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 for this work

Department of Clinical Medicine

39 Citations (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.

Original language	English
Journal	British Journal of Anaesthesia
Volume	123
Issue number	1
Pages (from-to)	e50-e64
ISSN	0007-0912
DOIs	https://doi.org/10.1016/j.bja.2019.04.044
Publication status	Published - 2019

Keywords

allergy
anaesthesia
Delphi process
epinephrine
guideline
hypersensitivity reaction
perioperative anaphylaxis
testing

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10.1016/j.bja.2019.04.044

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

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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, vol. 123, no. 1, pp. 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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KW - hypersensitivity reaction

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

Abstract

Keywords

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