An update on allergy and anaphylaxis in pediatric anesthesia

Research output: Contribution to journalReview article

Abstract

Childhood allergy is common, and increasing. Many children are incorrectly labeled as having allergy or adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of hypersensitivity reactions and the implications for anesthesia of food allergy, atopy, and family history of allergy in children. The epidemiology of anaphylaxis is discussed. We discuss the common triggers of perioperative anaphylaxis in children and explore emerging triggers including chlorhexidine and sugammadex. Accurate data on pediatric perioperative anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of anaphylaxis under anesthesia are discussed. We review the process of expert allergy testing following a suspected case of anaphylaxis to guide future safe anesthesia administration. The preoperative consultation is an opportunity for referral for allergy testing to allow de-labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first-line therapeutic agents.

Original languageEnglish
Number of pages9
JournalPaediatric Anaesthesia
DOIs
Publication statusE-pub ahead of print - 1 Aug 2019

Fingerprint

Anaphylaxis
Hypersensitivity
Anesthesia
Pediatrics
Referral and Consultation
Chlorhexidine
Food Hypersensitivity
Risk Management
Drug-Related Side Effects and Adverse Reactions
Epidemiology
Anti-Bacterial Agents
Therapeutics
Pharmaceutical Preparations

Cite this

@article{75f817e1ccfc4048ab16776f67f4a222,
title = "An update on allergy and anaphylaxis in pediatric anesthesia",
abstract = "Childhood allergy is common, and increasing. Many children are incorrectly labeled as having allergy or adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of hypersensitivity reactions and the implications for anesthesia of food allergy, atopy, and family history of allergy in children. The epidemiology of anaphylaxis is discussed. We discuss the common triggers of perioperative anaphylaxis in children and explore emerging triggers including chlorhexidine and sugammadex. Accurate data on pediatric perioperative anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of anaphylaxis under anesthesia are discussed. We review the process of expert allergy testing following a suspected case of anaphylaxis to guide future safe anesthesia administration. The preoperative consultation is an opportunity for referral for allergy testing to allow de-labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first-line therapeutic agents.",
keywords = "allergy, anaphylaxis, outcome, pediatric anesthesia",
author = "Bojana Stepanovic and David Sommerfield and Michaela Lucas and {von Ungern-Sternberg}, {Britta S.}",
year = "2019",
month = "8",
day = "1",
doi = "10.1111/pan.13703",
language = "English",
journal = "Pediatric Anesthesia",
issn = "1155-5645",
publisher = "John Wiley & Sons",

}

TY - JOUR

T1 - An update on allergy and anaphylaxis in pediatric anesthesia

AU - Stepanovic, Bojana

AU - Sommerfield, David

AU - Lucas, Michaela

AU - von Ungern-Sternberg, Britta S.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Childhood allergy is common, and increasing. Many children are incorrectly labeled as having allergy or adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of hypersensitivity reactions and the implications for anesthesia of food allergy, atopy, and family history of allergy in children. The epidemiology of anaphylaxis is discussed. We discuss the common triggers of perioperative anaphylaxis in children and explore emerging triggers including chlorhexidine and sugammadex. Accurate data on pediatric perioperative anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of anaphylaxis under anesthesia are discussed. We review the process of expert allergy testing following a suspected case of anaphylaxis to guide future safe anesthesia administration. The preoperative consultation is an opportunity for referral for allergy testing to allow de-labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first-line therapeutic agents.

AB - Childhood allergy is common, and increasing. Many children are incorrectly labeled as having allergy or adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of hypersensitivity reactions and the implications for anesthesia of food allergy, atopy, and family history of allergy in children. The epidemiology of anaphylaxis is discussed. We discuss the common triggers of perioperative anaphylaxis in children and explore emerging triggers including chlorhexidine and sugammadex. Accurate data on pediatric perioperative anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of anaphylaxis under anesthesia are discussed. We review the process of expert allergy testing following a suspected case of anaphylaxis to guide future safe anesthesia administration. The preoperative consultation is an opportunity for referral for allergy testing to allow de-labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first-line therapeutic agents.

KW - allergy

KW - anaphylaxis

KW - outcome

KW - pediatric anesthesia

UR - http://www.scopus.com/inward/record.url?scp=85070769084&partnerID=8YFLogxK

U2 - 10.1111/pan.13703

DO - 10.1111/pan.13703

M3 - Review article

JO - Pediatric Anesthesia

JF - Pediatric Anesthesia

SN - 1155-5645

ER -