PDF(Pubmed)
Abstract：
BACKGROUND: Perioperative anaphylaxis is rare but is associated with significant morbidity. This complication has been well described in France by the GERAP (Groupe d\'Etude des Réactions Anaphylactiques Périopératoires), a network focused on its study. The epidemiology of perioperative anaphylaxis is evolving, influenced by environmental factors and clinical practice. The aim of this study was to update the epidemiology of perioperative anaphylaxis in France.
METHODS: This multicentre retrospective study was performed in 26 allergy clinics of the GERAP network in 2017-8.
RESULTS: There were 765 patients with perioperative anaphylaxis included. Most cases were severe, with 428 (56%) reactions graded as 3 or 4 according to the Ring and Messmer classification. Skin test results were available for 676 patients, with a culprit agent identified in 471 cases (70%). Neuromuscular blocking agents were the main cause of perioperative anaphylaxis (n=281; 60%), followed by antibiotics (n=118; 25%) and patent blue dye (n=11; 2%). Cefazolin was the main antibiotic responsible for perioperative anaphylaxis (52% of antibiotic-related reactions). Suxamethonium and rocuronium were the main neuromuscular blocking agents responsible for perioperative anaphylaxis with 7.1 (6.1-8.4) and 5.6 (4.2-7.4) reactions per 100,000 vials sold, respectively, whereas cefazolin-related cases were estimated at 0.7 (0.5-0.9) reactions per 100,000 vials sold.
CONCLUSIONS: Our results confirm that most commonly identified triggering agents remain neuromuscular blocking agents. Reactions to antibiotics, particularly cefazolin, are becoming increasingly frequent. The origin of sensitisation to cefazolin is unknown, as no cross-sensitisation has been described, and it should be the subject of further study. Perioperative anaphylaxis should be followed over the years and understood given the changing triggers.
BACKGROUND: ClinicalTrials.gov (NCT04654923).
METHODS: This multicentre retrospective study was performed in 26 allergy clinics of the GERAP network in 2017-8.
RESULTS: There were 765 patients with perioperative anaphylaxis included. Most cases were severe, with 428 (56%) reactions graded as 3 or 4 according to the Ring and Messmer classification. Skin test results were available for 676 patients, with a culprit agent identified in 471 cases (70%). Neuromuscular blocking agents were the main cause of perioperative anaphylaxis (n=281; 60%), followed by antibiotics (n=118; 25%) and patent blue dye (n=11; 2%). Cefazolin was the main antibiotic responsible for perioperative anaphylaxis (52% of antibiotic-related reactions). Suxamethonium and rocuronium were the main neuromuscular blocking agents responsible for perioperative anaphylaxis with 7.1 (6.1-8.4) and 5.6 (4.2-7.4) reactions per 100,000 vials sold, respectively, whereas cefazolin-related cases were estimated at 0.7 (0.5-0.9) reactions per 100,000 vials sold.
CONCLUSIONS: Our results confirm that most commonly identified triggering agents remain neuromuscular blocking agents. Reactions to antibiotics, particularly cefazolin, are becoming increasingly frequent. The origin of sensitisation to cefazolin is unknown, as no cross-sensitisation has been described, and it should be the subject of further study. Perioperative anaphylaxis should be followed over the years and understood given the changing triggers.
BACKGROUND: ClinicalTrials.gov (NCT04654923).
摘要：
背景：围手术期过敏反应是罕见的，但与显著的发病率相关。GERAP在法国已经很好地描述了这种并发症（Grouped'EtudedesRéactionsAnphriculatisesPériopératoires），一个专注于研究的网络。围手术期过敏反应的流行病学正在发展，受环境因素和临床实践的影响。这项研究的目的是更新法国围手术期过敏反应的流行病学。
方法：这项多中心回顾性研究于2017-8年在GERAP网络的26个过敏诊所进行。
结果：纳入围手术期过敏反应患者765例。大多数病例很严重，根据Ring和Messmer分类，428（56％）反应分为3或4。有676名患者的皮肤测试结果，在471例(70%)中发现了罪魁祸首。神经肌肉阻断剂是围手术期过敏反应的主要原因(n=281;60%),其次是抗生素（n=118；25％）和专利蓝染料（n=11；2％）。头孢唑啉是引起围手术期过敏反应的主要抗生素（52％的抗生素相关反应）。甲胺铵和罗库溴铵是导致围手术期过敏反应的主要神经肌肉阻断剂，每100,000个小瓶中有7.1（6.1-8.4）和5.6（4.2-7.4）反应，分别,而头孢唑林相关病例估计为每100,000个小瓶中有0.7(0.5-0.9)个反应。
结论：我们的结果证实，最常见的触发剂仍然是神经肌肉阻断剂。对抗生素的反应，尤其是头孢唑啉，变得越来越频繁。头孢唑啉致敏的起源未知，由于没有描述交叉敏化，这应该是进一步研究的主题。围手术期过敏反应应跟踪多年，并根据触发因素的变化进行理解。
背景：ClinicalTrials.gov（NCT04654923）。
方法：这项多中心回顾性研究于2017-8年在GERAP网络的26个过敏诊所进行。
结果：纳入围手术期过敏反应患者765例。大多数病例很严重，根据Ring和Messmer分类，428（56％）反应分为3或4。有676名患者的皮肤测试结果，在471例(70%)中发现了罪魁祸首。神经肌肉阻断剂是围手术期过敏反应的主要原因(n=281;60%),其次是抗生素（n=118；25％）和专利蓝染料（n=11；2％）。头孢唑啉是引起围手术期过敏反应的主要抗生素（52％的抗生素相关反应）。甲胺铵和罗库溴铵是导致围手术期过敏反应的主要神经肌肉阻断剂，每100,000个小瓶中有7.1（6.1-8.4）和5.6（4.2-7.4）反应，分别,而头孢唑林相关病例估计为每100,000个小瓶中有0.7(0.5-0.9)个反应。
结论：我们的结果证实，最常见的触发剂仍然是神经肌肉阻断剂。对抗生素的反应，尤其是头孢唑啉，变得越来越频繁。头孢唑啉致敏的起源未知，由于没有描述交叉敏化，这应该是进一步研究的主题。围手术期过敏反应应跟踪多年，并根据触发因素的变化进行理解。
背景：ClinicalTrials.gov（NCT04654923）。
