Lai Sophie H Y, Lee Rowena S M, Lam Crystal K, Yik Andrew K H, Lim Qin Ying, Choi Florence, Lynch Donna M, Marquis Kathleen A, Zhang Kaiyue, Cheong Kai-Ning, Leung Karen K Y, Lau Yu Lung, Yuen Vivian M Y, Au Elaine Y L, Castells Mariana C, Rosa Duque Jaime S
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
Pediatr Allergy Immunol. 2025 Mar;36(3):e70066. doi: 10.1111/pai.70066.
Perioperative anaphylaxis (PA) is a rare life-threatening complication of anesthesia, with few descriptions of its diagnosis and outcomes in the pediatric population. Many agents can be potential culprits, and drug provocation testing (DPT) to confirm the diagnosis is limited by the nature of anesthetic drugs. PA diagnosis and culprit identification remain a challenge. For patients with limited drug options, desensitization has not been reported. This study evaluated the results of skin and laboratory testing for pediatric patients with PA and provides the protocol and outcome of the first desensitization to cisatracurium, a neuromuscular blocking agent (NMBA).
Patients ≤18 years old with PA from 2019 to 2024 were included, and medical records were retrospectively reviewed, which comprised serum tryptase levels, results of skin testing (ST), basophil activation testing (BAT), and outcomes.
Eleven patients were included. Tryptase was elevated in seven of 10 (70%) tested patients. ST yielded positive results for nine of 10 (90%), and two of 11 (18.2%) had positive BAT.
A culprit agent was identified in 10 of 11 (91%). The most common drugs were NMBAs (70%) and beta-lactam antibiotics (20%). One patient with a positive DPT to NMBAs and limited alternatives was successfully desensitized to cisatracurium with a 3-bag, 12-step protocol.
The most common drug culprits of PA in children were NMBAs and were identified by ST. Tryptase correlated with PA. BAT served as adjunctive diagnostic tests. Desensitization to cisatracurium was possible.
围手术期过敏反应（PA）是一种罕见的、危及生命的麻醉并发症，关于其在儿科患者中的诊断和结局的描述很少。许多药物都可能是潜在的罪魁祸首，而用于确诊的药物激发试验（DPT）受麻醉药物的性质限制。PA的诊断和罪魁祸首的识别仍然是一项挑战。对于药物选择有限的患者，尚未有脱敏治疗的报道。本研究评估了PA儿科患者的皮肤和实验室检测结果，并提供了首例对神经肌肉阻滞剂（NMBA）顺式阿曲库铵进行脱敏治疗的方案和结果。
纳入2019年至2024年年龄≤18岁的PA患者，并对其病历进行回顾性审查，包括血清类胰蛋白酶水平、皮肤试验（ST）结果、嗜碱性粒细胞活化试验（BAT）结果及结局。
共纳入11例患者。10例接受检测的患者中有7例（70%）类胰蛋白酶升高。10例患者中有9例（90%）ST结果呈阳性，11例中有2例（18.2%）BAT结果呈阳性。
11例患者中有10例（91%）确定了罪魁祸首药物。最常见的药物是NMBA（70%）和β-内酰胺类抗生素（20%）。1例对NMBA的DPT呈阳性且药物选择有限的患者，通过三袋、12步方案成功脱敏于顺式阿曲库铵。
儿童PA最常见的罪魁祸首药物是NMBA，可通过ST识别。类胰蛋白酶与PA相关。BAT作为辅助诊断试验。顺式阿曲库铵脱敏治疗是可行的。
