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British Journal of Anaesthesia, 2000, Vol. 85, No. 6 814-817
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial

Editorial II

Skin testing and the anaesthetist

John Watkins

In 1969, Hurwitz1 commented that the more drugs a patient receives, the greater the risk of an untoward reaction. Multiple drugs need to be used in surgery, since no single drug supplies all pharmacological needs, and this encourages unexpected drug interaction and pharmacological response. Problems are compounded by the necessity to use the intravenous route for drug administration, thus bypassing the body’s primary immune filters and presenting high concentrations of noxious chemicals directly to sensitive cells, notably mast cells and basophils.2 The substances liberated include histamine, eicosanoids and cytokines. The clinical outcome is not infrequently an immediate exaggerated systemic inflammatory response presenting hypotension and bronchospasm with varying degree of severity and which may, or may not, be immune (antibody) mediated. All such clinical presentations are usually referred to as anaphylactoid until laboratory and in vivo analysis can establish a genuine immediate immune-mediated hypersensitivity response (type I, IgE-mediated anaphylaxis) or otherwise, . . . [Full Text of this Article]

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