The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status

Lene H. Garvey, Didier G. Ebo, Mogens Kroigaard, Sinisa Savic, Russell Clarke, Peter Cooke, Pascale Dewachter, Tomaz Garcez, Anne B. Guttormsen, Philip M. Hopkins, David L. Hepner, David A. Khan, Helen Kolawole, Peter Kopac, Stuart Marshall, Paul-Michel Mertes, Peter Platt, Michael Rose, Vito Sabato, Paul Sadleir & 6 others Louise Savic, Kathrin Scherer, Tomonori Takazawa, Gerald W. Volcheck, Susanna Voltolini, Jose J. Laguna

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Suspected perioperative allergic reactions are often severe. To avoid potentially life-threatening re-exposure to the culprit drug, establishing a firm diagnosis and identifying the culprit is crucial. Drug provocation tests are considered the gold standard in drug allergy investigation but have not been recommended in the investigation of perioperative allergy, mainly because of the pharmacological effects of drugs such as induction agents and neuromuscular blocking agents. Some specialised centres have reported benefits of provocation testing in perioperative allergy investigation, but the literature on the subject is limited. Here we provide a status update on the use of drug provocation testing in perioperative allergy, including its use in specific drug groups. This review is based on a literature search and experiences of the authors comprising anaesthesiologists and allergists with experience in perioperative allergy investigation. In addition, 19 participating centres in the International Suspected Perioperative Allergic Reaction Group were surveyed on the use of provocation testing in perioperative allergy investigation. A response was received from 13 centres in eight European countries, New Zealand, and the USA. Also, 21 centres from the Australian and New Zealand Anaesthetic Allergy Group were surveyed. Two centres performed provocation routinely and seven centres performed no provocations at all. Nearly half of the centres reported performing provocations with induction agents and neuromuscular blocking agents. Drug provocation testing is being used in perioperative allergy investigation in specialised centres, but collaborations between relevant specialties and multi-centre studies are necessary to determine indications and establish common testing protocols.

Original languageEnglish
Pages (from-to)E126-E134
Number of pages9
JournalBritish Journal of Anaesthesia
Volume123
Issue number1
DOIs
Publication statusPublished - Jul 2019

Cite this

Garvey, Lene H. ; Ebo, Didier G. ; Kroigaard, Mogens ; Savic, Sinisa ; Clarke, Russell ; Cooke, Peter ; Dewachter, Pascale ; Garcez, Tomaz ; Guttormsen, Anne B. ; Hopkins, Philip M. ; Hepner, David L. ; Khan, David A. ; Kolawole, Helen ; Kopac, Peter ; Marshall, Stuart ; Mertes, Paul-Michel ; Platt, Peter ; Rose, Michael ; Sabato, Vito ; Sadleir, Paul ; Savic, Louise ; Scherer, Kathrin ; Takazawa, Tomonori ; Volcheck, Gerald W. ; Voltolini, Susanna ; Laguna, Jose J. / The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions : current status. In: British Journal of Anaesthesia. 2019 ; Vol. 123, No. 1. pp. E126-E134.
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abstract = "Suspected perioperative allergic reactions are often severe. To avoid potentially life-threatening re-exposure to the culprit drug, establishing a firm diagnosis and identifying the culprit is crucial. Drug provocation tests are considered the gold standard in drug allergy investigation but have not been recommended in the investigation of perioperative allergy, mainly because of the pharmacological effects of drugs such as induction agents and neuromuscular blocking agents. Some specialised centres have reported benefits of provocation testing in perioperative allergy investigation, but the literature on the subject is limited. Here we provide a status update on the use of drug provocation testing in perioperative allergy, including its use in specific drug groups. This review is based on a literature search and experiences of the authors comprising anaesthesiologists and allergists with experience in perioperative allergy investigation. In addition, 19 participating centres in the International Suspected Perioperative Allergic Reaction Group were surveyed on the use of provocation testing in perioperative allergy investigation. A response was received from 13 centres in eight European countries, New Zealand, and the USA. Also, 21 centres from the Australian and New Zealand Anaesthetic Allergy Group were surveyed. Two centres performed provocation routinely and seven centres performed no provocations at all. Nearly half of the centres reported performing provocations with induction agents and neuromuscular blocking agents. Drug provocation testing is being used in perioperative allergy investigation in specialised centres, but collaborations between relevant specialties and multi-centre studies are necessary to determine indications and establish common testing protocols.",
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Garvey, LH, Ebo, DG, Kroigaard, M, Savic, S, Clarke, R, Cooke, P, Dewachter, P, Garcez, T, Guttormsen, AB, Hopkins, PM, Hepner, DL, Khan, DA, Kolawole, H, Kopac, P, Marshall, S, Mertes, P-M, Platt, P, Rose, M, Sabato, V, Sadleir, P, Savic, L, Scherer, K, Takazawa, T, Volcheck, GW, Voltolini, S & Laguna, JJ 2019, 'The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status' British Journal of Anaesthesia, vol. 123, no. 1, pp. E126-E134. https://doi.org/10.1016/j.bja.2019.03.018

The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions : current status. / Garvey, Lene H.; Ebo, Didier G.; Kroigaard, Mogens; Savic, Sinisa; Clarke, Russell; Cooke, Peter; Dewachter, Pascale; Garcez, Tomaz; Guttormsen, Anne B.; Hopkins, Philip M.; Hepner, David L.; Khan, David A.; Kolawole, Helen; Kopac, Peter; Marshall, Stuart; Mertes, Paul-Michel; Platt, Peter; Rose, Michael; Sabato, Vito; Sadleir, Paul; Savic, Louise; Scherer, Kathrin; Takazawa, Tomonori; Volcheck, Gerald W.; Voltolini, Susanna; Laguna, Jose J.

In: British Journal of Anaesthesia, Vol. 123, No. 1, 07.2019, p. E126-E134.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions

T2 - current status

AU - Garvey, Lene H.

AU - Ebo, Didier G.

AU - Kroigaard, Mogens

AU - Savic, Sinisa

AU - Clarke, Russell

AU - Cooke, Peter

AU - Dewachter, Pascale

AU - Garcez, Tomaz

AU - Guttormsen, Anne B.

AU - Hopkins, Philip M.

AU - Hepner, David L.

AU - Khan, David A.

AU - Kolawole, Helen

AU - Kopac, Peter

AU - Marshall, Stuart

AU - Mertes, Paul-Michel

AU - Platt, Peter

AU - Rose, Michael

AU - Sabato, Vito

AU - Sadleir, Paul

AU - Savic, Louise

AU - Scherer, Kathrin

AU - Takazawa, Tomonori

AU - Volcheck, Gerald W.

AU - Voltolini, Susanna

AU - Laguna, Jose J.

PY - 2019/7

Y1 - 2019/7

N2 - Suspected perioperative allergic reactions are often severe. To avoid potentially life-threatening re-exposure to the culprit drug, establishing a firm diagnosis and identifying the culprit is crucial. Drug provocation tests are considered the gold standard in drug allergy investigation but have not been recommended in the investigation of perioperative allergy, mainly because of the pharmacological effects of drugs such as induction agents and neuromuscular blocking agents. Some specialised centres have reported benefits of provocation testing in perioperative allergy investigation, but the literature on the subject is limited. Here we provide a status update on the use of drug provocation testing in perioperative allergy, including its use in specific drug groups. This review is based on a literature search and experiences of the authors comprising anaesthesiologists and allergists with experience in perioperative allergy investigation. In addition, 19 participating centres in the International Suspected Perioperative Allergic Reaction Group were surveyed on the use of provocation testing in perioperative allergy investigation. A response was received from 13 centres in eight European countries, New Zealand, and the USA. Also, 21 centres from the Australian and New Zealand Anaesthetic Allergy Group were surveyed. Two centres performed provocation routinely and seven centres performed no provocations at all. Nearly half of the centres reported performing provocations with induction agents and neuromuscular blocking agents. Drug provocation testing is being used in perioperative allergy investigation in specialised centres, but collaborations between relevant specialties and multi-centre studies are necessary to determine indications and establish common testing protocols.

AB - Suspected perioperative allergic reactions are often severe. To avoid potentially life-threatening re-exposure to the culprit drug, establishing a firm diagnosis and identifying the culprit is crucial. Drug provocation tests are considered the gold standard in drug allergy investigation but have not been recommended in the investigation of perioperative allergy, mainly because of the pharmacological effects of drugs such as induction agents and neuromuscular blocking agents. Some specialised centres have reported benefits of provocation testing in perioperative allergy investigation, but the literature on the subject is limited. Here we provide a status update on the use of drug provocation testing in perioperative allergy, including its use in specific drug groups. This review is based on a literature search and experiences of the authors comprising anaesthesiologists and allergists with experience in perioperative allergy investigation. In addition, 19 participating centres in the International Suspected Perioperative Allergic Reaction Group were surveyed on the use of provocation testing in perioperative allergy investigation. A response was received from 13 centres in eight European countries, New Zealand, and the USA. Also, 21 centres from the Australian and New Zealand Anaesthetic Allergy Group were surveyed. Two centres performed provocation routinely and seven centres performed no provocations at all. Nearly half of the centres reported performing provocations with induction agents and neuromuscular blocking agents. Drug provocation testing is being used in perioperative allergy investigation in specialised centres, but collaborations between relevant specialties and multi-centre studies are necessary to determine indications and establish common testing protocols.

KW - allergy

KW - anaphylaxis

KW - challenge testing

KW - drug hypersensitivity

KW - drug provocation test

KW - perioperative period

KW - IMMUNOGLOBULIN-E ANTIBODIES

KW - NEGATIVE PREDICTIVE-VALUE

KW - HYPERSENSITIVITY REACTIONS

KW - LOCAL-ANESTHETICS

KW - DIAGNOSIS

KW - SKIN

KW - ANAPHYLAXIS

KW - GUIDELINES

KW - RISK

KW - CHLORHEXIDINE

U2 - 10.1016/j.bja.2019.03.018

DO - 10.1016/j.bja.2019.03.018

M3 - Article

VL - 123

SP - E126-E134

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

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ER -