Journal article

The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status.

  • Garvey LH Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Electronic address: lene.heise.garvey@regionh.dk.
  • Ebo DG Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
  • Krøigaard M Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark.
  • Savic S Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
  • Clarke R Department of Anaesthesia, Sir Charles Gairdner Hospital, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Australia.
  • Cooke P Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.
  • Dewachter P Service d'Anesthésie-Réanimation, Groupe Hospitalier de Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris 13, Sorbonne-Paris-Cité, Paris, France.
  • Garcez T Department of Immunology, Manchester University NHS Foundation Trust, Manchester, UK.
  • Guttormsen AB Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
  • Hopkins PM Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
  • Hepner DL Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  • Khan DA Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Kolawole H Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia.
  • Kopac P University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
  • Marshall S Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia.
  • Mertes PM Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS Strasbourg, EA 3072, Strasbourg, France.
  • Platt P Department of Anaesthesia, Sir Charles Gairdner Hospital, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Australia.
  • Rose M Department of Anaesthesia, Royal North Shore Hospital, and University of Sydney, Sydney, NSW, Australia.
  • Sabato V Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
  • Sadleir P Department of Anaesthesia, Sir Charles Gairdner Hospital, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Australia; Department of Pharmacology, University of Western Australia, Australia.
  • Savic L Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
  • Scherer K Allergy Unit, Department of Dermatology, University Hospital Basel, Basel University, Basel, Switzerland.
  • Takazawa T Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan.
  • Volcheck GW Division of Allergic Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
  • Voltolini S Allergy Unit, Policlinic Hospital San Martino, Genoa, Italy.
  • Laguna JJ Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain.
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  • 2019-04-28
Published in:
  • British journal of anaesthesia. - 2019
English Suspected perioperative allergic reactions are often severe. To avoid potentially life-threatening re-exposure to the culprit drug, establishing a firm diagnosis and identifying the culprit is crucial. Drug provocation tests are considered the gold standard in drug allergy investigation but have not been recommended in the investigation of perioperative allergy, mainly because of the pharmacological effects of drugs such as induction agents and neuromuscular blocking agents. Some specialised centres have reported benefits of provocation testing in perioperative allergy investigation, but the literature on the subject is limited. Here we provide a status update on the use of drug provocation testing in perioperative allergy, including its use in specific drug groups. This review is based on a literature search and experiences of the authors comprising anaesthesiologists and allergists with experience in perioperative allergy investigation. In addition, 19 participating centres in the International Suspected Perioperative Allergic Reaction Group were surveyed on the use of provocation testing in perioperative allergy investigation. A response was received from 13 centres in eight European countries, New Zealand, and the USA. Also, 21 centres from the Australian and New Zealand Anaesthetic Allergy Group were surveyed. Two centres performed provocation routinely and seven centres performed no provocations at all. Nearly half of the centres reported performing provocations with induction agents and neuromuscular blocking agents. Drug provocation testing is being used in perioperative allergy investigation in specialised centres, but collaborations between relevant specialties and multicentre studies are necessary to determine indications and establish common testing protocols.
Language
  • English
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https://sonar.ch/global/documents/54053
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