Table 1
Classification of severity and clinical signs of anaphylaxis.1414. Reducing the risk of the anaphylaxis during anaesthesia. Short text. Ann Fr Anesth Reanim. 2011;30:212-22.
15 Mertes PM, Malinovsky JM, Jouffroy L. Working Group of the SFAR and SFA, Aberer W, Tereehorst I, et al. Reducing the risk of anaphylaxis during anesthesia: 2011 update guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21:442-53.-1616 Hopkins PM, Cooke PJ, Clarke RC, et al. Consensus clinical scoring for suspected perioperative immediate hypersensitivity reactions. Br J Anaesth. 2019;123:e29-37.
Table 2
Diagnosis of perioperative anaphylaxis.2828 Spindola MAC, da Silva J. Anafilaxia e anestesia. In: In: Nunes RR, Bagatini A, Duarte LTD (org), Sociedade Brasileira de Anestesiologia. PROANESTESIA Programa de Atualização em Anestesiologia: Ciclo 1. Porto Alegre: Artmed Panamericana; 2018. p. 9-49 (Sistema de Educação Continuada à Distância, vol. 3).
Table 3
Differential diagnosis of intraoperative hypersensitivity. Adapted from 1515 Mertes PM, Malinovsky JM, Jouffroy L. Working Group of the SFAR and SFA, Aberer W, Tereehorst I, et al. Reducing the risk of anaphylaxis during anesthesia: 2011 update guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21:442-53.,2626 Kolawole H, Marshall SD, Crilly H, et al. Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines. Anaesth Intensive Care. 2017;45:151-8.,2727 Dewachter P, Mouton-Faivre C, Hepner DL. Perioperative Anaphylaxis: what should be known?. Curr Allergy Asthma Rep. 2015;15:21.
Table 4
Possible triggers of hypersensitivity reaction in the intraoperative period, according to anesthesia timeline. Adapted from 2929 Ewan PW, Dugué P, Mirakian R, et al. BSACI guidelines for the investigation of suspected anaphylaxis during general anesthesia. Clin Exp Allergy. 2009;40:15-31.,3030 Laguna JJ, Archilla J, Doña I, et al. Practical guidelines for perioperative hypersensitivity reactions. J Investig Allergol Immunol. 2018;28:216-32.,3131 Volcheck GW, Mertes PM. Local and general anesthetics immediate hypersensitivity reactions. Immunol Allergy Clin N Am. 2014;34:525-46..
Table 5
Management according to severity.77 Garvey LH, Dewachter P, Hepner DL, et al. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth. 2019;123:e50-e64.,1515 Mertes PM, Malinovsky JM, Jouffroy L. Working Group of the SFAR and SFA, Aberer W, Tereehorst I, et al. Reducing the risk of anaphylaxis during anesthesia: 2011 update guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21:442-53.,2626 Kolawole H, Marshall SD, Crilly H, et al. Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines. Anaesth Intensive Care. 2017;45:151-8.
Table 6
Immediate treatment of anaphylaxis. Adapted from 77 Garvey LH, Dewachter P, Hepner DL, et al. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth. 2019;123:e50-e64.,2626 Kolawole H, Marshall SD, Crilly H, et al. Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines. Anaesth Intensive Care. 2017;45:151-8.,3030 Laguna JJ, Archilla J, Doña I, et al. Practical guidelines for perioperative hypersensitivity reactions. J Investig Allergol Immunol. 2018;28:216-32.,3939 Harper NJN, Cook TM, Garcez T, et al. Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6). Br J Anaesth. 2018;121:172-88..
Table 7
Epinephrine dilution methods.2626 Kolawole H, Marshall SD, Crilly H, et al. Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines. Anaesth Intensive Care. 2017;45:151-8.
Table 8
Refractory anaphylaxis management.77 Garvey LH, Dewachter P, Hepner DL, et al. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth. 2019;123:e50-e64.,2626 Kolawole H, Marshall SD, Crilly H, et al. Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines. Anaesth Intensive Care. 2017;45:151-8.,4646 Clarke RC, Sadleir PH, Platt PR. The role of sugammadex in the development and modification of an allergic response to rocuronium: evidence from a cutaneous model. Anaesthesia. 2012;67:266-73.,4747 Platt PR, Clarke RC, Jonson GH, et al. Efficacy of sugammadex in rocuronium-induced or antibiotic-induced anaphylaxis. A case-control study. Anaesthesia. 2015;70:1264-7.
Table 9
Suggested management for suspected anaphylaxis and perioperative allergy in children.77 Garvey LH, Dewachter P, Hepner DL, et al. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth. 2019;123:e50-e64.,2626 Kolawole H, Marshall SD, Crilly H, et al. Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines. Anaesth Intensive Care. 2017;45:151-8.
Table 10
Follow-up after the anaphylactic reaction.77 Garvey LH, Dewachter P, Hepner DL, et al. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth. 2019;123:e50-e64.,3030 Laguna JJ, Archilla J, Doña I, et al. Practical guidelines for perioperative hypersensitivity reactions. J Investig Allergol Immunol. 2018;28:216-32.,3939 Harper NJN, Cook TM, Garcez T, et al. Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6). Br J Anaesth. 2018;121:172-88.,8282 Muraro A, Roberts G, Worm M, et al. Anaphylaxis: Guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69:1026-45.,8383 Demoly P, Adkinson NF, Brockow K, et al. International consensus on drug allergy. Allergy. 2014;69:420-37.
Table 11
Procedures to be follow at hospital discharge of patient.77 Garvey LH, Dewachter P, Hepner DL, et al. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth. 2019;123:e50-e64.,1515 Mertes PM, Malinovsky JM, Jouffroy L. Working Group of the SFAR and SFA, Aberer W, Tereehorst I, et al. Reducing the risk of anaphylaxis during anesthesia: 2011 update guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011;21:442-53.,2626 Kolawole H, Marshall SD, Crilly H, et al. Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines. Anaesth Intensive Care. 2017;45:151-8.,3030 Laguna JJ, Archilla J, Doña I, et al. Practical guidelines for perioperative hypersensitivity reactions. J Investig Allergol Immunol. 2018;28:216-32.,3939 Harper NJN, Cook TM, Garcez T, et al. Anaesthesia, surgery, and life-threatening allergic reactions: management and outcomes in the 6th National Audit Project (NAP6). Br J Anaesth. 2018;121:172-88.
