Making a Diagnosis in Allergic Reactions Occurring in the Operating Room

Opinion statementTo summarize the current knowledge of diagnosis in immediate perioperative hypersensitivity reactions (PHR). There is a growing interest in the diagnosis and management of PHR. Recently several clinical guidelines published on PHR; however, its implementation is unknown. The diagnosis and management of PHR is a challenge for both allergologists and anesthesiologists. They are life-threatening and rare reactions, difficult to diagnose for its clinical heterogenic presentation, simultaneous use of many drugs, and the significant pharmacological effects of some drugs. Allergy investigation purpose is to identify the culprit agent, find suitable alternatives, and ensure a safe future anesthesia, even if the causative agent is unknown. The diagnosis is based on clinical suspicion, obtaining acute and basal tryptase samples as a marker of suspected IgE mechanism, refer to allergistall suspected allergic reactions in a detailed formincluding all drugs and agents involved. Clinical history and skin testing are the primary diagnostic methods; however, specific IgE, basophil activation tests, and drug provocation tests using anesthetics can be used in highly specialized centers. To enhance PHR diagnosis, more knowledge and understanding of these reactions are needed, as well as a coordinated protocol between allergy and anesthesiology departments.
Source: Current Treatment Options in Allergy - Category: Allergy & Immunology Source Type: research