PERIOPERATIVE IMMEDIATE DRUG HYPERSENSITIVITY: CLINICAL FEATURES, DIAGNOSTICS, RISK ASSESSMENT

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.

drug allergy, adverse drug reactions, anaphylaxis, drug hypersensitivity, anesthesia, perioperative period