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Perioperative anaphylaxis: Evaluation and prevention of recurrent reactions

Dennis K Ledford, MD
Section Editor
N Franklin Adkinson, Jr, MD
Deputy Editor
Anna M Feldweg, MD


Anaphylaxis is a severe multisystem allergic reaction that may cause death. In this topic review, the term "anaphylaxis" is applied to both immunoglobulin E (IgE)-mediated and non-IgE-mediated reactions. The evaluation of patients who have experienced perioperative anaphylaxis and strategies for avoiding recurrent reactions during subsequent anesthesia will be reviewed here. The prevalence, etiologies, clinical manifestations, diagnosis, and differential diagnosis of perioperative anaphylaxis are discussed separately. (See "Perioperative anaphylaxis: Clinical manifestations, etiology, and management".)

The treatment of anaphylaxis is reviewed elsewhere. (See "Anaphylaxis: Emergency treatment".)


The evaluation of a patient who has experienced suspected perioperative or perianesthetic anaphylaxis involves a clinical history, review of records of the event, analysis of laboratory tests obtained at the time, and skin testing or in vitro serum-specific immunoglobulin E (IgE) testing if the reaction was believed to be IgE-mediated. The complexity of medications used for anesthesia and surgery present challenges when attempting to identify the cause, but critical interpretation of clinical information and select testing leads to better recognition of culprit drugs [1].

There are three goals of this evaluation:

Collection of evidence to support or refute that the adverse perioperative event was anaphylaxis.

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Literature review current through: Nov 2017. | This topic last updated: Jun 13, 2017.
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