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

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

doi:10.1016/j.bja.2019.03.018

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

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

^*Corresponding author for this work

Department of Clinical Medicine

24 Citations (Scopus)

Abstract

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.

Original language	English
Journal	British Journal of Anaesthesia
Volume	123
Issue number	1
Pages (from-to)	e126-e134
ISSN	0007-0912
DOIs	https://doi.org/10.1016/j.bja.2019.03.018
Publication status	Published - 2019

Keywords

allergy
anaphylaxis
challenge testing
drug hypersensitivity
drug provocation test
perioperative period

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10.1016/j.bja.2019.03.018

http://bjanaesthesia.org/article/S000709121930220X/pdf

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Garvey, L. H., Ebo, D. G., Krøigaard, M., Savic, S., Clarke, R., Cooke, P., Dewachter, P., Garcez, T., Guttormsen, A. B., Hopkins, P. M., Hepner, D. L., Khan, D. A., Kolawole, H., Kopac, P., Marshall, S., Mertes, P. M., Platt, P., Rose, M., Sabato, V., ... Laguna, J. J. (2019). The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status. British Journal of Anaesthesia, 123(1), e126-e134. https://doi.org/10.1016/j.bja.2019.03.018

Garvey, LH, Ebo, DG, Krøigaard, M, Savic, S, Clarke, R, Cooke, P, Dewachter, P, Garcez, T, Guttormsen, AB, Hopkins, PM, Hepner, DL, Khan, DA, Kolawole, H, Kopac, P, Marshall, S, Mertes, PM, Platt, P, Rose, M, Sabato, V, Sadleir, P, Savic, L, Scherer, K, Takazawa, T, Volcheck, GW, Voltolini, S & Laguna, JJ 2019, 'The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status', British Journal of Anaesthesia, vol. 123, no. 1, pp. e126-e134. https://doi.org/10.1016/j.bja.2019.03.018

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title = "The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status",

abstract = "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.",

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

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AU - Garvey, Lene H.

AU - Ebo, Didier G.

AU - Krøigaard, Mogens

AU - Savic, Sinisa

AU - Clarke, Russell

AU - Cooke, Peter

AU - Dewachter, Pascale

AU - Garcez, Tomaz

AU - Guttormsen, Anne B.

AU - Hopkins, Philip M.

AU - Hepner, David L.

AU - Khan, David A.

AU - Kolawole, Helen

AU - Kopac, Peter

AU - Marshall, Stuart

AU - Mertes, Paul Michel

AU - Platt, Peter

AU - Rose, Michael

AU - Sabato, Vito

AU - Sadleir, Paul

AU - Savic, Louise

AU - Scherer, Kathrin

AU - Takazawa, Tomonori

AU - Volcheck, Gerald W.

AU - Voltolini, Susanna

AU - Laguna, Jose J.

PY - 2019

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N2 - 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.

AB - 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.

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KW - anaphylaxis

KW - challenge testing

KW - drug hypersensitivity

KW - drug provocation test

KW - perioperative period

U2 - 10.1016/j.bja.2019.03.018

DO - 10.1016/j.bja.2019.03.018

M3 - Journal article

C2 - 31027914

AN - SCOPUS:85064262047

SN - 0007-0912

VL - 123

SP - e126-e134

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 1

ER -

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

Abstract

Keywords

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