滞剂（NMBAs）和抗生素是最常见的致病因素（分别为27.4%和23%）。最常见的NMBAs是罗库溴铵和阿曲库铵，两者通常与顺式阿曲库铵交叉反应。NMBAs之间的总体交叉反应率为58%。对于抗生素，最常见的致病因素是头孢呋辛、头孢曲松和阿莫西林/克拉维酸。利用这些数据，马来西亚在此期间2 - 4级POA的估计发病率约为每30000例麻醉中有1例。然而，由于报告的自愿性质，这可能是一个低估数字，特别是对于一些可能未被识别或未报告的较轻的2级病例。
