Allergy in Perioperative and Clinical Setting

Local anesthetic agents are estimated to precipitate about 1% a true allergic reaction—either allergic contact dermatitis with pruritic rash within 72 h at site administration and then possibly blisters, vesicles, and skin weeping, or within 1 h of administration, urticaria, including pruritus, hives and/or angioedema, sneezing, running nose, wheezing, shortness of breath, and even anaphylaxis. Skin tests are available to identify the safety of a variety of local anesthetic drugs and preservatives. Perioperative hypersensitivity (POH) reactions have an incidence between 1:353 and 1:18,600 procedures. True anaphylaxis is estimated to occur in 1:3500 to 1:20,000 surgeries with clinical manifestations varying from mild skin rash to cardiovascular collapse. Anaphylaxis has a mortality rate of 1.4–4.8%. Patient with perioperative anaphylaxis should be referred to allergist to identify the drug that led to the reaction. Treatment of POH (Perioperative Hypersensitivity Reactions) include discontinuing any possible drugs, and with only skin involvement, using antihistamines, and in the presence of hypotension, tachycardia, bronchospasm, or gastrointestinal signs, based on severity, treating with appropriate dose of epinephrine, considering volume expansion and securing airway, if needed.