PERIOPERATIVE IMMEDIATE DRUG HYPERSENSITIVITY: CLINICAL FEATURES, DIAGNOSTICS, RISK ASSESSMENT
- Authors: Zhukova DG1, Fedenko ES2, Yudin AA1,3, Rakhimova OY1
-
Affiliations:
- Central clinical hospital of the Russian Academy of sciences
- Institute of Immunology
- Pirogov Russian National Research Medical University
- Issue: Vol 11, No 6 (2014)
- Pages: 9-19
- Section: Articles
- URL: https://bakhtiniada.ru/raj/article/view/120793
- DOI: https://doi.org/10.36691/RJA486
- ID: 120793
Cite item
Open Access
Access granted
Subscription Access
Abstract
Background. To evaluate clinical features and to develop the diagnostic algorithm of perioperative drug’s hypersensitivity reactions. Methods. 40 patients who presented perioperative immediate drug’s hypersensitivity reactions were studied in the Central Clinical hospital of the Russian Academy of sciences during 2010-2012. The diagnostic protocol consisted of 2 steps: at the 1 step (during the acute clinical manifestation period) a case history, grade of severity of immediate hypersensitivity reactions, serum tryptase levels have been studied; at the 2 step (6-12 weeks after symptoms were over) inhibition test of natural emigration of leukocytes by Ado, sublingual, skin tests and drug provocation tests have been performed. Results. Clinical manifestations of drugs hypersensitivity were as follows: hypersensitivity reactions grade I (isolated cutaneous manifestations) - in 20 patients (50%), anaphylactic-type reactions - in 20 patients (50%): grade II (moderate anaphylaxis) - in 13 patients (32,5%), grade III (severe life-threatening anaphylaxis) - in 6 (15%), and grade IV (cardiac and respiratory arrest) - in 1 patient (2,5%). Positive tests at least with 1 drug had 28 patients (70%): neuromusculars blockers (22,5%); antibiotics (22,5%); lidocaine (10%); amidotrizoate (7,5%); NSAID (7,5%). Other 12 patients had negative tests (30%) with all suspected agents and moderate clinical symptoms if to compare with others 28 patients (p<0,05%). Clinical manifestations of perioperative reactions depend on the kind of used drug: neuromuscular blockers, lidocaine and amidotrizoate inducted more severe reactions then antibiotics (p<0,05%). Conclusion. Immediate perioperative drug hypersensitivity reactions manifest as anaphylaxis in 50% of cases and mostly were caused by neuromuscular blockers and antibiotics. The present protocol of allergological examination allows to detect etiological drug and to determine its clinical significance.
Full Text
##article.viewOnOriginalSite##About the authors
D G Zhukova
Central clinical hospital of the Russian Academy of sciences
Email: zulyaevan@mail.ru
Moscow
E S Fedenko
Institute of ImmunologyMoscow
A A Yudin
Central clinical hospital of the Russian Academy of sciences; Pirogov Russian National Research Medical UniversityMoscow
O Y Rakhimova
Central clinical hospital of the Russian Academy of sciencesMoscow
References
- Kroigaard M., Garvey L.H., Gillberg L. et al. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol. Scand. 2007, v. 51, p. 655-670.
- Mertes P.M., Malinovsky J.M., Jouffroy L. et al. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J. Investig. Allergol. Clin. Immunol. 2011, v. 21, p. 442-453.
- Lobera T., Audicana M.T., Pozo M.D. et al. Study of hypersensitivity reactions and anaphylaxis during anesthesia in Spain. J. Investig. Allergol. Clin. Immunol. 2008, v. 18, p. 350-356.
- Axon A.D. Anaphylaxis and anesthesia - all clear now? British Journal of Anaesthesia. 2004, v. 93, p. 501-504.
- Simons F.E., Ardusso L.R., Bilo M.B. et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ. J. 2011, v. 4, p. 13-37.
- Федеральные клинические рекомендации по аллергологии. Под. ред. Р.М. Хаитова, Н.И. Ильиной. М., «Фармарус Принт Медиа». 2014, 126 с.
- Ebo D.G., Fisher M.M., Hagendorens M.M. et al. Anaphylaxis during anaesthesia: diagnostic approach. Allergy. 2007, v. 62, p. 471-487.
- Ильина Н.И., Латышева Т.В., Мясникова Т.Н. и соавт. Лекарственная аллергия. Методические рекомендации для врачей. Под ред. Р.М. Хаитова. М., «Фармарус Принт Медиа». 2012, 75 с.
- Schatz M. Adverse reactions to local anesthetics. Immunol. All. Clin. N. Am. 1992, v. 12, 585 p.
- Gollapudi R.R., Teirstein P.S., Stevenson D.D., Simon R.A. Aspirin sensitivity: implications for patients with coronary artery disease. JAMA. 2004, v. 292, p. 3017.
- Messaad D., Sahla H., Benahmed S. et al. Drug Provocation tests in patients with a history suggesting an immediate drug hypersensitivity reaction. Ann. Inter. Med. 2004, v. 140, p. 1001-1006.
- Chaudhry T., Hissaria P., Wiese M. et al. Oral drug challenges in non-steroidal anti-inflammatory drug-induced urticaria, angioedema and anaphylaxis. Intern. Med. J. 2012, v. 42, p. 665-671.
- Solensky R., Khan D.A. Drug Allergy: An Updated Practice Parameter. Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology. Ann. Allergy Asthma Immunol. 2010, v. 105, p. 273.
- Aberer W., Bircher A., Romano A. et al. Drug provocation testing in the diagnosis of drug hypersensitivity reactions: general considerations. Allergy. 2003, v. 58, p. 854.
- Turjanmaa K., Alenius H., MäkinenKiljunen S. et al. Natural rubber allergy. J. Allergy Clin. Immunol. 1995, v. 93, p. 259-268.
- Федеральный закон № 3 от 8 января 1998 (в ред. от 25.11.2013 N 317-ФЗ, с изм., внесенными от 04.06.2014 N 145-ФЗ) «О наркотических средствах и психотропных веществах». http://base.consultant.ru/cons/cgi/online. cgi?base=LAW&n=154942&req=doc.
- Жукова Д.Г., Феденко Е.С., Юдин А.А., Цывкина Е.А. Оценка риска реакций гиперчувствительности к лекарственным средствам в периоперационном периоде с помощью специализированного опросника. Рос. Аллергол. Журн. 2014, № 4, с. 18-25.
Supplementary files
