Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Lene H. Garvey; Pascale Dewachter; David L. Hepner; Paul Michel Mertes; Susanna Voltolini; Russell Clarke; Peter Cooke; Tomaz Garcez; Anne Berit Guttormsen; Didier G. Ebo; Philip M. Hopkins; David A. Khan; Peter Kopac; Mogens Krøigaard; Jose Julio Laguna; Stuart Marshall; Peter Platt; Michael Rose; Vito Sabato; Paul Sadleir; Louise Savic; Sinisa Savic; Kathrin Scherer; Tomonori Takazawa; Gerald W. Volcheck; Helen Kolawole

doi:10.1016/j.bja.2019.04.044

Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Lene H. Garvey^*, Pascale Dewachter, David L. Hepner, Paul Michel Mertes, Susanna Voltolini, Russell Clarke, Peter Cooke, Tomaz Garcez, Anne Berit Guttormsen, Didier G. Ebo, Philip M. Hopkins, David A. Khan, Peter Kopac, Mogens Krøigaard, Jose Julio Laguna, Stuart Marshall, Peter Platt, Michael Rose, Vito Sabato, Paul SadleirLouise Savic, Sinisa Savic, Kathrin Scherer, Tomonori Takazawa, Gerald W. Volcheck, Helen Kolawole

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin

39 Citationer (Scopus)

Abstract

Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

Originalsprog	Engelsk
Tidsskrift	British Journal of Anaesthesia
Vol/bind	123
Udgave nummer	1
Sider (fra-til)	e50-e64
ISSN	0007-0912
DOI	https://doi.org/10.1016/j.bja.2019.04.044
Status	Udgivet - 2019

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10.1016/j.bja.2019.04.044

http://bjanaesthesia.org/article/S0007091219303290/pdf

Citationsformater

Garvey, L. H., Dewachter, P., Hepner, D. L., Mertes, P. M., Voltolini, S., Clarke, R., Cooke, P., Garcez, T., Guttormsen, A. B., Ebo, D. G., Hopkins, P. M., Khan, D. A., Kopac, P., Krøigaard, M., Laguna, J. J., Marshall, S., Platt, P., Rose, M., Sabato, V., ... Kolawole, H. (2019). Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. British Journal of Anaesthesia, 123(1), e50-e64. https://doi.org/10.1016/j.bja.2019.04.044

Garvey, LH, Dewachter, P, Hepner, DL, Mertes, PM, Voltolini, S, Clarke, R, Cooke, P, Garcez, T, Guttormsen, AB, Ebo, DG, Hopkins, PM, Khan, DA, Kopac, P, Krøigaard, M, Laguna, JJ, Marshall, S, Platt, P, Rose, M, Sabato, V, Sadleir, P, Savic, L, Savic, S, Scherer, K, Takazawa, T, Volcheck, GW & Kolawole, H 2019, 'Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations', British Journal of Anaesthesia, bind 123, nr. 1, s. e50-e64. https://doi.org/10.1016/j.bja.2019.04.044

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abstract = "Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.",

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author = "Garvey, {Lene H.} and Pascale Dewachter and Hepner, {David L.} and Mertes, {Paul Michel} and Susanna Voltolini and Russell Clarke and Peter Cooke and Tomaz Garcez and Guttormsen, {Anne Berit} and Ebo, {Didier G.} and Hopkins, {Philip M.} and Khan, {David A.} and Peter Kopac and Mogens Kr{\o}igaard and Laguna, {Jose Julio} and Stuart Marshall and Peter Platt and Michael Rose and Vito Sabato and Paul Sadleir and Louise Savic and Sinisa Savic and Kathrin Scherer and Tomonori Takazawa and Volcheck, {Gerald W.} and Helen Kolawole",

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AU - Voltolini, Susanna

AU - Clarke, Russell

AU - Cooke, Peter

AU - Garcez, Tomaz

AU - Guttormsen, Anne Berit

AU - Ebo, Didier G.

AU - Hopkins, Philip M.

AU - Khan, David A.

AU - Kopac, Peter

AU - Krøigaard, Mogens

AU - Laguna, Jose Julio

AU - Marshall, Stuart

AU - Platt, Peter

AU - Rose, Michael

AU - Sabato, Vito

AU - Sadleir, Paul

AU - Savic, Louise

AU - Savic, Sinisa

AU - Scherer, Kathrin

AU - Takazawa, Tomonori

AU - Volcheck, Gerald W.

AU - Kolawole, Helen

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N2 - Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

AB - Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

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KW - anaesthesia

KW - Delphi process

KW - epinephrine

KW - guideline

KW - hypersensitivity reaction

KW - perioperative anaphylaxis

KW - testing

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SN - 0007-0912

VL - 123

SP - e50-e64

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

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ER -

Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Abstract

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