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Mary LaughlinMD

PACUpresentation

May 18, 2011

ALLERGIC

REACTIONS

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Allergy: result of release of preformed and newly

synthesized mediators from mast cell and

basophils.

Anaphylaxis: potential life-threatening immediate

hypersensitivity reactions

-immune-mediated or

-nonimmune-mediated

(so- called pseudo-allergic or anaphylactoid

reactions)

DEFINE ALLERGY

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TYPES OF REACTIONS

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TYPES OF REACTIONS

By TIMING: Immediate vs. Delayed (1 hour)

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Early: malaise, pruritus, dizziness, and

dyspnea

Later: tachycardia, hypotension,

bronchospasm, rash

Progress can be slow or very fast

SYMPTOMS

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Neuromuscular Blocking Agents (NMBAs) 50-

70%

Latex - 15%

Antibiotics - 15%

Hypnotics, Opioids, Colloids, Blood products,

topicals, cleansers

NSAIDS increasing use

Propofol- contraindicated if EGG allergy NOEVIDENCE!!

NO cross-reactivity between povidone-iodine,

iodinated contrast media, and shellfish

COMMON OFFENDERS

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Most reactions are acute IgE-dependent but

15-50% at first exposure

Cross reactivity highly variable

Synthesizing IgE antibodies to foods, cosmetics,

disinfectants, and industrial materials? NMBA

cross reactivity

Non-allergic reactions: direct nonspecific mast cell

and basophil activation, which causes directhistamine release

NMBAS

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PCN/Cephalosporins - beta-lactam ring

Amoxicil l in and Penicil l in have similar side-chain to first

generation cephalosporins (2nd and 3 rd gen. safer)

ANTIBIOTICS

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During an IgE-mediated reaction, basophils and mast cells

are activated and then degranulate and release mediators in

intracellular fluids

H istamine - t1/2 ~ 20min

Tryptase - t1/2 ~ 90min (peak 30min) >25 Qg/L=likely IgE

mediated GOLD TOP -3 days

Skin test 4-6 wks later

NOT STRAIGHT FORWARD - because most info is historical

DIAGNOSIS

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IgE or non-IgE = Clinically IRRELEVANT

Prevention: If anaphylaxis, should be evaluated by

allergist/immunologist

Timing: >90% happen immediately or within minutes ofinjection (more delayed reaction usually latex, colloids,

dyes)

Early epinephrine 10mcg (NE, vasopressin,

glucagon)

Volume expansion

&2 agonists

Corticosteroids, antihistamine

Long term: drug desensitization

Warning bracelet/Warning card

TREATMENT

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Mertes, PM. et a l . Per ioperat ive Anaphylax is . Immunol Al lergy Cl in N Am 29

(2009) 429451.

Hei tz , JW, SO Bader. An evidence-based approach to medicat ion preparat ion for

the surg ica l pat ient a t r isk for la tex a l lergy: is i t t ime t o stop being stopper

poppers? Journa l o f C l in ica l Anesthes ia (2010) 22 , 477483.U

UptoDate

REFERENCES