Multiple drug allergies: Recommendations for perioperative management

Life-threatening hypersensitivity reactions are more likely to occur in patients with a history of allergy, atopy, or asthma. Hence, in a patient who presented with a history of multiple drug allergies (MDA), an allergological assessment should be performed prior to surgical procedure. Drug allergie...

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Bibliographic Details
Published in:	Best practice & research. Clinical anaesthesiology Vol. 34; no. 2; pp. 325 - 344
Main Authors:	Patil, Shilpadevi S., Sun, Lu, Fox, Charles J., Anthony, Kathryn E., Anzalone, Fallon A., Fisher, Paul M., Girma, Brook, Huang, Genkai J., Barsley, Emily L., Cornett, Elyse M., Urman, Richard D., Kaye, Alan D.
Format:	Journal Article
Language:	English
Published:	Elsevier Ltd 01-06-2020
Subjects:	adverse drug reactions anaphylaxis drug allergies medication hypersensitivity neuromuscular blocking agents drug allergies adverse drug reactions anaphylaxis neuromuscular blocking agents medication hypersensitivity
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Summary:	Life-threatening hypersensitivity reactions are more likely to occur in patients with a history of allergy, atopy, or asthma. Hence, in a patient who presented with a history of multiple drug allergies (MDA), an allergological assessment should be performed prior to surgical procedure. Drug allergies, being one of the causes of catastrophic events occurring in the perioperative period, are of major concern to anesthesiologists. Neuromuscular blocking agents are regularly used during anesthesia and are one of the most common causes of perioperative anaphylaxis. They are estimated to be responsible for 50%–70% of perioperative hypersensitivity reactions. Antibiotics and latex represent the next two groups of drug allergy. Allergic reactions to propofol are rare with an incidence of 1:60,000 exposures. Although intraoperative drug anaphylaxis is rare, it contributes to 4.3% of deaths occurring during general anesthesia. These recommendations discuss pathophysiology of MDA, preoperative evaluation, and anesthesia considerations as well as the prevention and management of allergic reactions in anesthetized patients with a history of MDA.
ISSN:	1521-6896 1532-169X
DOI:	10.1016/j.bpa.2020.05.004