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Allergic reactions during general anaesthesia in Slovenian children

机译：斯洛文尼亚儿童全麻期间的过敏反应

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IntroductionThe data on incidence and causes of anaphylaxis duringanesthesia in children are lacking. Latex, neuromuscularblocking agents (NMBAs) and antibiotics are mostfrequently described causes but more data includingassessment of cross reactivity of drugs and informationof subsequent anaesthesia would be useful.MethodsWe prospectively included 13 children (8 girls, aged 2 to13 years) that were referred to our department for investigationthe cause of systemic allergic reaction duringanaesthesia between 2010-13. Diagnostic procedureincluded detailed history, skin prick and intradermal testing,detection of specific IgE antibodies (to suxametonium,morphin, latex, beta-lactams (BL), chlorhexidine) andprovocation tests (nonsteroidal anti-inflammatory drugs,benzodiazepines and latex). We performed also basophilactivation tests (BAT) with BL, NMBAs, midazolam,propofol and glucocorticoids. Stimulation index (SI) >2was considered positive.ResultsFive children presented with anaphylaxis and eight withurticaria/angioedema. Seven of them had reaction duringtheir first anaesthesia. Seven children had positive testingresults to one group of drugs or one substance (twoto NMBAs, two to BL, one to glucocorticoids, one toopioids and one to latex). Three children presented withpositive testing results to more than one group of drugs(one to NMBAs, opioids and benzodiazepines, one toNMBA, benzodiazepines and isopropyl alcohol and oneto benzodiazepines and garamicin). Two children haddermographism. In one child parents did not want tostart diagnosing procedure. Cross- reactivity within thegroup of medication was found in eleven children(among NMBA, BL, glucocorticoids, benzodiazepines andopioids). BAT for NMBA was positive in three of fourchildren allergic to NMBAs, in both children allergic toBL, in one child allergic to glucocorticoids and in one ofthree children allergic to midazolam. Four children haduncomplicated following anaesthesia, one girl vomitedduring the next anaesthesia.ConclusionsCauses of anaphylaxis during anaesthesia in children arediverse. Multiple positive testing results complicate furtherpotential anaesthesia. BAT can be a useful additionaldiagnosing method in immediate hypersensitivity reactionsoccurring during anaesthesia.
机译：简介缺乏有关儿童麻醉期间过敏反应的发生率和原因的数据。乳胶，神经肌肉阻滞剂（NMBA）和抗生素是最常见的病因，但更多的数据包括药物的交叉反应性评估和后续麻醉的信息将是有用的。方法我们前瞻性地包括了13个儿童（8个女孩，年龄2至13岁）在2010-13年间调查麻醉期间全身性过敏反应的原因。诊断程序包括详细病史，皮肤点刺和皮内测试，检测特定的IgE抗体（针对硫磺铵，吗啡，乳胶，β-内酰胺（BL），洗必泰）和激发试验（非甾体类抗炎药，苯并二氮杂和乳胶）。我们还对BL，NMBA，咪达唑仑，丙泊酚和糖皮质激素进行了嗜碱性粒细胞活化试验（BAT）。刺激指数（SI）> 2被认为是阳性。结果5例表现出过敏反应和8例荨麻疹/血管性水肿。他们中有七个在第一次麻醉时有反应。七名儿童对一组药物或一种物质的检测结果为阳性（对NMBA两种，对BL两种，对糖皮质激素，一种对过环类药物，对乳胶，一种）。三个孩子对多于一种药物呈阳性检测结果（一种对NMBA，阿片类药物和苯二氮卓类药物，一种对NMBA，苯二氮卓类药物和异丙醇，对一种苯二氮卓类和garamicin化合物）。两个孩子皮肤描记术。在一个孩子中，父母不想开始诊断程序。在11名儿童（NMBA，BL，糖皮质激素，苯二氮卓类和阿片类药物）中发现药物组中的交叉反应性。对NMBA过敏的四个孩子中，对NMBA的BAT阳性，对BL过敏的两个孩子，对糖皮质激素过敏的一个孩子，对咪达唑仑过敏的三个孩子中的一个。四名儿童在麻醉后没有并发症，一名女孩在下一次麻醉时呕吐。结论儿童麻醉期间出现过敏反应的原因多种多样。多个阳性测试结果使进一步的麻醉复杂化。 BAT对于麻醉期间发生的速发型超敏反应可能是一种有用的附加诊断方法。

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