TY - JOUR

T1 - Management of suspected immediate perioperative allergic reactions

T2 - an international overview and consensus recommendations

AU - Garvey, Lene H.

AU - Dewachter, Pascale

AU - Hepner, David L.

AU - Mertes, Paul Michel

AU - Voltolini, Susanna

AU - Clarke, Russell

AU - Cooke, Peter

AU - Garcez, Tomaz

AU - Guttormsen, Anne Berit

AU - Ebo, Didier G.

AU - Hopkins, Philip M.

AU - Khan, David A.

AU - Kopac, Peter

AU - Krøigaard, Mogens

AU - Laguna, Jose Julio

AU - Marshall, Stuart

AU - Platt, Peter

AU - Rose, Michael

AU - Sabato, Vito

AU - Sadleir, Paul

AU - Savic, Louise

AU - Savic, Sinisa

AU - Scherer, Kathrin

AU - Takazawa, Tomonori

AU - Volcheck, Gerald W.

AU - Kolawole, Helen

PY - 2019

Y1 - 2019

N2 - Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

AB - Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

KW - allergy

KW - anaesthesia

KW - Delphi process

KW - epinephrine

KW - guideline

KW - hypersensitivity reaction

KW - perioperative anaphylaxis

KW - testing

U2 - 10.1016/j.bja.2019.04.044

DO - 10.1016/j.bja.2019.04.044

M3 - Journal article

C2 - 31130272

AN - SCOPUS:85064824261

VL - 123

SP - e50-e64

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 1

ER -