ABSTRACT
Allergy to neuromuscular blocking agents (NMBAs) is the most important caue of perioperative anaphylaxis in France. The diagnosis relies on a careful clinical history, the search of serum IgE antibodies, and the realization of skin tests. Although the skin tests are the most important tool and their sensitivity is widely recognized, the lack of information about their negative predictive value represents an important issue in the management of patients who require a new procedure with NMBA injection. We present a series of 49 patients with confirmed allergy to NMBAs, six of whom required a subsequent surgery with neuromuscular blockade. Negative skin tests allowed the selection of an alternative NMBA, which was well tolerated in all 6 cases. We found an excellent negative predictive value of skin tests in our series but larger studies are required to properly address this question.
Subject(s)
Anaphylaxis/prevention & control , Anesthesia/adverse effects , Drug Hypersensitivity/diagnosis , Hypersensitivity, Immediate/diagnosis , Neuromuscular Blocking Agents/adverse effects , Skin Tests/methods , Adult , Aged , Anaphylaxis/chemically induced , Drug Hypersensitivity/blood , Drug Hypersensitivity/etiology , Female , Humans , Hypersensitivity, Immediate/chemically induced , Male , Middle Aged , Predictive Value of TestsABSTRACT
The authors report four cases of severe anaphylactic reactions (grade III or IV) to rocuronium bromide. In three of them, it was the first contact with a muscle relaxant. In three patients the reaction was mediated by IgE anti-bodies. A cross-reactivity with other muscle relaxants was existing in two cases (suxamethonium, vecuronium and atracurium in one patient, suxamethonium, vecuronium and pancuronium in the other.
Subject(s)
Anaphylaxis/chemically induced , Androstanols/adverse effects , Neuromuscular Nondepolarizing Agents/adverse effects , Adult , Anaphylaxis/immunology , Antibodies/immunology , Atracurium/adverse effects , Cross Reactions , Female , Humans , Immunoglobulin E/immunology , Male , Middle Aged , Neuromuscular Depolarizing Agents/adverse effects , Pancuronium/adverse effects , Rocuronium , Skin Tests , Succinylcholine/adverse effects , Vecuronium Bromide/adverse effectsABSTRACT
A case of severe anaphylactic shock in a 28-month-old child following a testing-dose of aprotinin during major orthopaedic surgery is reported. Two months earlier, aprotinin had been administered during a similar controlateral surgical procedure. The grade III anaphylactic accident required a 48 h treatment in an intensive care unit. The outcome was favourable. The pin-prick tests were positive for aprotinin, substantiating the diagnosis of anaphylactic shock, whereas the test with specific IgE was negative. The value of current diagnostic tools for aprotinin allergy is discussed. The administration of a testing-dose in a patient previously treated with aprotinin cannot be recommended. Considering the risk for allergy, aprotinin should only be administered for recognized indications such as major orthopaedic surgery. Before any readministration of this agent an assessment by an allergist-anaesthetist is essential for determination of the risk-benefit ratio.