Neuromuscular blocking agent re-exposure in a retrospective cohort with neuromuscular blocking agent-associated anaphylaxis
Copyright © 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Neuromuscular blocking agents (NMBAs) are one of the most common causes of perioperative anaphylaxis. Although skin test positivity may help identify reactive NMBAs, it is unclear whether skin test negativity can guarantee the safety of systemically administered NMBAs.
OBJECTIVE: This study aimed to evaluate the real-world safety of alternative NMBAs screened using skin tests in patients with suspected NMBA-induced anaphylaxis.
METHODS: A retrospective cohort of suspected NMBA-induced anaphylaxis were recruited among patients at Seoul National University Hospital from June 2009 to May 2021, and their characteristics and outcomes were assessed.
RESULTS: A total of 47 cases (0.017%) of suspected anaphylaxis occurred in 282,707 patients who received NMBAs. Cardiovascular manifestations were observed in 95.7%, whereas cutaneous findings were observed in 59.6%. Whereas 83% had a history of undergoing general anesthesia, 17% had no history of NMBA use. In skin tests, the overall positivity to any NMBA was 94.6% (81.1% to culprit NMBAs) and the cross-reactivity was 75.7%, which is related to the chemical structural similarity among NMBAs; the cross-reactivity and chemical structure similarity of rocuronium were 85.3% and 0.814, respectively, with vecuronium; this is in contrast to 50% and 0.015 with cisatracurium and 12.5% and 0.208 with succinylcholine. There were 15 patients who underwent subsequent surgery with a skin test-negative NMBA; whereas 80.0% (12/15) safely completed surgery, 20.0% (3/15) experienced hypotension.
CONCLUSION: Similarities in chemical structure may contribute to the cross-reactivity of NMBAs in skin tests. Despite the high negative predictability of skin tests for suspected NMBA-induced anaphylaxis, the potential risk of recurrent anaphylaxis has not been eliminated.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:131 |
|---|---|
| Enthalten in: |
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology - 131(2023), 5 vom: 24. Nov., Seite 637-644.e1 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Jeong, Jiung [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
37341-29-0 |
|---|
| Anmerkungen: |
Date Completed 06.11.2023 Date Revised 07.11.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.anai.2023.06.023 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM358580781 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM358580781 | ||
| 003 | DE-627 | ||
| 005 | 20231226075043.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.anai.2023.06.023 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1195.xml |
| 035 | |a (DE-627)NLM358580781 | ||
| 035 | |a (NLM)37356714 | ||
| 035 | |a (PII)S1081-1206(23)00447-7 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Jeong, Jiung |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Neuromuscular blocking agent re-exposure in a retrospective cohort with neuromuscular blocking agent-associated anaphylaxis |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 06.11.2023 | ||
| 500 | |a Date Revised 07.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Neuromuscular blocking agents (NMBAs) are one of the most common causes of perioperative anaphylaxis. Although skin test positivity may help identify reactive NMBAs, it is unclear whether skin test negativity can guarantee the safety of systemically administered NMBAs | ||
| 520 | |a OBJECTIVE: This study aimed to evaluate the real-world safety of alternative NMBAs screened using skin tests in patients with suspected NMBA-induced anaphylaxis | ||
| 520 | |a METHODS: A retrospective cohort of suspected NMBA-induced anaphylaxis were recruited among patients at Seoul National University Hospital from June 2009 to May 2021, and their characteristics and outcomes were assessed | ||
| 520 | |a RESULTS: A total of 47 cases (0.017%) of suspected anaphylaxis occurred in 282,707 patients who received NMBAs. Cardiovascular manifestations were observed in 95.7%, whereas cutaneous findings were observed in 59.6%. Whereas 83% had a history of undergoing general anesthesia, 17% had no history of NMBA use. In skin tests, the overall positivity to any NMBA was 94.6% (81.1% to culprit NMBAs) and the cross-reactivity was 75.7%, which is related to the chemical structural similarity among NMBAs; the cross-reactivity and chemical structure similarity of rocuronium were 85.3% and 0.814, respectively, with vecuronium; this is in contrast to 50% and 0.015 with cisatracurium and 12.5% and 0.208 with succinylcholine. There were 15 patients who underwent subsequent surgery with a skin test-negative NMBA; whereas 80.0% (12/15) safely completed surgery, 20.0% (3/15) experienced hypotension | ||
| 520 | |a CONCLUSION: Similarities in chemical structure may contribute to the cross-reactivity of NMBAs in skin tests. Despite the high negative predictability of skin tests for suspected NMBA-induced anaphylaxis, the potential risk of recurrent anaphylaxis has not been eliminated | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Immunoglobulin E |2 NLM | |
| 650 | 7 | |a 37341-29-0 |2 NLM | |
| 650 | 7 | |a Neuromuscular Blocking Agents |2 NLM | |
| 700 | 1 | |a Yun, Jeong-Eun |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Hyun Jee |e verfasserin |4 aut | |
| 700 | 1 | |a Jang, Ji-Young |e verfasserin |4 aut | |
| 700 | 1 | |a Seo, Jang Ho |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Suh-Young |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Won Ho |e verfasserin |4 aut | |
| 700 | 1 | |a Seo, Jeong-Hwa |e verfasserin |4 aut | |
| 700 | 1 | |a Kang, Hye-Ryun |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology |d 1995 |g 131(2023), 5 vom: 24. Nov., Seite 637-644.e1 |w (DE-627)NLM075127695 |x 1534-4436 |7 nnns |
| 773 | 1 | 8 | |g volume:131 |g year:2023 |g number:5 |g day:24 |g month:11 |g pages:637-644.e1 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.anai.2023.06.023 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 131 |j 2023 |e 5 |b 24 |c 11 |h 637-644.e1 | ||