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Title:Anaesthetic management of patients with pre-existing allergic conditions : a narrative review
Authors:Dewachter, Pascale (Author)
Kopač, Peter (Author)
Laguna, Jose Julio (Author)
Mertes, Paul Michel (Author)
Sabato, Vito (Author)
Volcheck, Gerald W. (Author)
Cooke, Peter J. (Author)
Tipology:1.02 - Review Article
Organisation:Logo UKPBAG - University Clinic of Respiratory and Allergic Diseases Golnik
Abstract:This narrative review seeks to distinguish the clinical patterns of pre-existing allergic conditions from other confounding non-allergic clinical entities, and to identify the potential related risks and facilitate their perioperative management. Follow-up investigation should be performed after a perioperative immediate hypersensitivity to establish a diagnosis and provide advice for subsequent anaesthetics, the main risk factor for perioperative immunoglobulin E (IgE)-mediated anaphylaxis being a previous uninvestigated perioperative immediate hypersensitivity reaction. The concept of cross-reactivity between drugs used in the perioperative setting and food is often quoted, but usually not supported by evidence. There is no reason to avoid propofol in egg, soy, or peanut allergy. The allergenic determinants have been characterised for fish, shellfish, and povidone iodine, but remain unknown for iodinated contrast agents. Iodinated drugs may be used in seafood allergy. Evidence supporting the risk for protamine allergy in fish allergy and in neutral protamine Hagedorn insulin use is lacking. Conversely, cross-reactivity to gelatin-based colloid may occur in agal syndrome. Atopy and allergic asthma along with other non-allergic conditions, such as NSAID-exacerbated respiratory disease, chronic urticaria, mastocytosis, and hereditary or acquired angioedema, are not risk factors for IgEmediated drug allergy, but there is a perioperative risk associated with the potential for exacerbation of the various conditions.
Keywords:allergy and immunology, drug hypersensitivity, food hypersensitivity, immediate hypersensitivity, anaphylaxis, anesthesia, drug-related side effects and adverse reactions, perioperative period, adverse effects
Year of publishing:2019
Source:Velika Britanija
COBISS_ID:2048508785 Link is opened in a new window
ISSN on article:1471-6771
OceCobissID:515369241 Link is opened in a new window
DOI:10.1016/j.bja.2019.01.020 Link is opened in a new window
Note:Soavtor iz Slovenije: Peter Kopac; Nasl. z nasl. zaslona; Opis vira z dne 3. 6. 2019;
Files:URL URL - Source URL, visit
Journal:Br. j. anaesth.
Oxford University Press.
Rights:© 2019 British Journal of Anaesthesia
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