Perioperative anaphylaxis

PerioperativePerioperativePerioperativePerioperativePerioperativePerioperativePerioperativePerioperativeAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxisAnaphylaxis

CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.CHULEEPORN KONGMEESOOK, M.D.

OutlineOutline

•• EpidemiologyEpidemiology

•• Causal agentsCausal agents

•• InvestigationInvestigation•• InvestigationInvestigation

•• ManagementManagement

EpidemiologyEpidemiology

•• Other countries varies widely Other countries varies widely

1/1,700 1/1,700 -- 1/20,0001/20,000

•• In France 1/13,000In France 1/13,000

•• In Australia 1/10,000 In Australia 1/10,000 -- 1/20,0001/20,000

•• MortalityMortality rate 5rate 5--7% 7%

A.V. A.V. MichavilaMichavila Gomez et al Gomez et al AllergolAllergol ImmunopatholImmunopathol 20132013; ; 11--12 12 ((article in pressarticle in press))PM PM MertesMertes, et al , et al J Investig Allergol Clin Immunol J Investig Allergol Clin Immunol 20112011; ; 2121((66) : ) : 442442--453453

P. W. Ewan et al Clinical & Experimental Allergy P. W. Ewan et al Clinical & Experimental Allergy 20102010; ; 40 40 : : 1515––3131Middleton's Middleton's allergy:principlesallergy:principles and practice and practice 88thth editionedition

Epidemiology in ThailandEpidemiology in Thailand

•• PerioperativePerioperative allergic reactions 1/5,500allergic reactions 1/5,500

SomboonSomboon ThienthongThienthong et al J Med Assoc Thai 2005; 88 (7) : 128et al J Med Assoc Thai 2005; 88 (7) : 128--3333

Paul Michel Paul Michel MertesMertes et al et al J Allergy Clin Immunol 2011; 128 : 366J Allergy Clin Immunol 2011; 128 : 366--7373

SomboonSomboon ThienthongThienthong et al J Med Assoc Thai 2005; 88 (7) : 128et al J Med Assoc Thai 2005; 88 (7) : 128--3333

Paul Michel Paul Michel MertesMertes et al Anesthesiology 2003; 99:536et al Anesthesiology 2003; 99:536––4545

Paul Michel Paul Michel MertesMertes et al et al J Allergy Clin Immunol 2011;128:366J Allergy Clin Immunol 2011;128:366--7373

HistoryHistory

•• EExxtteenntt ooff ssiiggnsns

•• DrDruuggss aanndd rreellaatteedd ccoommpopouunnddss

•• TiTimmee eellaappsedsed bbeettweenween adadmmiinniissttrarattiioonn

aannd d ononsetset oof f ssyymmppttoomsms

•• PPrerevviioouuss aalllleerrggiieses ffrroomm ddrruuggss oorr rerellaatted ed ccoommpopouunndsds

•• UUnnddererllyyiinngg ccoonnddiittiiononss

D. G. D. G. EboEbo et al Allergy 2007;62: 471et al Allergy 2007;62: 471––487487

EExxtteenntt ooff ssiiggnsns

•• Most case of Most case of perioperativeperioperative anaphylaxis anaphylaxis

characterized by severe respiratory and characterized by severe respiratory and

cardiovascular manifestationscardiovascular manifestations


Paul Michel Paul Michel MertesMertes Anesthesiology 2003; 99:536Anesthesiology 2003; 99:536––4545

PM PM MertesMertes et al et al J Investig Allergol Clin Immunol 2011; 21(6): 442J Investig Allergol Clin Immunol 2011; 21(6): 442--453453

Paul Michel Paul Michel MertesMertes Anesthesiology Anesthesiology 20032003; ; 9999::536536––4545

•• Most common are NMBAs, latex and Most common are NMBAs, latex and

antibioticsantibiotics

DrDruuggss aanndd rreellaatteedd ccoommpopouunnddss



•• Clinical signs and symptoms usually start Clinical signs and symptoms usually start

within 5within 5––10 min after administration but 10 min after administration but

can occur within secondcan occur within second

TiTimmee eellaappsedsed bbeettweenween adadmmiinniissttrarattiioonnaannd d ononsetset oof f ssyymmppttoomsms

•• Natural rubber latex (NRL) and antiseptics Natural rubber latex (NRL) and antiseptics delayed onset and occurs during delayed onset and occurs during maintenance maintenance anaesthesiaanaesthesia or recoveryor recovery


P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 15P. W. Ewan et al Clinical & Experimental Allergy 2010; 40 : 15––3131

•• CCareareffuull rreettrroossppectectiivvee assessmassessmeenntt ooffmmeeddiical cal hhiissttooryry aanndd rreeccoordsrds

•• IIddeennttiifyfy rriisksk ooff ppaattiieennttss dduurriinngg

PPrerevviioouuss aalllleerrggiieses ffrroomm ddrruuggss oorrrerellaatted ced coommpopouunndsds

•• IIddeennttiifyfy rriisksk ooff ppaattiieennttss dduurriinnggpprereananesestthheetiticc vviissiitt


•• IdentIdentiiffiication of ucation of unnddererllyyiinngg ccoonnddiittiioonsnshheellp p ttoo iiddeenntitiffyy ccaauusasattiivvee ccompompooununddss

•• AAttooppiicc rriisksk for for aannaapphhyyllaaxxiis fs frroomm NNRRLL

UUnnddererllyyiinngg ccoonnddiittiiononss

•• AAttooppiicc rriisksk for for aannaapphhyyllaaxxiis fs frroomm NNRRLL

D. G. D. G. EboEbo et al Allergy et al Allergy 20072007;;6262: : 471471––487487



InvestigationInvestigation

•• Serum Serum tryptasetryptase

•• Skin testSkin test

•• Serum specific Serum specific IgEIgE antibodiesantibodies•• Serum specific Serum specific IgEIgE antibodiesantibodies

•• Other tests : Other tests : BasophilBasophil activation testactivation test


Serum Serum tryptasetryptase

•• Recommended 60Recommended 60––120 min after onset of 120 min after onset of symptomssymptoms

•• Tryptase’sTryptase’s halfhalf--life about 120 minlife about 120 min

•• New sample should collect >2 days after New sample should collect >2 days after reaction for comparison with baseline reaction for comparison with baseline levelslevels





TreatmentTreatment

David L. David L. HepnerHepner et al et al AnesthAnesth AnalgAnalg 2003;97:13812003;97:1381––95 95

THANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOU

Paul Michel Paul Michel MertesMertes Anesthesiology Anesthesiology 20032003; ; 9999::536536––4545

Health & Medicine

Perioperative anaphylaxis