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BJA Advance Access published online on August 12, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei198
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted June 3, 2005

Clinical Investigation

Allergic reactions in anaesthesia: are suspected causes confirmed on subsequent testing?

M. Krøigaard 1*, L. H. Garvey 1, T. Menné 2, and B. Husum 1

1 Danish Anaesthesia Allergy Centre, Department of Anaesthesia and Operating Theatre Services, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
2 Department of Dermatology, Gentofte University Hospital, Copenhagen, Denmark

* To whom correspondence should be addressed.
M. Krøigaard, E-mail: daac{at}rh.dk


  Abstract

Background. The aim of this retrospective survey of possible allergic reactions during anaesthesia was to investigate whether the cause suspected by anaesthetists involved corresponded with the cause found on subsequent investigation in the Danish Anaesthesia Allergy Centre (DAAC).

Methods. Case notes and anaesthetic charts from 111 reactions in 107 patients investigated in the DAAC were scrutinized for either suspicions of or warnings against specific substances stated to be the cause of the supposed allergic reaction.

Results. In 67 cases, one or more substances were suspected. In 49 of these (73%) the suspected cause did not match the results of subsequent investigation, either a different substance being the cause or no cause being found. Only five cases (7%) showed a complete match between suspected cause and investigation result. In the remaining 13 cases (19%) there was a partial match, the right substance being suspected, but investigations showed an additional allergen or several substances, including the right substance being suspected.

Conclusions. An informed guess is not a reliable way of determining the cause of a supposed allergic reaction during anaesthesia and may put a significant number of patients at unnecessary risk. Some patients may be labelled with a wrong allergy, leading to unnecessary warnings against harmless substances, and some patients may be put at risk of subsequent re-exposure to the real allergen. Patients with suspected allergic reactions during anaesthesia should be referred for investigation in specialist centres whenever possible.

Keywords: allergy; anaesthesia, general; complications, anaphylaxis; records, anaesthesia; records, medical.
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RANITIDINE ANAPHYLAXIS
HASHER P KADAVIL
British Journal of Anaesthesia, 14 Nov 2005 [Full text]

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