Drug Challenge Tests With General Anesthetics: Predictive Value of Skin Tests
Tornero Molina P1, Rojas-Perez-Ezquerra P1, Noguerado-Mellado B1, Baeza Ochoa de Ocáriz ML1, Garrido Sánchez A2, Alonso Mateos M2, Zubeldia Ortuño JM1
1Allergy Department, University Hospital Gregorio Marañón and Gregorio Marañón Health Research Institute, Madrid, Spain
2Anesthesiology Department, University Hospital Gregorio Marañón and Gregorio Marañón Health Research Institute, Madrid, Spain
J Investig Allergol Clin Immunol 2020; Vol 30(2)
Background: The study of perioperative drug reactions remains a major challenge for both diagnosis and therapy. The lack of a standard assessment of allergy to general anesthetics and of data establishing the true value of skin tests for most drugs used in induction and maintenance of anesthesia, as well as the lack of commercially available reagents for in vitro tests, renders the study of these reactions problematic. The aims of this study were to provide a diagnostic protocol for drug challenge testing with general anesthetics, to establish an etiological diagnosis that is as specific as possible, and to determine the predictive value of skin tests.
Methods: Twenty-nine patients with perioperative drug reactions were included in the study from November 2008 to December 2018.
Results: We confirmed the high negative predictive value 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 testing with general anesthetics and, therefore, to establish the true negative predictive value of skin tests, which leads to a definitive diagnosis and safer surgery.
Conclusions: After assessing risks and benefits and considering the importance of this group of drugs, we conclude that drug challenge testing with general anesthetics is necessary. We propose a protocol for perioperative drug reactions that enables us to make a highly accurate etiological diagnosis with minimum risk for the patient.
Key words: Drug challenge test, General anesthetics, Perioperative drug reactions, Predictive value, Skin tests