P. Bader, D. Frohneberg

4.1 Definition 32

4.2 Immunological Mechanism 32

4.2.1 IgE-Dependent Anaphylaxis 33

4.2.2 Non-IgE-Dependent Anaphylaxis 33

4.3 Clinical Presentation and Differential Diagnosis 33

4.4 Diagnostic Tests and Risk Factors 34

4.4.1 Diagnosis of Serious or Fatal Reaction to Contrast Media 34

4.5 Prevention and Treatment of Anaphylactic Reactions 35

4.6 The Role of Skin and Provocation Tests 36

4.7 Immediate and Nonimmediate Reactions to Contrast Media 37

4.7.1 Diagnostics 38 Immediate Hypersensitivity Reactions 38 Skin Reactions 38

4.7.2 Risk Factors 38

4.7.3 Prevention 38

4.7.4 Treatment 39

4.8 Reactions to Perioperative Drugs 40

4.8.1 General Anesthetic Agents and Neuromuscular Blocking Agents 40

4.8.2 Local Anesthetic Agents 40

4.8.3 Antibiotics 41

4.8.4 Opioids 41

4.8.5 Nonsteroidal Anti-inflammatory Drugs 41

4.8.6 Heparin 41

4.8.7 Colloid Infusion Products 42

4.8.8 Blood Products 42

4.9 Latex Allergy: Diagnosis and Management 42 References 43

Table 4.1. Common agents that cause perioperative anaphylaxis

Anaphylactic (IgE-dependent)

Medications (e.g., penicillin) Latex

Aspirin and other nonsteroidal anti-inflammatory drugs (probably)

Anaphylactoid (IgE independent): Multimediator complement activation, activation of contact system

(Radio)contrast media

Nonspecific degranulation of mast cells and basophils Opioids

Muscle relaxants

Immune aggregates Dextran (possibly)


Transfusion reactions to cellular elements (IgG, IgM)

ed reactions. However, these terms have not been adopted worldwide and anaphylactoid and anaphylactic remain commonly used in differentiating non-IgE-mediated and IgE-mediated reactions (Kemp and Lokkey 2002).

The incidence of anaphylaxis during general anesthesia is 1:13,000 in a French study with a mortality of 6 % (Laxenaire 1999). The most frequent causes of anaphylaxis during surgical and medical procedures are muscle relaxants, natural rubber latex, antibiotics, and anesthesia induction agents (Lieberman 2002). Colloids, opioids, and (radio)contrast media account for less than 10 % of all reactions. An overview of the types of reactions is listed in Table 4.1.

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