The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: allergen exposure, epidemiology, and diagnosis of anaphylaxis during general anaesthesia
The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: allergen exposure, epidemiology, and diagnosis of anaphylaxis during general anaesthesia
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日本围手术期过敏反应流行病学研究，一项前瞻性全国性研究：全身麻醉期间过敏原暴露、流行病学和过敏反应诊断
DOI：
10.1016/j.bja.2023.02.018
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发表时间：
2023
影响因子：
9.8
通讯作者：
Matsuoka Yo
中科院分区：
文献类型：
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作者：
Takazawa Tomonori;Horiuchi Tatsuo;Nagumo Kazuhiro;Sugiyama Yuki;Akune Tsubasa;Amano Yasuhiro;Fukuda Masataka;Haraguchi Takashi;Ishibashi Chika;Kanemaru Eiki;Kato Takao;Katoh Keiichi;Kawano Takashi;Kochiyama Tsukasa;Kuri Michioki;Kurita Akihide;Matsuoka Yo
背景围手术期过敏反应的诊断通常具有挑战性。本研究描述了一种新开发的工具，用于识别患者的过敏反应的高可能性的效用，并旨在调查过敏反应的频率与每种药物在围手术期在Japanes.MethodsThis研究包括患者的过敏反应的2级或更高的严重程度在全身麻醉在42设施在日本在2019年和2020年。我们开发并采用了一种独特的客观评价工具，产生了诊断过敏反应的综合评分，其中包括皮肤试验和嗜碱性粒细胞活化试验的结果，以及围手术期过敏反应的临床评分。使用每种药物的病例数和过敏反应的病例总数进行了调查，以计算过敏反应的频率。Results全麻进行了218 936例，其中包括55例疑似围手术期过敏反应。开发的综合评分诊断其中43例过敏反应的可能性很高。在32例病例中确定了病原体。血浆组胺水平显示过敏反应的诊断准确性高。最常见的病原体是罗库溴铵（210 852例患者中10例，0.005%），sugammadex 150629例患者中7例（0.005%），头孢唑啉（106005例患者中7例，0.007%）。结论我们开发了一种诊断过敏反应的复合工具，并发现类胰蛋白酶水平，皮肤试验，嗜碱性粒细胞活化试验结果和临床评分提高了过敏反应诊断的准确性。在我们的研究中，围手术期过敏反应的发生率约为5000例全身麻醉病例中的1例。临床试验注册UMIN 000035350。
BackgroundDiagnosis of perioperative anaphylaxis is often challenging. This study describes the utility of a newly developed tool for identifying patients with a high possibility of anaphylaxis, and aimed to investigate the frequency of anaphylaxis with each drug during the perioperative period in Japan.MethodsThis study included patients with anaphylaxis of Grade 2 or higher severity during general anaesthesia at 42 facilities across Japan in 2019 and 2020. We developed and adopted a unique objective evaluation tool yielding a composite score for diagnosing anaphylaxis, which includes the results of skin tests and basophil activation tests, and clinical scores for perioperative anaphylaxis. The number of cases using each drug and the total number of anaphylaxis cases were investigated to calculate the frequency of anaphylaxis.ResultsGeneral anaesthesia was performed in 218 936 cases, which included 55 patients with suspected perioperative anaphylaxis. The developed composite score diagnosed 43 of them with a high probability of anaphylaxis. The causative agent was identified in 32 cases. Plasma histamine levels showed high diagnostic accuracy for anaphylaxis. The top causative agents were rocuronium (10 cases in 210 852 patients, 0.005%), sugammadex (7 cases in 150 629 patients, 0.005%), and cefazolin (7 cases in 106 005 patients, 0.007%).ConclusionsWe developed a composite tool to diagnose anaphylaxis, and found that the combination of tryptase levels, skin testing, and basophil activation testing results and clinical score improved the certainty of anaphylaxis diagnosis. The incidence of perioperative anaphylaxis in our study was 1 in about 5000 general anaesthesia cases.Clinical trial registrationUMIN000035350.