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General anesthetics drug challenge tests: predictive value of skin tests

Tornero Molina P1,3, Rojas-Perez-Ezquerra P1,3, Noguerado-Mellado B1,3, Baeza Ochoa de Ocáriz ML1,3, Garrido Sánchez A2,3, Alonso Mateos M2,3, Zubeldia Ortuño JM1,3

1Allergy Department, University Hospital Gregorio Marañon, Madrid, Spain
2Anesthesiology Department, University Hospital Gregorio Marañon, Madrid, Spain
3Gregorio Marañón Health Research Institute, Madrid, Spain

J Investig Allergol Clin Immunol 2020; Vol. 30(2)
doi: 10.18176/jiaci.0402

Background: The study of perioperative drug reactions remains a major challenge both for diagnosis and therapeutic management. Lack of standardization of the study of allergy to general anesthetics and nonexistence of data establishing the true value of skin tests for the majority of drugs used in anesthesia induction and maintenance, as well as the lack of commercially available reagents to perform in vitro tests, is a continuous dilemma in the study of these reactions.
Objective: The aim of this study was to provide a diagnostic protocol for drug challenge test with general anesthetics to establish an etiological diagnosis as specific as possible and to determine the predictive value of skin tests.
Material and Methods: Twenty-nine patients with perioperative drug reactions were included in the study from November 2008 to December 2017.
Results: With this study, we have confirmed the high negative predictive value (NPV) of the tests (96-100%) in the case of propofol, rocuronium and fentanyl. To our knowledge, this is the first study to describe drug challenge test with general anesthetics, and therefore the true NPV of skin tests, which gives a definitive diagnosis, and better safety in later surgical needs.
Conclusions: After assessing risks and benefits and considering the importance of this group of drugs, we conclude that drug challenge test with general anesthetics are necessary. We propose a diagnostic protocol for perioperative drug reactions that allows to reach an etiological diagnosis as accurate as possible with the minimum risks for the patient.

Key words: Drug challenge test, General anesthetics, Perioperative drug reactions, Predictive value, Skin tests

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