Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-10-14 DOI:10.1016/j.bja.2024.07.042

Danielle Crimmins,Helen Crilly,Christian van Nieuwenhuysen,Kate Ziser,Syeda Zahir,Gemma Todd,Leanne Ryan,David Heyworth-Smith,Liam Balkin,Annabelle Harrocks,Anton W G Booth

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Abstract

BACKGROUND Sugammadex hypersensitivity is an emerging safety concern. We aimed to describe the clinical and diagnostic features of perioperative hypersensitivity to sugammadex, and secondarily to provide an estimate of perioperative sugammadex hypersensitivity incidence in Australia. METHODS We retrospectively analysed cases of hypersensitivity to sugammadex diagnosed by positive intradermal or skin prick testing at six perioperative allergy clinics in Australia. We included all grades of hypersensitivity and compared life-threatening with non-life-threatening presentations. Incidence of hypersensitivity events was estimated relative to the estimated number of sugammadex administrations across two health services between January 1, 2010 and June 30, 2023. RESULTS Thirty cases were included (15 life-threatening and 15 non-life-threatening). The most common clinical signs were hypotension (n=25, 83.3%) and flushing/erythema (n=21, 70%). The median time to recognition of hypersensitivity was 5 (interquartile range 2-7.5) min. Five cases were recognised 10-30 min after administration. Serum tryptase was measured in 28 (93.3%) patients. Tryptase was positive in 15 (100%) life-threatening cases and nine (69.2%) non-life-threatening cases. The estimated incidence of sugammadex hypersensitivity was 0.004% (95% confidence interval 0.002-0.008%). CONCLUSIONS Sugammadex hypersensitivity presents similarly to other causes of perioperative hypersensitivity, however recognition can be delayed. The combination of positive serum tryptase and positive skin tests suggests an IgE-mediated mechanism of hypersensitivity. The estimated incidence of sugammadex hypersensitivity in Australia is lower than earlier reports.

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舒格迈地过敏症：对澳大利亚大型队列的多中心回顾性分析。

背景舒格迈地过敏症是一个新出现的安全问题。我们的目的是描述围手术期对舒降之敏过敏的临床和诊断特征，其次是估算澳大利亚围手术期舒降之敏过敏的发生率。我们纳入了所有等级的过敏症，并对危及生命和不危及生命的过敏症进行了比较。根据 2010 年 1 月 1 日至 2023 年 6 月 30 日期间两家医疗服务机构使用苏麦得的估计次数，估算了过敏事件的发生率。最常见的临床症状是低血压（25 例，83.3%）和潮红/红斑（21 例，70%）。识别过敏症的中位时间为 5 分钟（四分位距为 2-7.5 分钟）。有 5 例在用药后 10-30 分钟才被发现。28例（93.3%）患者的血清色氨酸酶得到检测。15例（100%）危及生命的病例和9例（69.2%）不危及生命的病例中色氨酸酶呈阳性。舒格迈地过敏症的估计发生率为 0.004%（95% 置信区间为 0.002-0.008%）。血清胰蛋白酶阳性和皮试阳性的组合提示了 IgE 介导的超敏机制。据估计，苏麦得过敏症在澳大利亚的发病率低于之前的报告。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.