Assuntos
Anafilaxia/etiologia , Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Hipersensibilidade a Drogas/etiologia , Excipientes/efeitos adversos , SARS-CoV-2/imunologia , Vacinas Sintéticas/efeitos adversos , Vacina de mRNA-1273 contra 2019-nCoV , Adulto , Idoso , Anafilaxia/diagnóstico , Vacina BNT162 , Hipersensibilidade a Drogas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Inquéritos e Questionários , Vacinas de mRNAAssuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Anafilaxia/etiologia , Infecções por Coronavirus/prevenção & controle , Hipersensibilidade a Drogas/etiologia , Excipientes/efeitos adversos , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/imunologia , Vacinas Sintéticas/efeitos adversos , Anafilaxia/diagnóstico , Hipersensibilidade a Drogas/diagnóstico , Testes Cutâneos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The study of perioperative drug reactions remains a major challenge for both diagnosis and therapy. The lack of a standard assessment of allergy to general anesthetics and of data establishing the true value of skin tests for most drugs used in induction and maintenance of anesthesia, as well as the lack of commercially available reagents for in vitro tests, renders the study of these reactions problematic. The aims of this study were to provide a diagnostic protocol for drug challenge testing with general anesthetics, to establish an etiological diagnosis that is as specific as possible, and to determine the predictive value of skin tests. METHODS: Twenty-nine patients with perioperative drug reactions were included in the study from November 2008 to December 2018. RESULTS: We confirmed the high negative predictive value of the tests (96%-100%) in the case of propofol, rocuronium, and fentanyl. To our knowledge, this is the first study to describe drug challenge testing with general anesthetics and, therefore, to establish the true negative predictive value of skin tests, which leads to a definitive diagnosis and safer surgery. CONCLUSIONS: After assessing risks and benefits and considering the importance of this group of drugs, we conclude that drug challenge testing with general anesthetics is necessary. We propose a protocol for perioperative drug reactions that enables us to make a highly accurate etiological diagnosis with minimum risk for the patient.
