Laxenaire M C
Département d'anesthésie-réanimation, CHU hôpital central, Nancy, France.
Ann Fr Anesth Reanim. 1996;15(8):1211-8. doi: 10.1016/s0750-7658(97)85882-0.
Since 1989, the epidemiological survey of anaphylactoid reactions occurring during anaesthesia is obtained in France with repeated inquiries by the Perioperative Anaphylactic Reactions Study Group. The members of this group collect during the study period the cases of patients having suffered from an anaphylactoid reaction and tested in their allergo-anaesthetic outpatient clinic, their characteristics (age, gender), the results of the allergological tests (mechanism, agents responsible for the reactions). The two previous surveys published in the Annales françaises d'anesthesie et de réanimation in 1990 and 1993 included 1,240 and 1,585 patients respectively. The current survey concerned 1,750 patients tested in 27 diagnostic centres, from January 1992 to June 1994. The reactions occurred at all ages, predominantly between 10 and 50 years, the sex-ratio (F/M) was 2.4. Allergological tests carried out to diagnose an immune mechanism for the shock were cutaneous tests in all centres (prick-tests in 21 centres, intradermal tests in 27 centres) using the same dilutions for the tested agents and the same threshold for positivity. Specific IgE antibodies against muscle relaxants, thiopentone and propofol, were measured by radio immunoassays in 20 centres. The leucocyte histamine release test was used in 10 centres. The immune origin of the shock--IgE dependent anaphylaxis--was diagnosed in 1,000 patients (57.8%) and due to 1,030 agents muscle relaxants (59.2%), latex (19%), hypnotics (5.9%), benzodiazepines (2.1%), opioids (3.5%), plasma substitutes (5%), antibiotics (3.1%) and other drugs given during anaesthesia such as aprotinine and protamine (2.2%). Suxamethonium was responsible for 39.3% of muscle relaxant anaphylaxis, vecuronium for 36%, atracurium for 14.5%, pancuronium for 4.8%, gallamine for 3.1% and alcuronium for 2.3%. The latter has been withdrawn from the French market in 1993. These differences in the incidence of reactions are correlated with the clinical use of muscle relaxants in France for vecuronium and atracurium, however not for suxamethonium, responsible for 39% of the reactions but representing only 5% of the muscle relaxants sold in France. The comparison with the two previous surveys confirms that the mechanism of more than half of the anaphylactoid reactions occurring during anaesthesia is of immune origin, due to specific IgE antibodies. It is therefore essential to systematically carry out an allergologic assessment several weeks after the reaction, in order to discard for the subsequent anaesthetics the agent(s) responsible for anaphylaxis. If the muscle relaxants remain the first drugs involved in shock occurring at induction, there is a significant increase in latex shock, as demonstrated by the three epidemiological surveys (0.5%, 12.5% and now 19%). The incidence of other anaesthetic agents, antibiotics and plasma substitutes remains unchanged.
自1989年起，法国围手术期过敏反应研究小组通过反复问询，对麻醉期间发生的类过敏反应进行了流行病学调查。该小组的成员在研究期间收集了发生类过敏反应并在其变态反应-麻醉门诊接受检测的患者病例、患者特征（年龄、性别）以及变态反应学检测结果（反应机制、引发反应的药物）。此前于1990年和1993年发表在《法国麻醉与复苏年鉴》上的两项调查分别涵盖了1240例和1585例患者。本次调查涉及1992年1月至1994年6月期间在27个诊断中心接受检测的1750例患者。反应发生在各个年龄段，主要集中在10至50岁之间，性别比（女/男）为2.4。为诊断休克的免疫机制而进行的变态反应学检测在所有中心均为皮肤试验（21个中心采用点刺试验，27个中心采用皮内试验），对检测药物使用相同的稀释液，设定相同的阳性阈值。20个中心通过放射免疫分析法检测了针对肌肉松弛剂、硫喷妥钠和丙泊酚的特异性IgE抗体。10个中心采用了白细胞组胺释放试验。休克的免疫起源——IgE介导的过敏反应——在1000例患者（57.8%）中得到诊断，涉及1030种药物，其中肌肉松弛剂（59.2%）、乳胶（19%）、催眠药（5.9%）、苯二氮䓬类药物（2.1%）、阿片类药物（3.5%）、血浆代用品（5%）、抗生素（3.1%）以及麻醉期间使用的其他药物如抑肽酶和鱼精蛋白（2.2%）。琥珀胆碱导致了39.3%的肌肉松弛剂过敏反应，维库溴铵导致36%，阿曲库铵导致14.5%，泮库溴铵导致4.8%，加拉碘铵导致3.1%，阿库氯铵导致2.3%。阿库氯铵已于1993年退出法国市场。这些反应发生率的差异与法国肌肉松弛剂维库溴铵和阿曲库铵的临床使用情况相关，但与琥珀胆碱无关，琥珀胆碱导致了39%的反应，但在法国销售的肌肉松弛剂中仅占5%。与前两次调查的比较证实，麻醉期间发生的超过一半的类过敏反应机制源于免疫，由特异性IgE抗体引起。因此至关重要的是，在反应发生数周后系统地进行变态反应学评估，以便在后续麻醉中排除引发过敏反应的药物。如果肌肉松弛剂仍然是诱导期休克的首要相关药物，那么乳胶休克有显著增加，这在三项流行病学调查中得到了证明（分别为0.5%、12.5%，现在为19%）。其他麻醉药物、抗生素和血浆代用品的发生率保持不变。
