Perioperative Hypersensitivity in Children
Condition: Drug Allergy
MeSH terms: Hypersensitivity; Drug Hypersensitivity
Study type: Interventional

Summary: 
      There are limited studies on perioperative hypersensitivity (POH) reactions in children. The
      diagnosis of POH might be underestimated due to the difficulty of recognizing the reactions.
      Anaphylaxis may go unnoticed due to the unconscious state of the patient. Urticaria may be
      overlooked due to the sterile covers. This study aimed to evaluate POH reactions
      prospectively.
    

Detailed description: 
      Patients with intraoperative signs of diffuse erythema, urticaria, angioedema, sudden
      hypotension, tachycardia, bradycardia, arrhythmia, bronchospasm, vomiting, difficulty in
      ventilation, and end-tidal carbon dioxide (CO2) increase were included in the study.
      Reactions were graded from I to IV depending on increasing severity (Grade I, presence of
      cutaneous signs; Grade II, presence of measurable but non-life-threatening symptoms,
      including cutaneous effects, arterial hypotension, cough, or difficulty in mechanical
      ventilation; Grade III, presence of life-threatening reactions: cardiovascular arrest,
      tachycardia or bradycardia, arrhythmias, severe bronchospasm; Grade IV, circulatory
      inefficacy, cardiac and/or respiratory arrest).

      In case of suspicious findings in terms of hypersensitivity reactions during surgery or
      recovery from anesthesia; the basal serum tryptase level was recorded at the time of the
      reaction, 2 hours after the reaction, and any time after 24 hours.

      The severity of the reaction, vital signs, treatments applied, and medications administered
      after the reaction were recorded in the pre-prepared follow-up form. Then, skin tests were
      performed with all exposure agents,latex and chlorhexidine 4-6 weeks after the reaction in
      accordance with the records kept by the Pediatric Allergy and Immunology Clinic. A wheal
      diameter of at least 3mm larger than negative control is regarded a positive skin prick test,
      while in intradermal testing (IDT), a diameter 3 mm larger than the intracutaneously
      administered depot of the drug solution following 15-20 min is considered positive. Histamine
      was used as a positive control, and saline as a negative control. For positive skin test
      cases, basophil activation test was performed with the available drug. Skin prick and
      intradermal test concentrations were applied according to the recommendations for
      non-irritant test concentrations published by the European Network for Drug Allergy (ENDA)
      (8). Specific immunoglobulin E (spIgE) measurements were performed for latex and
      chlorhexidine on skin test positive cases, and for penicillin before the skin test for one
      case that experienced anaphylaxis due to antibiotics. The methodology used was ImmunoCAP®
      (Thermo Fisher Scientific, Uppsala, Sweden). Serum total tryptase levels were measured with
      ImmunoCAP® (Thermo Fisher Scientific). The increased serum tryptase value was calculated with
      the following formula: >1.2*basal tryptase level +2 mcg/L. In suspicious cases where the
      latex skin test was not clinically compatible, cutaneous provocation with latex was
      performed. Comparisons were made with the basophil activation test for positive results in
      drug skin tests.
    

Intervention name(s): diagnostics
Intervention type(s): Diagnostic Test
Intervention description(s): Serum tryptase levels were evaluated in all suspected children with perioperative hypersensitivity
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: children,; anesthesia; anaphylaxis