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Practical Guidelines for Perioperative Hypersensitivity Reactions

Laguna JJ1#, Archilla J2, Doña I3#, Corominas M4, Gastaminza G5#, Mayorga C3#, Berjes-Gimeno P6, Tornero P7, Martin S2, Planas A8, Moreno E9*#, Torres MJ3*#

1Allergy Unit and Allergy-Anaesthesia Unit, Hospital Central Cruz Roja, Madrid, Spain
2Anaesthesia Unit, Hospital Central Cruz Roja, Madrid, Spain
3Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain.
4Allergy Unit-Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L´Hospitalet de Llobregat, Spain
5Allergy and Clinic Immunology Department, Clinica Universidad de Navarra, Navarra, Spain
6Allergy Unit, University Hospital Ramón y Cajal, Madrid, Spain
7Allergy Unit, University Hospital Gregorio Marañón, Madrid, Spain
8Anaesthesia Unit, University Hospital La Princesa, Madrid, Spain
9Allergy Unit, Salamanca University Hospital-IBSAL, Salamanca, Spain
*Both authors have contributed equally
#Authors participate in the ISCIII RETIC ARADyAL

J Investig Allergol Clin Immunol 2018; Vol. 28(4)
doi: 10.18176/jiaci.0236

Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists, so it is advisable that hospitals have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocols is not present in many hospitals, leading to problems in treatment, the communication of incidents and subsequent etiological diagnosis. In this document we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and for referral of patients with perioperative hypersensitivity reactions to Allergy Units. Members of the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC) have created this document in collaboration with members of the Spanish Anaesthesia Society (SEDAR). A practical algorithm is proposed for the etiologic diagnosis and recommendations are provided for the management of hypersensitive patients.

Key words: Anaesthesia, Allergy, Anaphylaxis, Hypersensitivity, Perioperative, Skin tests, Tryptase