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Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature

Skin tests are the gold standard for detecting the culprit drug of anaphylaxis, and should ideally be performed after an interval of 4–6 weeks after the reaction to avoid false-negative results. However, when re-operation cannot be delayed and early allergy tests are necessary, special attention is...

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Autores principales: Orihara, Masaki, Takazawa, Tomonori, Nagumo, Kazuhiro, Sakamoto, Shinya, Horiuchi, Tatsuo, Saito, Shigeru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Singapore 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378110/
https://www.ncbi.nlm.nih.gov/pubmed/32476042
http://dx.doi.org/10.1007/s00540-020-02802-x
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author Orihara, Masaki
Takazawa, Tomonori
Nagumo, Kazuhiro
Sakamoto, Shinya
Horiuchi, Tatsuo
Saito, Shigeru
author_facet Orihara, Masaki
Takazawa, Tomonori
Nagumo, Kazuhiro
Sakamoto, Shinya
Horiuchi, Tatsuo
Saito, Shigeru
author_sort Orihara, Masaki
collection PubMed
description Skin tests are the gold standard for detecting the culprit drug of anaphylaxis, and should ideally be performed after an interval of 4–6 weeks after the reaction to avoid false-negative results. However, when re-operation cannot be delayed and early allergy tests are necessary, special attention is required during subsequent anesthesia, because early skin tests tend to produce false-negative results. This report presents a case of rocuronium-induced anaphylaxis in which early skin tests showed negative results for all the drugs tested. The second anesthesia was safely performed by avoiding all the drugs used for the first anesthesia. Ultimately, skin tests and basophil activation tests (BATs) performed after re-operation demonstrated rocuronium as the drug responsible for anaphylaxis. We recommend performing BATs in addition to skin tests to improve the accuracy of diagnosis of anaphylaxis. In this report, we also discuss interpretation of the results of early skin tests and subsequent selection of drugs for anesthesia. After postponement of surgery due to anaphylaxis, we are often required to perform allergy tests at an early stage if re-operation cannot be delayed. In such cases, skin test results alone should not be used to guide subsequent anesthesia management to avoid recurrent anaphylaxis.
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spelling pubmed-73781102020-08-04 Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature Orihara, Masaki Takazawa, Tomonori Nagumo, Kazuhiro Sakamoto, Shinya Horiuchi, Tatsuo Saito, Shigeru J Anesth Clinical Report Skin tests are the gold standard for detecting the culprit drug of anaphylaxis, and should ideally be performed after an interval of 4–6 weeks after the reaction to avoid false-negative results. However, when re-operation cannot be delayed and early allergy tests are necessary, special attention is required during subsequent anesthesia, because early skin tests tend to produce false-negative results. This report presents a case of rocuronium-induced anaphylaxis in which early skin tests showed negative results for all the drugs tested. The second anesthesia was safely performed by avoiding all the drugs used for the first anesthesia. Ultimately, skin tests and basophil activation tests (BATs) performed after re-operation demonstrated rocuronium as the drug responsible for anaphylaxis. We recommend performing BATs in addition to skin tests to improve the accuracy of diagnosis of anaphylaxis. In this report, we also discuss interpretation of the results of early skin tests and subsequent selection of drugs for anesthesia. After postponement of surgery due to anaphylaxis, we are often required to perform allergy tests at an early stage if re-operation cannot be delayed. In such cases, skin test results alone should not be used to guide subsequent anesthesia management to avoid recurrent anaphylaxis. Springer Singapore 2020-05-31 2020 /pmc/articles/PMC7378110/ /pubmed/32476042 http://dx.doi.org/10.1007/s00540-020-02802-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Clinical Report
Orihara, Masaki
Takazawa, Tomonori
Nagumo, Kazuhiro
Sakamoto, Shinya
Horiuchi, Tatsuo
Saito, Shigeru
Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature
title Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature
title_full Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature
title_fullStr Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature
title_full_unstemmed Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature
title_short Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature
title_sort interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature
topic Clinical Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378110/
https://www.ncbi.nlm.nih.gov/pubmed/32476042
http://dx.doi.org/10.1007/s00540-020-02802-x
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