Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

July 2019Volume 123, Issue 1, Pages e50–e64

Lene H. Garvey1,2,∗,Correspondence information about the author Lene H. Garvey†,‡,Email the author Lene H. Garvey

, 

Pascale Dewachter3,4,†,‡

, 

David L. Hepner5,†,‡

, 

Paul Michel Mertes6,†,‡

, 

Susanna Voltolini7,†,‡

, 

Russell Clarke8,9,‡

, 

Peter Cooke10,‡

, 

Tomaz Garcez11,‡

, 

Anne Berit Guttormsen12,‡

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Didier G. Ebo13,‡

, 

Philip M. Hopkins14,‡

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David A. Khan15,‡

, 

Peter Kopac16,‡

, 

Mogens Krøigaard1,‡

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Jose Julio Laguna17,‡

, 

Stuart Marshall18,19,‡

, 

Peter Platt8,9,‡

, 

Michael Rose20,‡

, 

Vito Sabato13,‡

, 

Paul Sadleir8,9,21,‡

, 

Louise Savic22,‡

, 

Sinisa Savic23,‡

, 

Kathrin Scherer24,‡

, 

Tomonori Takazawa25,‡

, 

Gerald W. Volcheck26,‡

, 

Helen Kolawole18,19,†,‡

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DOI: https://doi.org/10.1016/j.bja.2019.04.044

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Summary

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.

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