Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis

Background: Perioperative anaphylaxis is a severe immediate hypersensitivity reaction to drugs administered in immediate temporal association to surgical procedures. The European Academy of Allergy and Clinical Immunology recommends allergologic tests be performed within the golden period of between...

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Autores principales:	Wasurat Sungworn, Orathai Theankeaw, Aree Jameekornrak Taweechue, Chamard Wongsa, Torpong Thongngarm, Mongkhon Sompornrattanaphan
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Anaphylaxis Anesthesia Hypersensitivity reactions Intraoperative Perioperative period Science (General) Q1-390 Social sciences (General) H1-99
Acceso en línea:	https://doaj.org/article/aef3478446894e4d80ec96833b7ca70c
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spelling	oai:doaj.org-article:aef3478446894e4d80ec96833b7ca70c2021-12-02T05:03:03ZSuccessful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis2405-844010.1016/j.heliyon.2021.e08401https://doaj.org/article/aef3478446894e4d80ec96833b7ca70c2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2405844021025044https://doaj.org/toc/2405-8440Background: Perioperative anaphylaxis is a severe immediate hypersensitivity reaction to drugs administered in immediate temporal association to surgical procedures. The European Academy of Allergy and Clinical Immunology recommends allergologic tests be performed within the golden period of between 1 and 4 months after the date of the event to avoid false negatives. Nonetheless, many obstacles prevent patients from receiving diagnostic tests within the recommended time frame. Case presentation: A 39-year-old male with congenital glaucoma had a history of multiple episodes of perioperative anaphylaxis since the age of 1 year including generalized urticaria, bronchospasm, cyanosis, and hypotension. Because the sequence of events was unclear due to incomplete documentation of operations and the destruction of medical records, the allergists tested different perioperative drugs on the patient. Although the first test results were all negative, repeated tests at 6 weeks were positive for morphine and ketamine. We identified more than one causative drug at the second round of skin tests. Using recommended skin test concentrations, negative skin tests in 5 control subjects could support the validity of the second test. The patient underwent sinus surgery in the next 3 months after the second skin test using propofol, midazolam, sevoflurane, chlorhexidine, and cefazolin without any anaphylactic reactions. Conclusions: Repeated skin tests after negative results of the first tests may identify the causative drugs, thus providing optimal patient safety, and should be considered under the physician's discretion together with consideration of the severity of the allergic symptoms, time interval from last reactions, and the patient's consent.Wasurat SungwornOrathai TheankeawAree Jameekornrak TaweechueChamard WongsaTorpong ThongngarmMongkhon SompornrattanaphanElsevierarticleAnaphylaxisAnesthesiaHypersensitivity reactionsIntraoperativePerioperative periodScience (General)Q1-390Social sciences (General)H1-99ENHeliyon, Vol 7, Iss 11, Pp e08401- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Anaphylaxis Anesthesia Hypersensitivity reactions Intraoperative Perioperative period Science (General) Q1-390 Social sciences (General) H1-99
spellingShingle	Anaphylaxis Anesthesia Hypersensitivity reactions Intraoperative Perioperative period Science (General) Q1-390 Social sciences (General) H1-99 Wasurat Sungworn Orathai Theankeaw Aree Jameekornrak Taweechue Chamard Wongsa Torpong Thongngarm Mongkhon Sompornrattanaphan Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis
description	Background: Perioperative anaphylaxis is a severe immediate hypersensitivity reaction to drugs administered in immediate temporal association to surgical procedures. The European Academy of Allergy and Clinical Immunology recommends allergologic tests be performed within the golden period of between 1 and 4 months after the date of the event to avoid false negatives. Nonetheless, many obstacles prevent patients from receiving diagnostic tests within the recommended time frame. Case presentation: A 39-year-old male with congenital glaucoma had a history of multiple episodes of perioperative anaphylaxis since the age of 1 year including generalized urticaria, bronchospasm, cyanosis, and hypotension. Because the sequence of events was unclear due to incomplete documentation of operations and the destruction of medical records, the allergists tested different perioperative drugs on the patient. Although the first test results were all negative, repeated tests at 6 weeks were positive for morphine and ketamine. We identified more than one causative drug at the second round of skin tests. Using recommended skin test concentrations, negative skin tests in 5 control subjects could support the validity of the second test. The patient underwent sinus surgery in the next 3 months after the second skin test using propofol, midazolam, sevoflurane, chlorhexidine, and cefazolin without any anaphylactic reactions. Conclusions: Repeated skin tests after negative results of the first tests may identify the causative drugs, thus providing optimal patient safety, and should be considered under the physician's discretion together with consideration of the severity of the allergic symptoms, time interval from last reactions, and the patient's consent.
format	article
author	Wasurat Sungworn Orathai Theankeaw Aree Jameekornrak Taweechue Chamard Wongsa Torpong Thongngarm Mongkhon Sompornrattanaphan
author_facet	Wasurat Sungworn Orathai Theankeaw Aree Jameekornrak Taweechue Chamard Wongsa Torpong Thongngarm Mongkhon Sompornrattanaphan
author_sort	Wasurat Sungworn
title	Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis
title_short	Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis
title_full	Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis
title_fullStr	Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis
title_full_unstemmed	Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis
title_sort	successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/aef3478446894e4d80ec96833b7ca70c
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Successful identification of culprit drugs of perioperative anaphylaxis by repeated skin testing after negative first skin tests in a patient with a long distant history of perioperative anaphylaxis

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