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Ramsey A. Penicillin Allergy and Perioperative Anaphylaxis. FRONTIERS IN ALLERGY 2022; 3:903161. [PMID: 35769557 PMCID: PMC9234876 DOI: 10.3389/falgy.2022.903161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/10/2022] [Indexed: 01/17/2023] Open
Abstract
Penicillin allergy is the most commonly reported drug allergy, while perioperative anaphylaxis is overall rare. This review covers the epidemiology of both penicillin allergy and perioperative anaphylaxis both separately and taken together. Considerations regarding anaphylaxis to penicillin during pregnancy are also discussed, since penicillin is the drug of choice for Group B Streptococcus prophylaxis. The minimal cross reactivity between penicillins and cephalosporins is addressed, since the vast majority of patients with a penicillin allergy label can receive perioperative cephalosporins. The management of the patient who has experienced perioperative anaphylaxis, including the importance of allergy referral is covered. Approaches to pre-operative penicillin allergy evaluations and opportunities for education are highlighted.
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Affiliation(s)
- Allison Ramsey
- Rochester Regional Health, Rochester, NY, United States
- Clinical Assistant Professor of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- *Correspondence: Allison Ramsey
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Simionescu AA, Danciu BM, Stanescu AMA. Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes. J Pers Med 2021; 11:jpm11111060. [PMID: 34834412 PMCID: PMC8623240 DOI: 10.3390/jpm11111060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Anaphylactic reactions during pregnancy can range from subjective cutaneous symptoms to anaphylaxis and lethal anaphylactic shock. The fetal and maternal outcomes are unpredictable. This study is the first systematic review of the clinical presentation of severe anaphylaxis in pregnancy as defined by the World Allergy Organization to determine maternal and fetal outcomes. We searched PubMed, the Web of Science, and Scopus databases for articles published between 1 January 1985 and 15 April 2021 using the following terms (((anaphylactic shock) AND (pregnancy)) OR ((anaphylaxis) AND (pregnancy))). In 42 studies involving 47 patients, 36.17% of patients were 31-35 years old, and 74.47% of cases occurred peripartum, mostly during cesarean section. Accurate diagnosis with valid and reliable outcome measures was reported for 71.74% of cases. Twenty-two allergens were identified: antibiotics (penicillins and cephalosporins), anesthetic drugs (suxamethonium, mepivacaine), latex, oxytocin, sodium and sucrose iron, laminaria, misoprostol, rubber from Foley catheter, oral phytomenadione, ranitidine, chamomile, and ant sting. Two cases of maternal death related to latex and intravenous iron sucrose, and six infants with neurological disease were reported, mostly related to antibiotics. This review of the currently available literature shows that favorable outcomes are attainable with a high degree of observation, multidisciplinary cooperation, and rapid treatment.
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Affiliation(s)
- Anca Angela Simionescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: or
| | - Bianca Mihaela Danciu
- Department of Obstetrics, Gynecology and Neonatology, National Institute for Maternal and Child Health “Alfred Rusescu”—Polizu, 127715 Bucharest, Romania;
| | - Ana Maria Alexandra Stanescu
- Department of Family Medicine, Carol Davila University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania;
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State-of-the-Art on Biomarkers for Anaphylaxis in Obstetrics. Life (Basel) 2021; 11:life11090870. [PMID: 34575019 PMCID: PMC8467046 DOI: 10.3390/life11090870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
Anaphylaxis is an unpredictable systemic hypersensitivity reaction and constitutes a high risk of maternal and fetal morbidity and mortality when occurring during pregnancy. Currently, the acute management of anaphylaxis is based on clinical parameters. A total serum tryptase is only used to support an accurate diagnosis. There is a need to detect other biomarkers to further assess high-risk patients in obstetrics. Our objective is to present biomarkers in this complex interdisciplinary approach beyond obstetrician and anaesthetic management. Candidate biomarkers derive either from mediators involved in immunopathogenesis or upcoming molecules from systems biology and proteomics. Serum tryptase is determined by singleplex immunoassay method and is important in the evaluation of anaphylactic mast cell degranulation but also in the assessment of other risk factors for anaphylaxis such as systemic mastocytosis. Another category of biomarkers investigates the IgE-mediated sensitization to triggers potentially involved in the etiology of anaphylaxis in pregnant women, using singleplex or multiplex immunoassays. These in vitro tests with natural extracts from foods, venoms, latex or drugs, as well as with molecular allergen components, are useful because in vivo allergy tests cannot be performed on pregnant women in such a major medical emergency due to their additional potential risk of anaphylaxis.
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Takahashi M, Hotta K, Inoue S, Takazawa T, Horiuchi T, Igarashi T, Takeuchi M. Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report. JA Clin Rep 2019; 5:84. [PMID: 32026066 PMCID: PMC6967107 DOI: 10.1186/s40981-019-0302-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.
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Affiliation(s)
- Miyuki Takahashi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Kunihisa Hotta
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Soichiro Inoue
- Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasak-shii, Kanagawa, 216-8511, Japan
| | - Tomonori Takazawa
- Intensive Care Unit, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi-shi, Gunma, 371-8511, Japan
| | - Tatsuo Horiuchi
- Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8511, Japan
| | - Takashi Igarashi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Mamoru Takeuchi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
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Abstract
RATIONALE Anaphylaxis is a very rare event in pregnancy, triggering maternal hypotension leading to intrapartum hypoxic-ischemic encephalopathy in infant. Furthermore, cesarean sections are performed at a high rate in anaphylactic pregnant women. PATIENT CONCERNS A 34-year-old pregnant woman presented with maternal anaphylaxis following prophylactic antibiotic injection for cesarean section. Within a few minutes after initiation of intradermal skin test with cefotetan, the pregnant woman developed generalized itchy rash, chest tightness, and dyspnea. DIAGNOSES Several minutes after the injection of antibiotics, a diffuse urticarial rash was detected over her face and trunk followed by complaints of chest tightness and dyspnea. She was diagnosed with hypotension and hypoxia. Further, fetal heart tones showed bradycardia. A presumptive diagnosis of anaphylactic reaction induced by cefotetan was made for surgical prophylaxis. INTERVENTIONS The patient was managed for anaphylaxis, via administration of epinephrine, glucocorticoid, and antihistamine. Emergency cesarean section performed under general anesthesia resulted in a favorable perinatal outcome for the fetus. OUTCOMES Maternal and fetal outcomes were good after prompt treatment for anaphylaxis and emergency cesarean section. LESSONS This is the first reported case of anaphylaxis following cefotetan administration in pregnancy. Cefotetan, a second-generation cephalosporin, is a commonly prescribed antibiotic used to treat a wide range of bacterial infections. The case demonstrated life-threatening anaphylactic reaction during pregnancy. Even a skin test using antibiotics alone triggered anaphylaxis.
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Affiliation(s)
| | - Aeli Ryu
- Departments of Obstetrics and Gynaecology
| | - Jiwon Min
- Departments of Obstetrics and Gynaecology
| | - Nan Seol Kim
- Anesthesiology and Pain Medicine, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Chaiyasit N, Romero R, Chaemsaithong P, Docheva N, Bhatti G, Kusanovic JP, Dong Z, Yeo L, Pacora P, Hassan SS, Erez O. Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation. J Perinat Med 2017; 45:539-550. [PMID: 28672752 PMCID: PMC5625338 DOI: 10.1515/jpm-2016-0344] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/09/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Clinical chorioamnionitis is the most common infection/inflammatory process diagnosed in labor and delivery units worldwide. The condition is a syndrome that can be caused by (1) intra-amniotic infection, (2) intra-amniotic inflammation without demonstrable microorganisms (i.e. sterile intra-amniotic inflammation), and (3) maternal systemic inflammation that is not associated with intra-amniotic inflammation. The presence of intra-amniotic inflammation is a risk factor for adverse maternal and neonatal outcomes in a broad range of obstetrical syndromes that includes clinical chorioamnionitis at term. Although the diagnosis of intra-amniotic infection has relied on culture results, such information is not immediately available for patient management. Therefore, the diagnosis of intra-amniotic inflammation could be helpful as a proxy for intra-amniotic infection, while results of microbiologic studies are pending. A rapid test is now available for the diagnosis of intra-amniotic inflammation, based on the determination of neutrophil collagenase or matrix metalloproteinase-8 (MMP-8). The objectives of this study were (1) to evaluate the diagnostic indices of a rapid MMP-8 test for the identification of intra-amniotic inflammation/infection in patients with the diagnosis of clinical chorioamnionitis at term, and (2) to compare the diagnostic performance of a rapid MMP-8 test to that of a conventional enzyme-linked immunosorbent assay (ELISA) interleukin (IL)-6 test for patients with clinical chorioamnionitis at term. MATERIALS AND METHODS A retrospective cohort study was conducted. A transabdominal amniocentesis was performed in patients with clinical chorioamnionitis at term (n=44). Amniotic fluid was analyzed using cultivation techniques (for aerobic and anaerobic bacteria as well as genital Mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Amniotic fluid IL-6 concentrations were determined by ELISA, and rapid MMP-8 results were determined by Yoon's MMP-8 Check®. Intra-amniotic inflammation was defined as an elevated amniotic fluid IL-6 concentration ≥2.6 ng/mL, and intra-amniotic infection was diagnosed by the presence of microorganisms in the amniotic fluid accompanied by intra-amniotic inflammation. The diagnostic indices of Yoon's MMP-8 Check® for the identification of intra-amniotic inflammation were calculated. In order to objectively compare Yoon's MMP-8 Check® with the ELISA IL-6 test for the identification of intra-amniotic inflammation, we used an amniotic fluid white blood cell (WBC) count ≥50 cells/mm3 to define intra-amniotic inflammation. RESULTS (1) A positive rapid MMP-8 test had a sensitivity of 82.4% (28/34), specificity of 90% (9/10), positive predictive value of 96.6% (28/29), negative predictive value of 60% (9/15), positive likelihood ratio 8.2 (95% CI 1.3-53.2), and negative likelihood ratio 0.2 (95% CI 0.1-0.4) for the identification of intra-amniotic inflammation (prevalence 77.3%); (2) a positive rapid MMP-8 test had a sensitivity of 91.7% (22/24), specificity of 65% (13/20), positive predictive value of 75.9% (22/29), negative predictive value of 86.7% (13/15), positive likelihood ratio of 2.6 (95% CI 1.4-4.8), and negative likelihood ratio of 0.1 (95% CI 0.03-0.5) for the identification of intra-amniotic infection; (3) the rapid MMP-8 test had a significantly higher specificity than the ELISA IL-6 test in the identification of intra-amniotic inflammation as determined by an amniotic fluid WBC count ≥50 cells/mm3. The sensitivity and accuracy of the rapid MMP-8 test were comparable to those of the ELISA IL-6 test; and (4) importantly, the rapid MMP-8 test had 100% sensitivity and 100% negative predictive value in the identification of neonates affected with fetal inflammatory response syndrome (FIRS). CONCLUSION The rapid diagnosis of intra-amniotic inflammation is possible by analysis of amniotic fluid using a point-of-care test for MMP-8. Patients with a positive test are at risk of delivering a neonate affected with systemic inflammation, a risk factor for adverse neonatal outcome.
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Affiliation(s)
- Noppadol Chaiyasit
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Piya Chaemsaithong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nikolina Docheva
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile
- Division of Obstetrics and Gynecology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Zhong Dong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Percy Pacora
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Tsuzuki Y, Narita M, Nawa M, Nakagawa U, Wakai T. Management of maternal anaphylaxis in pregnancy: a case report. Acute Med Surg 2016; 4:202-204. [PMID: 29123862 PMCID: PMC5667276 DOI: 10.1002/ams2.238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/26/2016] [Indexed: 11/18/2022] Open
Abstract
Case A 26‐year‐old woman (gravida 2, para 1) at 25 weeks’ gestation was brought to the emergency department because of anaphylactic symptoms. She reported eating Japanese soba and developed symptoms of dyspnea, generalized itchy rash, abdominal pain, and severe uterine contractions within 15–30 min of eating. She was immediately treated by normal saline infusion, two injections of epinephrine (intramuscularly), and a nebulized short‐acting β2‐receptor agonist, followed by H1‐antihistamine and methylprednisolone. Obstetrical management was undertaken by an obstetrician. Outcome The patient recovered rapidly without a biphasic reaction of anaphylaxis. After 11 weeks, a healthy, neurologically intact baby was born. Conclusion Management of anaphylaxis in pregnant patients is basically the same of that in non‐pregnant ones. Treatment should commence immediately to prevent further development of the anaphylaxis reaction and fetal neurological deficiency.
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Affiliation(s)
- Yasunobu Tsuzuki
- Department of Pediatrics and Allergy Sapporo Tokushukai Hospital Sapporo Hokkaido Japan
| | - Mitsuo Narita
- Department of Pediatrics Sapporo Tokushukai Hospital Sapporo Hokkaido Japan
| | - Masayuki Nawa
- Department of Obstetrics and Gynecology Sapporo Tokushukai Hospital Sapporo Hokkaido Japan
| | - Urara Nakagawa
- Department of General Medicine Sapporo Tokushukai Hospital Sapporo Hokkaido Japan
| | - Toshiaki Wakai
- Department of General Medicine Sapporo Tokushukai Hospital Sapporo Hokkaido Japan
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Hepner DL, Castells M, Mouton-Faivre C, Dewachter P. Anaphylaxis in the clinical setting of obstetric anesthesia: a literature review. Anesth Analg 2014; 117:1357-67. [PMID: 24257386 DOI: 10.1213/ane.0b013e3182a706c7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prevalence of anaphylaxis occurring during pregnancy is approximately 3 cases per 100,000 deliveries. The management of anaphylaxis occurring during the third trimester of pregnancy may be challenging because of the additive effects of aortocaval compression and cardiovascular disturbances of anaphylaxis. In this review, we identify the clinical signs of anaphylaxis occurring during labor and cesarean delivery, discuss the more common allergens that cause anaphylaxis during this clinical setting, and develop a rational approach to the identification of the offending allergen. We also suggest strategies for the management of anaphylaxis occurring during the third trimester of pregnancy, including the prompt administration of epinephrine and emergency cesarean delivery in cases of severe reactions. Evidence is limited to case reports and extrapolation from nonfatal and fatal cases, interpretation of pathophysiology, and consensus opinion.
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Affiliation(s)
- David L Hepner
- From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; †Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; ‡Pôle d'Anesthésie-Réanimation & Consultation d'Allergo-Anesthésie, Centre Hospitalier Universitaire, Nancy, France; and §Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Européen Georges Pompidou and Université Paris Descartes Sorbonne Paris Cité, Paris, France
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Adriaensens I, Vercauteren M, Soetens F, Janssen L, Leysen J, Ebo D. Allergic reactions during labour analgesia and caesarean section anaesthesia. Int J Obstet Anesth 2013; 22:231-42. [DOI: 10.1016/j.ijoa.2013.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 04/10/2013] [Accepted: 04/14/2013] [Indexed: 01/09/2023]
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Berenguer A, Couto A, Brites V, Fernandes R. Anaphylaxis in pregnancy: a rare cause of neonatal mortality. BMJ Case Rep 2013; 2013:bcr-2012-007055. [PMID: 23314874 DOI: 10.1136/bcr-2012-007055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Anaphylaxis is a rare condition in pregnancy. Drugs are the aetiological agents most often implicated. Maternal anaphylaxis can lead to significant fetal morbidity and even mortality if uterine perfusion and maternal oxygenation are compromised. Significant risk of neonatal neurological damage or death can occur even when the maternal clinical outcome is favourable. The authors present the case of a newborn, born at gestational age of 29 weeks, who died at 11 days of life with hypoxic-ischaemic cerebral injuries as a consequence of maternal anaphylaxis following the administration of amoxicillin in the community setting.
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Brown SA, Seifert SA, Rayburn WF. Management of envenomations during pregnancy. Clin Toxicol (Phila) 2013; 51:3-15. [DOI: 10.3109/15563650.2012.760127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mertes PM, Karila C, Demoly P, Auroy Y, Ponvert C, Lucas MM, Malinovsky JM. [What is the reality of anaphylactoid reactions during anaesthesia? Classification, prevalence, clinical features, drugs involved and morbidity and mortality]. ACTA ACUST UNITED AC 2011; 30:223-39. [PMID: 21353759 DOI: 10.1016/j.annfar.2011.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- P-M Mertes
- Service d'anesthésie-réanimation chirurgicale, hôpital Central, CHU de Nancy, 29 avenue de Lattre-de-Tassigny, Nancy cedex, France.
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Sleth JC, Lafforgue E, Cherici O, Nagy P. Choc anaphylactique au cours de la grossesse à terme. À propos de deux cas et revue de la littérature. ACTA ACUST UNITED AC 2009; 28:790-4. [DOI: 10.1016/j.annfar.2009.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
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Severe Anaphylaxis to Volplex, a Colloid Solution during Cesarean Section: A Case Report and Review. Obstet Gynecol Int 2009; 2009:374791. [PMID: 19946647 PMCID: PMC2778838 DOI: 10.1155/2009/374791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 03/07/2009] [Accepted: 03/16/2009] [Indexed: 11/18/2022] Open
Abstract
Anaphylaxis is a life-threatening event that can occur anytime during pregnancy. It has been reported following administration of various substances with adverse maternal and neonatal consequences. It should be considered in the differential diagnosis of intrapartum collapse. We encountered a case of severe anaphylactic reaction following a routine cesarean section. It is very important that all members of the perinatal team are aware of early recognition and management of anaphylactic reaction. We think that it is important to highlight this as a further case report of severe anaphylactic reaction to a colloid solution and discuss the pathophysiology and
management.
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Chaudhuri K, Gonzales J, Jesurun CA, Ambat MT, Mandal-Chaudhuri S. Anaphylactic shock in pregnancy: a case study and review of the literature. Int J Obstet Anesth 2009; 17:350-7. [PMID: 18691872 DOI: 10.1016/j.ijoa.2008.05.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Accepted: 05/01/2008] [Indexed: 10/21/2022]
Abstract
We describe a 22-year-old previously healthy primigravida who presented with spontaneous rupture of membranes at 40 weeks of gestation. Because of her history of inadequate prenatal care, a chemoprophylaxis regimen against group B streptococcal infection was prescribed upon admission. Within a few minutes after initiation of an i.v. infusion of penicillin G, the patient developed generalized erythema and severe hypotension, which was essentially unresponsive to intravenous boluses of ephedrine. Following stabilization of maternal blood pressure with incremental doses of epinephrine, emergency cesarean section was performed with delivery of a severely depressed neonate. Postoperative recovery of the mother was uneventful, although the baby was diagnosed to have suffered significant neurological damage. This unfortunate event highlights the therapeutic dilemma in anaphylaxis during pregnancy, a relatively rare but potentially life-threatening event. A critical review of the scientific literature reveals several etiological agents for anaphylaxis during the perioperative period, with penicillin as the leading cause of anaphylaxis-related mortality. Although epinephrine is the vasopressor of choice during hemodynamic resuscitation in the non-pregnant patient, during pregnancy it may pose a risk to the placental-fetal circulation. Additionally, upon review of the various published reports to date, timing and mode of delivery of the neonate in the face of anaphylactic shock remains controversial.
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Affiliation(s)
- K Chaudhuri
- Department of Anesthesiology, Texas Tech University Health Sciences Center, El Paso, Texas 79905, USA.
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Sheikh J. Intrapartum anaphylaxis to penicillin in a woman with rheumatoid arthritis who had no prior penicillin allergy. Ann Allergy Asthma Immunol 2007; 99:287-9. [PMID: 17910335 DOI: 10.1016/s1081-1206(10)60667-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Little is known about the development of drug allergy during pregnancy or in patients with altered immune status. OBJECTIVE To report a case of new-onset penicillin allergy during pregnancy in a woman with rheumatoid arthritis. METHODS A 39-year-old woman with rheumatoid arthritis developed intrapartum anaphylaxis that led to fetal demise. She had previously received penicillin-based antibiotics without any allergic reactions. Because of group B streptococcus colonization, an intravenous infusion of penicillin G was started during labor. Within minutes, she developed severe anaphylaxis. RESULTS A fluorescent enzyme immunoassay revealed a moderate level of specific IgE to penicilloyl G and penicilloyl V (3.15 kU/L and 2.77 kU/L, respectively). Given the patient's history, these positive results were considered confirmatory of penicillin allergy. This case raises a number of salient points. First, patients can develop severe allergy to penicillin despite having safely received penicillins in the past. Possible factors that influenced the development of severe penicillin sensitivity in this patient are discussed. Second, unexpected intrapartum anaphylaxis can occur, which can be life threatening to the mother or fetus. Third, safe and reliable methods for diagnosis of drug allergy must be available. CONCLUSIONS This case illustrates that during the current unavailability of skin testing reagents in the United States, a positive result on in vitro testing can be helpful in confirming penicillin allergy in cases in which drug challenge is deemed unsafe.
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Affiliation(s)
- Javed Sheikh
- Department of Medicine, Division of Allergy & Inflammation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
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