Perioperative Hypersensitivity Reactions: Diagnosis, Treatment and Evaluation
Perioperative Hypersensitivity Reactions: Diagnosis, Treatment and Evaluation
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围手术期超敏反应：诊断、治疗和评估
DOI：
10.1007/s40521-016-0078-0
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发表时间：
2016
影响因子：
1.1
通讯作者：
L. H. Garvey
中科院分区：
文献类型：
--
作者：
L. H. Garvey
意见声明围手术期超敏反应很难诊断，因为症状很难与麻醉对心血管和呼吸系统的影响区分开来。有许多非过敏性鉴别诊断，随后的调查应旨在确定反应背后的机制。在许多情况下，不能排除过敏机制，应对患者在反应前暴露的所有药物和物质进行系统研究。与患者自身的基线水平相比，在反应时采集的血清类胰蛋白酶有助于确定是否可能是IgE介导的机制。在这些情况下，应确定罪魁祸首药物，以确保未来避免罪魁祸首，同时仅对未来麻醉药物的选择造成必要的限制。近年来，在围手术期发现了一些“隐藏的”和很少记录的过敏原，因此，应确定和检测所有暴露。调查是高度专业化的，包括皮肤测试，体外测试，最近在一些专业中心也包括激发。麻醉师和过敏症专家之间的合作是必要的，以确保在这种复杂的环境中为患者提供最高标准的护理。
Opinion statementPerioperative hypersensitivity reactions are difficult to diagnose as symptoms are hard to differentiate from the effects of anaesthesia on the cardiovascular and respiratory systems. There are numerous non-allergic differential diagnoses, and subsequent investigations should aim to determine the mechanism behind the reaction. In many cases, an allergic mechanism cannot be ruled out and systematic investigations should be performed of all drugs and substances the patient was exposed to prior to the reaction. Serum tryptase taken at the time of reaction compared with the patient’s own baseline level is helpful in determining whether an IgE-mediated mechanism is likely. In these cases, the culprit drug should be identified to ensure future avoidance of the culprit whilst causing only the necessary restrictions to the choice of future anaesthetic drugs. In recent years, a number of “hidden” and rarely documented allergens have been identified in the perioperative setting and, therefore,allexposures should be identified and tested. Investigations are highly specialised and comprise skin testing, in vitro testing and in some specialised centres, recently, also provocation. A combined approach with cooperation between anaesthesiologists and allergists is necessary to ensure the highest standard of care for patients in this complicated setting.