An immunologically mediated reaction may not produce all the classic symptoms and signs. Yet another difficulty is that totally different aetiologies, particularly anaesthetic misadventure, may lead to similar signs and symptoms. Against this complicated background, the clinician must be constantly on the alert for physiological changes in response to drug administration and seek to diagnose rapidly the cause of a particular reaction. A wide range of precipitants may produce a true immunological reaction, including the active agent, the solvent or any preservative in the drug solutions administered. Agents administered coincidentally, such as antibiotics, skin preparation solutions and latex rubber should also be considered.
Rapid diagnosis needs to be accompanied by equally rapid response.
There is increasing evidence that immunologically based reactions must be treated with adrenaline before any other agent. Subsequent management will very much depend on the nature and severity of the reaction, but serial blood samples should be taken for complement, immunoglobulin and other assays. Prolonged intensive care may be necessary. Once the acute event, is over it is necessary to try and establish the true cause of the reaction so that definitive information may be given to the patient and incorporated in the patient's records. This requires careful consideration of all possible causes of the reaction and thoughtful analysis of blood results.