Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis

Solé, Dirceu; Spindola, Maria Anita Costa; Aun, Marcelo Vivolo; Araújo Azi, Liana Maria Tôrres de; Bernd, Luiz Antonio Guerra; Garcia, Daniela Bianchi; Capelo, Albertina Varandas; Cumino, Débora de Oliveira; Lacerda, Alex Eustáquio; Lima, Luciana Cavalcanti; Morato, Edelton Flávio; Nunes, Rogean Rodrigues; Rubini, Norma de Paula Motta; Silva, Jane da; Tardelli, Maria Angela; Watanabe, Alexandra Sayuri; Curi, Erick Freitas; Sano, Flavio

doi:10.1016/j.bjane.2020.10.005

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Revista Brasileira de Anestesiologia

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Sumário

Narrative Review • Rev. Bras. Anestesiol. 70 (6) • Nov-Dec 2020 • https://doi.org/10.1016/j.bjane.2020.10.005 copy

Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis^☆ ☆ This document was published in Arquivos de Asma, Alergia e Imunologia DOI: 10.5935/2526-5393.20200003 with the consent of authors and editors.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.

Keywords
Allergy and immunology; Hypersensitivity; Anaphylaxis; Perioperative period; Anesthesia; Skin tests

Drug	Skin prick test	Intradermal test
Cephalosporins	20 mg.mL^-1	20 mg.mL^-1 (Cefepime 2 mg.mL^-1)
Thiopental	25 mg.mL^-1	2.5 mg.mL^-1
Propofol	10 mg.mL^-1	1 mg.mL^-1
Ketamine	10 mg.mL^-1	1 mg.mL^-1
Etomidate	2 mg.mL^-1	0.2 mg.mL^-1
Midazolam	5 mg.mL^-1	0.05 mg.mL^-1
Fentanyl	0.05 mg.mL^-1	0.005 mg.mL^-1
Alfentanil	0.5 mg.mL^-1	0.05 mg.mL^-1
Sufentanil	0.005 mg.mL^-1	0.0005 mg.mL^-1
Remifentanil	0.05 mg.mL^-1	0.005 mg.mL^-1
Morphine	1 mg.mL^-1	0.01 mg.mL^-1
Atracurium	1 mg.mL^-1	0.01 mg.mL^-1
Cisatracurium	2 mg.mL^-1	0.02 mg.mL^-1
Mivacurium	0.2 mg.mL^-1	0.002 mg.mL^-1
Rocurorium	10 mg.mL^-1	0.05 mg.mL^-1
Vecuronium	4 mg.mL^-1	0.4 mg.mL^-1
Pancuronium	2 mg.mL^-1	0.2 mg.mL^-1
Suxamethonium	10 mg.mL^-1	0.1 mg.mL^-1
Pyrazolones	0.1 to 2 mg.mL^-1	0.1 to 2 mg.mL^-1
Others NSAIDs	0.1 mg.mL^-1	0.1 mg.mL^-1
Local anesthetics	Pure	1/10
Patent blue	25 mg.mL^-1	0.25 mg.mL^-1
Methylene blue	10 mg.mL^-1	0.01 mg.mL^-1
Chlorhexidine	5 mg.mL^-1	0.002 mg.mL^-1 (sterile, colorless, alcohol-free solution)
Povidone	100 mg.mL^-1	Not to be performed

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. liana.araujo@ufba.br