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Böhm I, Morelli J, Nairz K, Silva Hasembank Keller P, Heverhagen JT. Myths and misconceptions concerning contrast media-induced anaphylaxis: a narrative review. Postgrad Med 2017; 129:259-266. [DOI: 10.1080/00325481.2017.1282296] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ingrid Böhm
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
- Radiology Laboratory, Department Clinical Research, University of Bern, Bern, Switzerland
| | - John Morelli
- Department of Radiology, St. John’s Medical Center, Tulsa, OK, USA
| | - Knud Nairz
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | | | - Johannes T. Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
- Radiology Laboratory, Department Clinical Research, University of Bern, Bern, Switzerland
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52
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Sesé L, Gaouar H, Autegarden JE, Alari A, Amsler E, Vial-Dupuy A, Pecquet C, Francès C, Soria A. Immediate hypersensitivity to iodinated contrast media: diagnostic accuracy of skin tests and intravenous provocation test with low dose. Clin Exp Allergy 2016; 46:472-8. [PMID: 26750091 DOI: 10.1111/cea.12703] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 12/01/2015] [Accepted: 01/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The diagnosis of HSR to iodinated contrast media (ICM) is challenging based on clinical history and skin tests. OBJECTIVE This study evaluates the negative predictive value (NPV) of skin tests and intravenous provocation test (IPT) with low-dose ICM in patients with suspected immediate hypersensitivity reaction (HSR) to ICM. METHODS Thirty-seven patients with suspected immediate hypersensitivity reaction to ICM were included retrospectively. Skin tests and a single-blind placebo-controlled intravenous provocation test (IPT) with low-dose iodinated contrast media (ICM) were performed. RESULTS Skin tests with ICM were positive in five cases (one skin prick test and five intradermal test). Thirty-six patients were challenged successfully by IPT, and only one patient had a positive challenge result, with a grade I reaction by the Ring and Messmer classification. Ten of 23 patients followed up by telephone were re-exposed to a negative tested ICM during radiologic examination; two experienced a grade I immediate reaction. CONCLUSIONS & CLINICAL RELEVANCE For immediate hypersensitivity reaction to ICM, the NPV for skin tests and IPT with low dose was 80% (95% CI 44-97%).
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Affiliation(s)
- L Sesé
- Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - H Gaouar
- Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - J-E Autegarden
- Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - A Alari
- Inserm UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Villejuif, Paris, France.,Institut Pasteur, UMR 1181, B2PHI, Paris, France
| | - E Amsler
- Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - A Vial-Dupuy
- Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - C Pecquet
- Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - C Francès
- Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.,Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), UPMC Univ Paris 06, Sorbonne Universités, Paris, France.,Institut National de Santé et de Recherche Médicale (INSERM) U1135, Cimi-Paris, Paris, France
| | - A Soria
- Service de Dermatologie-Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France.,Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), UPMC Univ Paris 06, Sorbonne Universités, Paris, France.,Institut National de Santé et de Recherche Médicale (INSERM) U1135, Cimi-Paris, Paris, France
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53
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Koch C, Chaudru S, Lederlin M, Jaquinandi V, Kaladji A, Mahé G. Remote Ischemic Preconditioning and Contrast-Induced Nephropathy: A Systematic Review. Ann Vasc Surg 2016; 32:176-87. [DOI: 10.1016/j.avsg.2015.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 12/01/2022]
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54
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Should adrenaline be used in patients with hemodynamically stable anaphylaxis? Incident case control study nested within a retrospective cohort study. Sci Rep 2016; 6:20168. [PMID: 26837822 PMCID: PMC4738298 DOI: 10.1038/srep20168] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/22/2015] [Indexed: 12/12/2022] Open
Abstract
Although adrenaline (epinephrine) is a cornerstone of initial anaphylaxis treatment, it is not often used. We sought to assess whether use of adrenaline in hemodynamically stable patients with anaphylaxis could prevent the development of hypotension. We conducted a retrospective cohort study of 761 adult patients with anaphylaxis presenting to the emergency department (ED) of a tertiary care hospital over a 10-year period. We divided the patients into two groups according to the occurrence of hypotension and compared demographic characteristics, clinical features, treatments and outcomes. Of the 340 patients with anaphylaxis who were normotensive at first presentation, 40 patients experienced hypotension during their ED stay. The ED stay of the hypotension group was significantly longer than that of patients who did not experience hypotension (496 min vs 253 min, P = 0.000). Adrenaline use in hemodynamically stable anaphylaxis patient was independently associated with a lower risk of developing in-hospital occurrence of hypotension: OR, 0.254 [95% CI, 0.091–0.706]. Adrenaline use in hemodynamically stable anaphylaxis patients was associated with a reduced risk of developing in-hospital occurrence of hypotension. Adverse events induced by adrenaline were rare when the intramuscular route was used.
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55
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Simons FER, Ebisawa M, Sanchez-Borges M, Thong BY, Worm M, Tanno LK, Lockey RF, El-Gamal YM, Brown SG, Park HS, Sheikh A. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J 2015; 8:32. [PMID: 26525001 PMCID: PMC4625730 DOI: 10.1186/s40413-015-0080-1] [Citation(s) in RCA: 317] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022] Open
Abstract
The World Allergy Organization (WAO) Guidelines for the assessment and management of anaphylaxis provide a unique global perspective on this increasingly common, potentially life-threatening disease. Recommendations made in the original WAO Anaphylaxis Guidelines remain clinically valid and relevant, and are a widely accessed and frequently cited resource. In this 2015 update of the evidence supporting recommendations in the Guidelines, new information based on anaphylaxis publications from January 2014 through mid- 2015 is summarized. Advances in epidemiology, diagnosis, and management in healthcare and community settings are highlighted. Additionally, new information about patient factors that increase the risk of severe and/or fatal anaphylaxis and patient co-factors that amplify anaphylactic episodes is presented and new information about anaphylaxis triggers and confirmation of triggers to facilitate specific trigger avoidance and immunomodulation is reviewed. The update includes tables summarizing important advances in anaphylaxis research.
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Affiliation(s)
- F Estelle R Simons
- Department of Pediatrics & Child Health and Department of Immunology, College of Medicine, Faculty of Health Sciences, The University of Manitoba, Room FE125, 820 Sherbrook Street, Winnipeg, R3A 1R9 MB Canada
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergy & Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa Japan
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Medico-Docente La Trinidad, Caracas, Venezuela
| | - Bernard Y Thong
- Department of Rheumatology, Allergy & Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Margitta Worm
- Allergie-Centrum-Charite, Klinik fur Dermatologie, Venerologie und Allergologie, Campus Charite Mitte, Universitatsmedizin, Berlin, Germany
| | - Luciana Kase Tanno
- Department of Allergy and Clinical Immunology, Hospital Servidor Publico Estadual de Sao Paulo and Hospital Sirio-Libanes, Sao Paulo, Brazil
| | | | - Yehia M El-Gamal
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Simon Ga Brown
- Royal Hobart Hospital, Tasmania, and University of Western Australia and Royal Perth Hospital, Perth, Western Australia
| | - Hae-Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Seoul, South Korea
| | - Aziz Sheikh
- Allergy & Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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56
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Motoi R, Yano I, Ozaki J, Hokoyama K, Yamamoto T, Fukatsu S, Ishizuka R, Matsumura Y, Taniguchi M, Higashimura K, Matsubara K. [Effect of Water Intake on Allergy-like Events Associated with Non-ionic Iodine Contrast Agents]. YAKUGAKU ZASSHI 2015; 135:1177-84. [PMID: 26423874 DOI: 10.1248/yakushi.15-00111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The use of iodine contrast agents occasionally causes serious allergic symptoms including anaphylaxis. At Kyoto University Hospital to prevent nephropathy we began recommending water intake before and after administration of iodine contrast agents in September 2012. In the present study we investigated the effect of water intake on the incidence of allergy-like events after the use of non-ionic iodine contrast agents. We extracted the occurrence of allergy-like events from the incident report system in our hospital from January 2011 to September 2014, and classified these events into the following 3 grades: 1+ (follow-up); 2+ (medication treatment); and 3+ (hospitalization). The allergy-like incidence rate was calculated for subsequent evaluation according to season and water intake. Allergy-like events significantly decreased from 0.49% before the recommendation of water intake to 0.26% at 1 year and 0.20% at 2 years after implementing the recommendation. The incidence of allergy-like events was significantly higher in summer than in winter before water intake was recommended. After implementing the recommendation, the value for summer significantly decreased to an incidence similar to that of winter. Respiratory and gastrointestinal allergy-like symptoms were dramatically decreased after implementing the recommendation. Water intake may be useful for preventing allergy-like events associated with non-ionic iodine contrast agents, especially during the summer.
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Affiliation(s)
- Reiko Motoi
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital
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57
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Radiology Department Preparedness for the Management of Severe Acute Iodinated Contrast Reactions: Do We Need to Change Our Approach? AJR Am J Roentgenol 2015; 205:90-4. [DOI: 10.2214/ajr.14.13884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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58
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Yoon SH, Lee SY, Kang HR, Kim JY, Hahn S, Park CM, Chang YS, Goo JM, Cho SH. Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis. Allergy 2015; 70:625-37. [PMID: 25649510 DOI: 10.1111/all.12589] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with a previous history of hypersensitivity reaction (HSR) to iodinated contrast media (ICM) are at high risk of the development of HSR to ICM. Many studies have tried to evaluate the diagnostic potential of skin tests in this population but have not yet reached a common conclusion. We investigated the role of skin tests in patients with HSR to ICM in terms of positive rate, cross-reactivity rate, and tolerability to skin test-negative ICM according to the type of HSR. METHODS We performed literature searches of the MEDLINE and EMBASE databases and included studies where skin tests were performed in patients with HSR to ICM, with extractable outcomes. Outcomes were pooled using a random-effects model. RESULTS Twenty-one studies were included. Pooled per-patient positive rates of skin tests were 17% (95% CI, 10-26%) in patients with immediate HSR, and up to 52% (95% CI, 31-72%) when confined to severe immediate HSR. Among patients with nonimmediate HSR, the positive rate was 26% (95% CI, 15-41%). The pooled per-patient cross-reactivity rate was higher in nonimmediate HSR (68%; 95% CI, 48-83%) than that in immediate HSR (39%; 95% CI, 29-50%). Median per-test cross-reactivity rates between pairs of ICM were 7% (IQR, 6-9%) in immediate HSR and 38% (IQR, 22-51%) in nonimmediate HSR. Pooled per-patient recurrence rates of HSR to skin test-negative ICM were 7% (95% CI, 4-14%) in immediate HSR and 35% (95% CI, 19-55%) in nonimmediate HSR. CONCLUSION Skin tests may be helpful in diagnosing and managing patients with HSR to ICM, especially in patients with severe immediate HSR.
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Affiliation(s)
- S. H. Yoon
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
| | - S.-Y. Lee
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
- Department of Internal Medicine; Seoul National University Bundang Hospital; Seongnam Korea
| | - H.-R. Kang
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
| | - J.-Y. Kim
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
| | - S. Hahn
- Department of Medicine; Seoul National University College of Medicine; Seoul Korea
| | - C. M. Park
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
- Cancer Research Institute; Seoul National University; Seoul Korea
| | - Y.-S. Chang
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University Bundang Hospital; Seongnam Korea
| | - J. M. Goo
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
- Cancer Research Institute; Seoul National University; Seoul Korea
| | - S.-H. Cho
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
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59
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Abstract
Drug-induced anaphylaxis is a common cause of anaphylaxis and a leading cause of fatal anaphylaxis. Antibiotics, radiocontrast, and nonsteroidal anti-inflammatory drugs are commonly implicated drugs. Vocal cord dysfunction can mimic anaphylaxis and is often overlooked. β-Lactams are a common cause of anaphylaxis; however, skin testing and drug challenge can usually determine tolerability of other classes of β-lactams. Nonionic contrast agents cause anaphylaxis less frequently than ionic contrast, and immunoglobulin E-mediated mechanisms may have a role in some of these reactions. Skin testing with radiocontrast may have a role in evaluating patients with anaphylaxis to nonionic contrast.
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Affiliation(s)
- Merin Kuruvilla
- Atlanta ENT, 5555 Peachtree Dunwoody Rd, Suite 125, Atlanta, GA-30342, USA
| | - David A Khan
- Division of Allergy & Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8859, USA.
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60
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Ahn YH, Koh YI, Kim JH, Ban GY, Lee YK, Hong GN, Jin UR, Choi BJ, Shin YS, Park HS, Ye YM. The potential utility of iodinated contrast media (ICM) skin testing in patients with ICM hypersensitivity. J Korean Med Sci 2015; 30:245-51. [PMID: 25729245 PMCID: PMC4330477 DOI: 10.3346/jkms.2015.30.3.245] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/16/2014] [Indexed: 11/20/2022] Open
Abstract
Both immediate and delayed hypersensitivity reactions to iodinated contrast media (ICM) are relatively common. However, there are few data to determine the clinical utility of immunologic evaluation of ICM. To evaluate the utility of ICM skin testing in patients with ICM hypersensitivity, 23 patients (17 immediate and 6 delayed reactions) were enrolled from 3 university hospitals in Korea. With 6 commonly used ICM including iopromide, iohexol, ioversol, iomeprol, iopamidol and iodixanol, skin prick (SPT), intradermal (IDT) and patch tests were performed. Of 10 patients with anaphylaxis, 3 (30.0%) and 6 (60.0%) were positive respectively on SPTs and IDTs with the culprit ICM. Three of 6 patients with urticaria showed positive IDTs. In total, 11 (64.7%) had positive on either SPT or IDT. Three of 6 patients with delayed rashes had positive response to patch test and/or delayed IDT. Among 5 patients (3 anaphylaxis, 1 urticaria and 1 delayed rash) taken subsequent radiological examinations, 3 patients administered safe alternatives according to the results of skin testing had no adverse reaction. However, anaphylaxis developed in the other 2 patients administered the culprit ICM again. With 64.7% (11/17) and 50% (3/6) of the sensitivities of corresponding allergic skin tests with culprit ICM for immediate and delayed hypersensitivity reactions, the present study suggests that skin tests is useful for the diagnosis of ICM hypersensitivity and for selecting safe ICM and preventing a recurrence of anaphylaxis caused by the same ICM.
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Affiliation(s)
- Young-Hwan Ahn
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Il Koh
- Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Medical School, Gwangju, Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yeon-Kyung Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ga-Na Hong
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - U-Ram Jin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Byung-Joo Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo-Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Kannan JA, Bernstein JA. Perioperative anaphylaxis: diagnosis, evaluation, and management. Immunol Allergy Clin North Am 2015; 35:321-34. [PMID: 25841554 DOI: 10.1016/j.iac.2015.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Perioperative anaphylaxis can occur during or after surgery and can have life-threatening consequences. As anesthesia protocols become more complex and incorporate multiple agents to regulate physiologic processes intraoperatively, perioperative anaphylaxis is becoming increasingly recognized. The allergist should obtain detailed records from the anesthesiologist in order to perform appropriate testing to identify the likely causative agents. Testing should ideally be performed 4 to 6 weeks after the reaction to account for a refractory period after mast cell activation. This article includes 2 cases of perioperative anaphylaxis and reviews the historical elements that must be considered after a reaction has occurred.
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Affiliation(s)
- Jennifer A Kannan
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, 3255 Eden Avenue, Suite 350, ML 563, Cincinnati, OH 45267-0563, USA
| | - Jonathan A Bernstein
- Division of Immunology, Allergy and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, 3255 Eden Avenue, Suite 350, ML 563, Cincinnati, OH 45267-0563, USA; Bernstein Clinical Research Center, 8444 Winton Road, Cincinnati, OH 45231, USA.
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