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Keywords:

  • Anesthesia complications: anaphylaxis, anaphylactoid reaction;
  • drugs: neuromuscular blocking drugs, chlorhexidine;
  • allergy testing: tryptase, specific IgE, skin testing

Background: Anaphylactoid reactions in anaesthesia are rare and should ideally be investigated in specialist centres. At Gentofte University Hospital, we established such a centre in 1998 as a joint venture between the Departments of Anaesthesiology and Dermatology. We present the methodology, diagnostic algorithm and preliminary results from our centre.

Methods: We are open for referral of patients from all of Denmark. Reactions are classified using a three-grade severity scale and all reactions ranging from mild to severe are investigated. Investigations follow a standard step-by-step protocol of in vitro testing and skin testing. Blood samples for tryptase analysis are taken at the time of reaction and a control sample is taken together with samples for specific IgE analysis 2–4 weeks after the reaction. Subsequent skin testing comprises both prick tests and intradermal tests in most cases. Patients are tested with all substances they were exposed to, including antibiotics, colloids, latex and chlorhexidine.

Results: A total of 68 patients have been referred to date (July 2001) and 36 have completed investigations. Positive test results were mainly seen in patients with more severe reactions, and there were more men than women in the group with the most severe reactions. Six patients had positive specific IgE, three for penicillin, two for latex and one for thiopental. In all, 21 patients had positive skin tests to various substances, of whom four men with anaphylactic shock tested positive for chlorhexidine. Only one patient has tested positive to a neuromuscular blocking drug (NMBD) so far.

Discussion:

Our preliminary results appear to differ in two ways from results usually found in this field. Firstly, only one patient has tested positive for a NMBD and secondly, we have had four patients with anaphylactic shock who have tested positive for chlorhexidine. Possible reasons for these differences are discussed.