Perioperative anaphylaxis in children and first successful cisatracurium desensitization.

IF 4.3 2区医学 Q2 ALLERGY

Pediatric Allergy and Immunology Pub Date : 2025-03-01 DOI:10.1111/pai.70066

Sophie H Y Lai, Rowena S M Lee, Crystal K Lam, Andrew K H Yik, Qin Ying Lim, Florence Choi, Donna M Lynch, Kathleen A Marquis, Kaiyue Zhang, Kai-Ning Cheong, Karen K Y Leung, Yu Lung Lau, Vivian M Y Yuen, Elaine Y L Au, Mariana C Castells, Jaime S Rosa Duque

{"title":"Perioperative anaphylaxis in children and first successful cisatracurium desensitization.","authors":"Sophie H Y Lai, Rowena S M Lee, Crystal K Lam, Andrew K H Yik, Qin Ying Lim, Florence Choi, Donna M Lynch, Kathleen A Marquis, Kaiyue Zhang, Kai-Ning Cheong, Karen K Y Leung, Yu Lung Lau, Vivian M Y Yuen, Elaine Y L Au, Mariana C Castells, Jaime S Rosa Duque","doi":"10.1111/pai.70066","DOIUrl":null,"url":null,"abstract":"Background: Perioperative anaphylaxis (PA) is a rare life-threatening complication of anesthesia, with few descriptions of its diagnosis and outcomes in the pediatric population. Many agents can be potential culprits, and drug provocation testing (DPT) to confirm the diagnosis is limited by the nature of anesthetic drugs. PA diagnosis and culprit identification remain a challenge. For patients with limited drug options, desensitization has not been reported. This study evaluated the results of skin and laboratory testing for pediatric patients with PA and provides the protocol and outcome of the first desensitization to cisatracurium, a neuromuscular blocking agent (NMBA).Methods: Patients ≤18 years old with PA from 2019 to 2024 were included, and medical records were retrospectively reviewed, which comprised serum tryptase levels, results of skin testing (ST), basophil activation testing (BAT), and outcomes.Results: Eleven patients were included. Tryptase was elevated in seven of 10 (70%) tested patients. ST yielded positive results for nine of 10 (90%), and two of 11 (18.2%) had positive BAT.Results: A culprit agent was identified in 10 of 11 (91%). The most common drugs were NMBAs (70%) and beta-lactam antibiotics (20%). One patient with a positive DPT to NMBAs and limited alternatives was successfully desensitized to cisatracurium with a 3-bag, 12-step protocol.Conclusion: The most common drug culprits of PA in children were NMBAs and were identified by ST. Tryptase correlated with PA. BAT served as adjunctive diagnostic tests. Desensitization to cisatracurium was possible.","PeriodicalId":19929,"journal":{"name":"Pediatric Allergy and Immunology","volume":"36 3","pages":"e70066"},"PeriodicalIF":4.3000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926948/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Allergy and Immunology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/pai.70066","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ALLERGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Perioperative anaphylaxis (PA) is a rare life-threatening complication of anesthesia, with few descriptions of its diagnosis and outcomes in the pediatric population. Many agents can be potential culprits, and drug provocation testing (DPT) to confirm the diagnosis is limited by the nature of anesthetic drugs. PA diagnosis and culprit identification remain a challenge. For patients with limited drug options, desensitization has not been reported. This study evaluated the results of skin and laboratory testing for pediatric patients with PA and provides the protocol and outcome of the first desensitization to cisatracurium, a neuromuscular blocking agent (NMBA).

Methods: Patients ≤18 years old with PA from 2019 to 2024 were included, and medical records were retrospectively reviewed, which comprised serum tryptase levels, results of skin testing (ST), basophil activation testing (BAT), and outcomes.

Results: Eleven patients were included. Tryptase was elevated in seven of 10 (70%) tested patients. ST yielded positive results for nine of 10 (90%), and two of 11 (18.2%) had positive BAT.

Results: A culprit agent was identified in 10 of 11 (91%). The most common drugs were NMBAs (70%) and beta-lactam antibiotics (20%). One patient with a positive DPT to NMBAs and limited alternatives was successfully desensitized to cisatracurium with a 3-bag, 12-step protocol.

Conclusion: The most common drug culprits of PA in children were NMBAs and were identified by ST. Tryptase correlated with PA. BAT served as adjunctive diagnostic tests. Desensitization to cisatracurium was possible.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Pediatric Allergy and Immunology 医学-过敏

CiteScore

9.10

自引率

9.10%

发文量

200

审稿时长

4-8 weeks

期刊介绍： Pediatric Allergy and Immunology is the world''s leading journal in pediatric allergy, publishing original contributions and comprehensive reviews related to the understanding and treatment of immune deficiency and allergic inflammatory and infectious diseases in children. Other areas of interest include: development of specific and accessory immunity; the immunological interaction during pregnancy and lactation between mother and child. As Pediatric Allergy and Immunology promotes communication between scientists engaged in basic research and clinicians working with children, we publish both clinical and experimental work.