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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 perioperative or perianesthetic anaphylaxis involves a clinical history, review of records of the event, analysis of laboratory tests obtained at the time, and possibly skin testing if the reaction was suspected to be immunoglobulin E (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 two goals of this evaluation:

Identification of the culprit agent so that the agent can be avoided in the future. Not identifying the responsible agent necessitates the use of multiple second-line agents, a strategy that is not without risk to the patient.


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Literature review current through: Sep 2016. | This topic last updated: Jul 27, 2015.
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