Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(10): 704-715
DOI: 10.1055/s-0043-100231
Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Perioperative Anaphylaxie auf Arzneimittel

Perioperative Anaphylaxia on Drugs
Wolfgang Pfützner
,
Hinnerk Wulf
Further Information

Publication History

Publication Date:
19 October 2017 (online)

Zusammenfassung

Im Rahmen eines operativen Eingriffs erhalten Patienten zahlreiche Arzneimittel. Entwickeln sie eine anaphylaktische Reaktion, so ist akut schwer zu beurteilen, welche Substanz für diese verantwortlich ist. Die meisten der intraoperativen Einschätzungen zur Ursache einer Anaphylaxie sind falsch. Umso wichtiger ist es, die verursachende Substanz später zu identifizieren, um eine Reexposition, z. B. bei einer erneuten OP, zu verhindern.

Abstract

The diagnostic evaluation of perioperative anaphylaxia is of great importance for the medical care of the affected persons in the context of renewed interventions in general anesthesia. The most frequent triggers include muscle relaxants, antibiotics, latex and analgesics of the type of the cyclooxygenase inhibitors, but other perioperatively administered drugs such as opioids, anesthetics, benzodiazepines, dyes, disinfectants and even corticosteroids or drug additives may also be the cause in rare cases. The most important aim is therefore the identification of the responsible drug, for which a near-time allergological diagnosis should be carried out within the first 4 weeks to 6 months after the reaction. At the end of the examinations, the patient receives a structured allergy passport, which includes information on the drug reaction, the triggers and alternative medicines, as well as possible preventive measures for future surgical procedures. It should be noted, however, that the latter are not a guarantee that, upon renewed exposure to the causative medicinal product, there will be no, possibly even heavier, anaphylactic reaction.

Kernaussagen
  • Im Rahmen erneuter Eingriffe in Allgemeinanästhesie ist die diagnostische Abklärung perioperativer Anaphylaxien von hoher Bedeutung für die medikamentöse Versorgung der Betroffenen.

  • Zu den häufigsten Auslösern gehören Muskelrelaxanzien, Antibiotika, Latex und Analgetika vom Typ der Cyclooxygenasehemmer. In seltenen Fällen können allerdings auch andere perioperativ verabreichte Arzneimittel wie Opioide, Anästhetika, Benzodiazepine, Farbstoffe, Desinfektionsmittel und selbst Kortikosteroide oder Arzneimittelzusatzstoffe ursächlich sein.

  • Wichtigstes Ziel ist die Identifikation des verantwortlichen Arzneimittels, wofür eine zeitnahe allergologische Diagnostik innerhalb der ersten 4 Wochen bis 6 Monate nach der Reaktion erfolgen sollte.

  • Am Ende der Untersuchungen erhält der Patient einen strukturierten Allergiepass, der Angaben zur erlittenen Arzneimittelreaktion, zu den Auslösern und Ausweichmedikamenten sowie mögliche Präventivmaßnahmen für zukünftige operative Eingriffe aufführt.

  • Zu beachten ist, dass Präventivmaßnahmen keine Gewähr dafür sind, dass es bei erneuter Exposition mit dem ursächlichen Arzneimittel nicht wieder zu einer, möglicherweise sogar schwerwiegenderen, anaphylaktischen Reaktion kommt.

 
  • Literatur

  • 1 Niebel P, Wulf H. Deklaration von Helsinki zur Patientensicherheit in der Anästhesiologie. Teil 4: SOP zur perioperativen Anaphylaxie. Anästhesiol Intensivmed Notfallmed Schmerzther 2013; 48: 230-232
  • 2 Ring J, Beyer K, Biedermann T. et al. Guideline for acute therapy and management of anaphylaxis: S2 Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Association of German Allergologists (AeDA), the Society of Pediatric Allergy and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Society for Psychosomatic Medicine (DGPM), the German Working Group of Anaphylaxis Training and Education (AGATE) and the patient organization German Allergy and Asthma Association (DAAB). Allergo J Int 2014; 23: 96-112
  • 3 Dewachter P, Mouton-Favre C, Hepner D. Perioperative anaphylaxis: what should be known?. Curr Allergy Asthma Rep 2015; 15: 21-30
  • 4 Krøigaard M, Garvey L, Menné T. et al. Allergic reactions in anaesthesia: are suspected causes confirmed on subsequent testing?. Br J Anaesthesia 2005; 95: 468-471
  • 5 Krøigaard M, Garvey L, Gillberg L. et al. Scandinavian clinical practice guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol Scand 2007; 51: 655-670
  • 6 Mertes P, Malinovsky J, Jouffroy L. et al. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol 2011; 21: 442-453
  • 7 Mertes P, Alla F, Tréchot P. et al. Anaphylaxis during anesthesia in France: an 8-year national survey. J Allergy Clin Immunol 2011; 128: 366-373
  • 8 Hedin H, Richter W. Pathomechanisms of dextran-induced anaphylactoid/anaphylactic reactions in man. Int Arch Allergy Appl Immunol 1982; 68: 122-126
  • 9 Finkelman F, Khodoun M, Strait R. Human IgE-independent systemic anaphylaxis. J Allergy Clin Immunol 2016; 137: 1674-1680
  • 10 Merk H. Pathogenetische Grundlagen pseudoallergischer Reaktionen. In: Biedermann T, Heppt W, Renz H, Röcken M. Hrsg. Allergologie. Berlin: Springer; 2016: 165-173
  • 11 Möbs C, Pfützner W. [Diagnostics of drug hypersensitivity reactions]. Hautarzt 2017; 68: 19-28
  • 12 Lobera T, Audicana M, Pozo M. et al. Study of hypersensitivity reactions and anaphylaxis during anesthesia in Spain. J Investig Allergol Clin Immunol 2008; 18: 350-356
  • 13 Dewachter P, Mouton-Faivre C, Emala C. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology 2009; 111: 1141-1150
  • 14 Malinovsky J, Decagny S, Wessel F. et al. Systematic follow-up increases incidence of anaphylaxis during adverse reactions in anesthetized patients. Acta Anaesthesiol Scand 2008; 52: 175-181
  • 15 Harper N, Dixon T, Dugué P. et al. Suspected anaphylactic reactions associated with anaesthesia. Anaesthesia 2009; 64: 199-211
  • 16 Saager L, Turan A, Egan C. et al. Incidence of intraoperative hypersensitivity reactions. Anesthesiology 2015; 122: 551-559
  • 17 Karila C, Brunet-Langot D, Labbez F. et al. Anaphylaxis during anesthesia: results of a 12-year survey at a French pediatric center. Allergy 2005; 60: 828-834
  • 18 Moneret-Vautrin DA, Mertes PM. Anaphylaxis to general anesthetics. Chem Immunol Allergy 2010; 95: 180-189
  • 19 Harboe T, Guttormsen A, Irgens A. et al. Anaphylaxis during anesthesia in Norway: a 6-year single-center follow-up study. Anesthesiology 2005; 102: 897-903
  • 20 Brockow K, Przybilla B, Aberer W. et al. Guideline for the diagnosis of drug hypersensitivity reactions: S2K-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and Immunology (OGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products (BfArM). Allergo J Int 2015; 24: 94-105
  • 21 Kounis NG. Kounis syndrome (allergic angina and allergic myocardial infarction): A natural paradigm?. Int J Cardiol 2006; 110: 7-14
  • 22 Worm M, Eckermann O, Dölle S. et al. Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany, Austria and Switzerland. Dtsch Arztebl Int 2014; 111: 367-375
  • 23 Kisch-Wedel H, Thiel M. Anästhesie bei allergischer Diathese. Anästhesist 2002; 51: 868-881
  • 24 Tacquard C, Collange O, Gomis P. et al. Anaesthetic hypersensitivity reactions in France between 2011 and 2012: the 10th GERAP epidemiologic survey. Acta Anaest Scand 2017; 61: 290-299
  • 25 Van Aken H. Anaphylaktische Ereignisse nach Muskelrelaxantien. Anästhesist 2003; 52: 635
  • 26 Baldo BA, Fisher MM. Substituted ammoniums ions as allergenic determinants in drug allergy. Nature 1983; 306: 262-264
  • 27 Moneret-Vautrin D. Cross-reactions to muscle relaxants in the operating room. Clin Rev Allergy Immunol 1997; 15: 471-476
  • 28 Baldo B, Fisher M, Pham N. On the origin and specificity of antibodies to neuromuscular blocking (muscle relaxant) drugs: an immunochemical perspective. Clin Exp Allergy 2009; 39: 325-344
  • 29 Levy J, Gottge M, Szlam F. et al. Wheal and flare responses to intradermal rocuronium and cisatracurium in humans. Br J Anaesth 2000; 85: 844-849
  • 30 Berg C, Heier T, Wilhelmsen V. et al. Rocuronium and cisatracurium-positive skin tests in non-allergic volunteers: determination of drug concentration thresholds using a dilution titration technique. Acta Anaesthesiol Scand 2003; 47: 576-582
  • 31 Warszawska J, Raimann F, Ippolito A. et al. Muskelrelaxantien in der Anästhesie und Intensivmedizin. Arzneimitteltherapie 2016; 34: 467-477
  • 32 Rote Liste. 2016. Frankfurt am Main: Rote Liste Service GmbH; 2016: 973
  • 33 Fisher M, Munro I. Life-threatening anaphylactoid reactions to muscle relaxants. Anest Analg 1983; 62: 559-564
  • 34 Choi S, Yi J, Rha Y. Rocuronium anaphylaxis in a 3-year-old girl with no previous exposure to neuromuscular blocking agents. Asian Pac J Allergy Immunol 2013; 31: 163-166
  • 35 Pfützner W, Möbs C. Anaphylaktische Reaktionen im Rahmen von Narkoseeingriffen. Pädiatrische Allergologie 2017; 2: 18-26
  • 36 Wahl R, Wurpts G, Merk H. Perioperative anaphylaxis caused by recuronium allergy in a child. Hautarzt 2011; 62: 812-814
  • 37 Brusch A, Clarke R, Platt P. et al. Exploring the link between pholcodine exposure and neuromuscular blocking agent anaphylaxis. Br J Clin Pharmacol 2013; 78: 14-23
  • 38 Dong S, Acouetey D, Guéant-Rodriguez R. et al. Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers. Clin Exp Allergy 2013; 43: 1256-1262
  • 39 Tacquard C, Collange O, Gomis P. et al. Anaesthetic hypersensitivity reactions in France between 2011 and 2012: the 10th GERAP epidemiologic survey. Acta Anaesth Scand 2017; 61: 290-299
  • 40 Mirakian R, Ewan P, Durham S. et al. BSACI guidelines for the management of drug allergy. Clin Exp Allergy 2008; 39: 43-61
  • 41 Romano A, Gaeta F, Poves M, Valuzzi R. Cross-reactivity among beta-lactams. Curr Allergy Asthma Rep 2016; 16: 24
  • 42 Gaeta F, Valluzzi RL, Alonzi C. et al. Tolerability of aztreonam and carbapenems in patients with IgE-mediated hypersensitivity to penicillins. J Allergy Clin Immunol 2015; 135: 972-976
  • 43 Shah NS, Ridgway JP, Pettit N. et al. Documenting penicillin allergy: the impact of inconsistency. PLoS One 2016; 11: 1-11
  • 44 Silvagnanam S, Deleu D. Red man syndrome. Crit Care 2003; 7: 119-120
  • 45 Panos G, Watson DC, Sargianou M. et al. Red man syndrome adverse reaction following intravenous infusion of cefepime. Antimic Agents Chemoth 2012; 56: 6387-6388
  • 46 Harper N. Propofol and food allergy. Br J Anaesthesia 2016; 116: 11-13
  • 47 Richard C, Beaudouin E, Moneret-Vautrin D. et al. Severe anaphylaxis to Propofol: first case of evidence of sensitization to soy oil. Eur Ann Allergy Clin Immunol 2016; 48: 103-106
  • 48 Asserhøj L, Mosbech H, Krøigaard M. et al. No evidence for contraindications to the use of propofol in adults allergic to egg, soy or peanut. Br J Anaesth 2016; 116: 77-82
  • 49 Murphy A, Campbell D, Baines D. et al. Allergic reactions to propofol in egg-allergic children. Anesth Analg 2011; 113: 140-144
  • 50 Ludwig A, von der Helm C, Welzel J. Anaphylaktische Reaktion auf Sevofluran am Arbeitsplatz. Akt Dermatol 2015; 41: 468-470
  • 51 Vellore A, Drought V, Sherwood-Jones D. et al. Occupational asthma and allergy to sevoflurane and isoflurane in anaesthetic staff. Allergy 2006; 61: 1485-1486
  • 52 Slegers-Karsmakers S, Stricker B. Anaphylactic reaction to isoflurane. Anaesthesia 1988; 43: 506-507
  • 53 Rosenberger A, Treudler R, Blume-Peytavi U. et al. Allergien und pseudoallergische Reaktionen auf Narkosemittel. Hautarzt 1997; 48: 791-799
  • 54 Ring J, Franz R, Brockow K. Anaphylactic reactions to local anesthetics. Chem Immunol Allergy 2010; 95: 190-200
  • 55 Batinac T, Sotošek Tokmadžić V, Peharda V. et al. Adverse reactions and alleged allergy to local anesthetics: analysis of 331 patients. J Dermatol 2013; 40: 522-527
  • 56 Bhole M, Manson A, Seneviratne S. et al. IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective. Br J Anaesth 2012; 108: 903-911
  • 57 Thyssen JP, Menné T, Elberling J. et al. Hypersensitivity to local anaesthetics–update and proposal of evaluation algorithm. Contact Dermatitis 2008; 59: 69-78
  • 58 Malinovsky JM, Chiriac AM, Tacquard C. et al. Allergy to local anesthetics: reality or myth?. Presse Med 2016; 45: 753-757
  • 59 Kvisselgaard A, Krøigaard M, Mosbech H. et al. No cases of perioperative allergy to local anaesthetics in the Danish Anaesthesia Allergy Centre. Acta Anaesthesiol Scand 2017; 61: 149-155
  • 60 Baldo B, Pham N. Histamine-releasing and allergenic properties of opioid analgesic drugs: resolving the two. Anaesth Intensive Care 2012; 40: 216-235
  • 61 Szczeklik A, Stevenson D. Aspirin-induced asthma: advances in pathogenesis, diagnosis and management. J Allergy Clin Immunol 2003; 111: 913-921
  • 62 Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and implications for clinical practice. BMJ 2004; 328: 434
  • 63 Koschel D, Weber C, Höffken G. Tolerability to etoricoxib in patients with aspirin-exacerbated respiratory disease. J Investig Allergol Clin Immunol 2013; 23: 275-280
  • 64 Haybarger E, Young A, Giovannitti J. Benzodiazepine allergy with anesthesia administration: a review of current literature. Anesth Prog 2016; 63: 160-167
  • 65 Majumdar SK. Allergy to diazepam. Br Med J 1977; 1: 444
  • 66 Chen P, Huda W, Levy N. Chlorhexidine anaphylaxis: implications for post-resuscitation management. Anaesthesia 2016; 71: 232-244
  • 67 Kautz O, Schuhmann H, Degerbeck F. et al. Severe anaphylaxis to the antiseptic polyhexanide. Allergy 2010; 66: 1058-1072
  • 68 Meng J, Rotiroti G, Burdett E. et al. Anaphylaxis during general anaesthesia: experience from a drug allergy centre in the UK. Acta Anaesthesiol Scand 2017; 61: 281-289
  • 69 Basedow S, Eigelshoven S, Homey B. Immediate and delayed hypersensitivity to corticosteroids. J Dtsch Dermatol Ges 2011; 9: 885-888
  • 70 Bache S, Petersen J, Garvey L. Anaphylaxis to ethylene oxide – a rare and overlooked phenomenon?. Acta Anaesthesiol Scand 2011; 55: 1279-1282
  • 71 Wenande E, Kroigaard M, Mosbech H. et al. Polyethylene glycols (PEG) and related structures: overlooked allergens in the perioperative setting. A A Case Rep 2015; 4: 61-64
  • 72 Munk S, Heegaard S, Mosbech H. et al. Two episodes of anaphylaxis following exposure to hydroxypropyl methylcellulose during cataract surgery. J Cataract Refract Surg 2013; 39: 948-951
  • 73 Christiansen I, Pedersen P, Krøigaard M. et al. Anaphylaxis to intravenous gentamicin with suspected sensitization through gentamicin-loaded bone cement. J Allergy Clin Immunol Pract 2016; 4: 1258-1259
  • 74 Janssen I, Ryang YM, Gempt J. et al. Risk of leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine. Spine J 2017; 17: 837-844
  • 75 Krishna M, York M, Chin T. et al. Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom: aetiology and diagnostic performance of acute serum tryptase. Clin Exp Immunol 2014; 178: 399-404
  • 76 Lafuente A, Javaloyes G, Berroa F. et al. Early skin testing is effective for diagnosis of hypersensitivity reactions occuring during anesthesia. Allergy 2013; 68: 820-822
  • 77 Brockow K, Garvey L, Aberer W. et al. Skin test concentrations for systemically administered drugs – an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy 2013; 68: 702-712
  • 78 Möbs C, Pfützner W. Cellular in vitro diagnostics of adverse drug reactions. Allergo J Int 2014; 23: 164-171
  • 79 Christiansen I, Krøigaard M, Mosbech H. et al. Clinical and diagnostic features of perioperative hypersensitivity to cefuroxime. Clin Exp Allergy 2014; 45: 807-814
  • 80 Schopp J, Iyer R, Wang C. et al. Allergic reactions to iodinated contrast media: premedication considerations for patients at risk. Emerg Radiol 2013; 20: 299-306
  • 81 Worthley D, Gillis D, Kette F. et al. Radiocontrast anaphylaxis with failure of premedication. Int Med J 2005; 35: 58-60
  • 82 Davenport M, Cohan R, Caoili E. et al. Repeat contrast medium reactions in premedicated patients: frequency and severity. Radiology 2009; 253: 372-379
  • 83 Dillman J, Ellis J, Cohan R. et al. Allergic-like breakthrough reactions to gadolinium contrast agents after corticosteroid and antihistamine premedication. AJR 2008; 190: 187-190
  • 84 Kim SH, Lee SH, Lee SM. et al. Outcomes of premedication for non-ionic radio-contrast media hypersensitivity reactions in Korea. Eur J Radiol 2011; 80: 363-367