Journal ArticleDOI
Anaphylaxis during anesthesia in France: An 8-year national survey
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TLDR
The incidence of allergic reactions during anesthesia, estimated on a national basis, is higher than previously estimated and the similar incidence of reactions according to sex before adolescence suggests a role for sex hormones in the increase of anaphylaxis observed in women.Abstract:
Background More attention should be paid to rare serious adverse events such as anaphylaxis to increase the safety of anesthesia. Objective To report the results of an 8-year survey of anaphylaxis during anesthesia in France. Methods Data from patients who experienced anaphylaxis between January 1, 1997, and December 31, 2004, were analyzed. Estimated incidences were obtained by combining this database with data from the French pharmacovigilance system by using a capture-recapture method. The number of patients exposed to the offending agents was obtained from data collected during the national survey of anesthesia practice. Results A total of 2516 patients was included. A diagnosis of IgE-mediated reaction was established in 1816 cases (72.18%). The most common causes were neuromuscular blocking agents ([NMBAs]; n = 1067; 58.08%), latex (n = 361; 19.65%), and antibiotics (n = 236; 12.85%). The median annual incidence per million procedures was higher for females 154.9 (5th-95th percentile, 117.2-193.1) than for males 55.4 (5th-95th percentile, 42.0-68.0). It reached 250.9 (5th-95th percentile, 189.8-312.9) for women in cases of allergic reactions to NMBAs. In children, a diagnosis of IgE-mediated reactions was obtained in 122 cases (45.9%). The most common causes were latex (n = 51; 41.8%), NMBAs (n = 39; 31.97%), and antibiotics (n = 11; 9.02%). In contrast with adults, no female predominance was observed. Conclusion The incidence of allergic reactions during anesthesia, estimated on a national basis, is higher than previously estimated. These results should be taken into account in the evaluation of the benefit-to-risk ratio of the various anesthetic techniques in individuals. The similar incidence of reactions according to sex before adolescence suggests a role for sex hormones in the increase of anaphylaxis observed in women.read more
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Iconographies supplémentaires de l'article : Intérêt d’une consultation d’allergologie au décours d’une réaction d’hypersensibilité immédiate aux anesthésiques généraux
Najla Bahloul,L Ben Mahmoud,H. Ghozzi,F. Derbel,G. Rahma,Ahmed Hakim,Zouheir Sahnoun,Samy Kammoun,K. Zeghal +8 more
Abstract: Resume Introduction L’anesthesie generale implique l’administration de plusieurs medications en une duree de temps tres courte. Ces produits peuvent donner plusieurs effets secondaires, notamment des complications allergiques peranesthesiques. Plusieurs etudes ont evalue l’importance d’un bilan allergologique suite aux accidents peranesthesiques. L’objectif de cette etude est de demontrer l’interet du bilan allergologique suite a un accident d’hypersensibilite immediate peri-anesthesique. Methode A partir de la base de donnees de pharmacovigilance du centre regional de pharmacovigilance (CRPV) de Sfax, nous avons inclus des cas d’hypersensibilite immediate aux produits anesthesiques generaux notifies sur une periode de trois ans. Les tests cutanes ont ete realises en conformite avec les recommandations de l’ENDA/EAACI. Les produits anesthesiques generaux testes ont ete les suivants : l’atracurium, le cisatracurium, le suxamethonium, le midazolam, le propofol et la ketamine. Resultats Dans notre etude, 15 cas d’HSI aux produits anesthesiques generaux ont ete notifies dans le CRPV et seulement 7 cas ont fait l’exploration allergologique. Six produits anesthesiques ont ete impliques dans la survenue des reactions d’HSI : le Cisatracurium dans 5 cas, l’atracurium dans 3 cas, le suxamethonium dans 2 cas, le propofol dans 2 cas, la ketamine dans 1 cas, et le Midazolam dans 2 cas. Les prick tests ont ete negatifs dans tous les cas, les intradermo reactions (IDR) ont ete positives pour le cisatracurium et la ketamine pour la patiente no 1, pour l’atracurium et le midazolam pour la patiente no 2, pour le cisatracurium pour la patiente no 3, pour l’atracurium et le suxamethonium pour la patiente no 4, pour le cisatracurium uniquement pour les patientes no 5 et no 6 et pour tous les produits sauf la ketamine pour la patiente no 7. Une reactivite croisee entre les curares a ete observee dans un cas et une sensibilisation entre les curares et les hypnotiques a ete observee dans 3 cas. Conclusion La realisation d’une consultation d’allergologie a la suite d’un accident perianesthesique s’avere importante pour ne pas reexposer le patient a un produit contre lequel il est sensibilise, et permet de guider le choix d’un anesthesique qui peut etre utilise lors d’une nouvelle anesthesie.
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Drug and Venom Allergy in Mastocytosis
TL;DR: In this paper , the authors reviewed the epidemiology, mechanisms, diagnosis, management, and treatment options for Hymenoptera venom and drug-induced reactions in patients with mastocytosis.
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