Recommendations for Diagnosing and Management of Patients with Perioperative Drug Reactions

• DOI: 10.1007/s40521-020-00253-z
• Publication Date: 2020-03-30T15:04:23Z
• Authors: J. J. Laguna; C. Boteanu; E. Moreno; J. Dionicio; S. Martin; M. Jimenez-Blanco; G. Bogas; J. Archilla
• Keywords: Culprit; Tryptase; Drug allergy; Etiology; Basophil activation

To summarize the current knowledge of diagnosis and management of patients with perioperative immediate hypersensitivity reactions (POH) The diagnosis and management of POH is a challenge for both allergologists and anesthesiologists. They are rare entities; its difficulty lies in its poor clinical specificity, at the time of the acute event, and also in the lack of standardization of its etiological study, which favors that multiple reactions are not adequately studied, with the subsequent risk of re-exposure to the causative agent. POH investigation aims are to identify a culprit drug and safe alternatives, and to ensure safe future anesthesia, even if no culprit is identified. The diagnosis goes through the recognition and treatment in the acute phase with adrenaline, obtaining tryptase samples as a marker of suspected IgE mechanism, and the collection of all the substances involved in the reaction. Clinical history and skin tests are the fundamental diagnostic tools; also specific IgE, basophil activation test, and drug provocation tests with anesthetics in highly specialized centers can be used. We recommended that all patients with suspected POH undergo a thorough investigation, increasing the collaboration between allergologists and anesthesiologists and also creating specialized units integrated by both.