Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-27T10:46:30.816Z Has data issue: false hasContentIssue false
  • English
  • Français

Prick-test evaluation to anaesthetics in patients attending a general allergy clinic

Published online by Cambridge University Press:  07 July 2006

E. Tamayo ,
G. Rodríguez-Ceron ,
J. I. Gómez-Herreras ,
A. Fernández ,
J. Castrodeza  and
F. J. Álvarez
E. Tamayo
Affiliation:
Valladolid University Hospital, Department of Anaesthesiology and Reanimation, Valladolid, Spain
G. Rodríguez-Ceron
Affiliation:
Valladolid University Hospital, Department of Anaesthesiology and Reanimation, Valladolid, Spain
J. I. Gómez-Herreras
Affiliation:
Rio Hortega Hospital, Department of Anaesthesiology and Reanimation, Valladolid, Spain
A. Fernández
Affiliation:
Rio Hortega Hospital, Department of Allergology, Valladolid, Spain
J. Castrodeza
Affiliation:
University of Valladolid, Faculty of Medicine, Department of Medicine and Public Health, Valladolid, Spain
F. J. Álvarez
Affiliation:
University of Valladolid, Faculty of Medicine, Department of Pharmacology and Therapeutics, Valladolid, Spain
Get access

Abstract

Summary

Background and objectives: To analyse the prevalence of positive prick-tests to all medicaments normally checked in allergy units when a patient is suspected of being allergic to anaesthetics. To establish the degree of agreement between the antecedents of a previous history of an allergic reaction to a medicament and the positive result, or not, to the specific prick-test for the said medicament. Methods: This was a prospective study, during 2003 and 2004, which analysed 473 patients referred by their doctors to allergy units to make retrospective diagnoses of an allergy to a drug. The prick-test was done using the undiluted drug. All patients were tested for 41 drugs. These include antibiotics, trimethoprim–sulphamethoxazole, non-steroidal anti-inflammatory drugs (NSAIDs) and perioperative drugs (PD): neuromuscular blocking drugs, latex, iodine, local anaesthetics, hypnotics, opioids and coadjuvants. Cohen's Kappa Index was used to determine the degree of agreement. Results: 71.5% of patients studied presented a positive prick-test. The largest number of positive cases was found in antibiotics (56.4%), followed by PD (15.6%), NSAIDs (14.4%) and trimethoprim–sulphamethoxazole (12.7%). Among PD, the highest prevalence of positive prick-tests was found for neuromuscular blocking drugs (5.3%). Agreement between the substance suspected of causing the allergic reaction and the positive prick-test was excellent for penicillin (Kappa = 0.74) and other antibiotics (Kappa = 0.721) and good for NSAIDs (Kappa = 0.47) and iodine (Kappa = 0.54). Conclusions: The prevalence of patients with positive prick-tests to PD occurred in 15.6% in this prospective cohort. Neuromuscular blocking drugs were found to have the highest prevalence of positive prick-tests. There is positive agreement when the substance responsible for the allergic reaction is suspected, otherwise agreement is low.

Keywords

ANAPHYLAXIS, drug effects, epidemiologyANAESTHESIA, adverse effectsALLERGYDRUG HYPERSENSITIVITY, epidemiology
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 12 , December 2006 , pp. 1031 - 1036
Copyright
2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Laxenaire MC. Neuromuscular blocking drugs and allergic risk. Can J Anaesth 2003; 50: 429–433.Google Scholar
Moss J. Allergic to anesthetics. Anesthesiology 2003; 99: 521–523.Google Scholar
Levy JH. Anaphylactic reactions to neuromuscular blocking drugs: are we making the correct diagnosis? Anesth Analg 2004; 98: 881–882.Google Scholar
Hepner DL, Castells MC. Anaphylaxis during the peri-operative period. Anesth Analg 2003; 97: 1381–1395.Google Scholar
Dewachter P. La prévention du risque allergique peut-elle etre assurée par une médication préanesthésique. Ann Fr Anesth Ránim 2002; 21: S151–S167.Google Scholar
Vervloet D, Charpin D, Pradal Met al. Faut-il faire des tests de dépistage aux myorelaxants? Repones des auteurs. Rev Fr Allergol 1990: 30: 1–5.Google Scholar
Porri F, Lemiere C, Birnbaum Jet al. Prevalence of muscle relaxant sensitivity in a general population: implications for a preoperative screening. Clin Exp Allergy 1999; 29: 72–75.Google Scholar
Laxenaire MC. Drugs and other agents involved in anaphylactic shock occurring during anaesthesia. A French multicenter epidemiological inquiry. Ann Fr Anesth Reanim 1993; 12: 91–96.Google Scholar
Laxenaire MC, Mertes MP, GERAP. Anaphylaxis during anaesthesia. Results of a two-year survey in France. Br J Anaesth 2001; 87: 549–558.Google Scholar
Tamayo E, Perez M, Gomez JI, Alvarez FJ. Allergy to anaesthetising agents: a clinical experience from Spain. Br J Anaesth 1999; 83: 336–337.Google Scholar
Fleiss JL. Statistical Methods for Rates and Proportions.New York: John Wiley and Sons, 1981: 212–225.
Hung OR, Bands C, Laney G, Drover D, Stevens S, MacSween M. Drug allergies in the surgical population. Can J Anaesth 1994; 41: 1149–1155.Google Scholar
Laxenaire MC, Charpentier C, Feldman L. Réactions anaphilactoïdes aux substituts colloïdaux du plasma: incidence, facteurs de risque, mécanismes. Ann Fr Anaesth Reanim 1994; 13: 301–310.Google Scholar
Wyatt JP. Patients' knowledge about their drug allergies. J Accid Emerg Med 1996; 13: 114–115.Google Scholar
Demoly P, Bousquet J. Epidemiology of drug allergy. Curr Opin Allergy Clin Immunol 2001; 1: 305–310.Google Scholar
Fisher MM, Baldo BA. Anaphylaxis during anaesthesia: current aspects of diagnosis and prevention. Eur J Anaesthesiol 1994; 11: 263–284.Google Scholar
Mertes PM, Laxenaire MC, Alla F. Anaphylactic and anaphylactoid reactions occurring during anaesthesia in France in 1999–2000. Results of a two-year survey in France. Anesthesiology 2003; 99: 536–545.Google Scholar
Fisher MM, Baldo BA. The incidence and clinical features of anaphylactic reactions during anaesthesia in Australia. Ann Fr Anesth Reanim 1993; 12: 97–104.Google Scholar
Lieberman P. Anaphylactic reactions during surgical and medical procedures. Allergy Clin Immunol 2002; 110: S64–S69.Google Scholar
Turjanmaa K, Kanto M, Kautiainen H, Reunala T, Palosuo T. Long-term outcome of 160 adult patients with natural rubber latex allergy. J Allergy Clin Immunol 2002; 110: S70–S74.Google Scholar
Sánchez-Fernández C, Quirce S, Sánchez-Cano M. Preoperative screening for general anesthesia. Allergy Net 1998; 53: 542–543.Google Scholar
Patriarca G, Nucera E, Pollastrini Eet al. Sublingual desensitization: a new approach to latex allergy problem. Anesth Analg 2002; 95: 956–960.Google Scholar
Anderson JA. Allergic reactions to drugs and biological agents. JAMA 1992; 268: 2844–2857.Google Scholar
Thong BY, Leong KP, Tang CY, Chng HH. Drug allergy in a general hospital: results of novel prospective inpatient reporting system. Ann allergy Asthma Immunol 2003; 90: 342–347.Google Scholar
Guttormsen AB. Allergic reactions during anaesthesia-increased attention to the problem in Denmark and Norway. Acta Anaesthesiol Scand 2001; 45: 1189–1190.Google Scholar
Dhonneur G, Combes X, Chassard D, Merle JC. Skin sensitivity to rocuronium and vecuronium: a randomized controlled prick testing study in healthy volunteers. Anesth Analg 2004; 98: 986–989.Google Scholar
Fisher M. Prick testing for neuromuscular blocking drugs. Anesth Analg 2004; 99: 1880.Google Scholar
Dhonneur G. Prick testing for neuromuscular blocking drugs. Anesth Analg 2004; 99: 1880–1881.Google Scholar