Perioperative allergy testing

Hypersensitivity reactions are rare yet significant perioperative complications. Prompt referral of patients with previous perioperative hypersensitivity to the immunology service aids in the identification of the culprit agent and safe alternatives for future anaesthetics. Both in-vivo and in-vitro tests exist for the evaluation of perioperative hypersensitivity. Serum tryptase sampling is utilized to confirm the diagnosis of perioperative hypersensitivity reactions together with clinical history. Skin testing is the first-line investigation due to its well established profile. In-vitro tests such as specific immunoglobulin E quantification and basophil activation test have the advantage of sparing the patient from re-exposure. Drug provocation tests remain to be the gold standard yet require careful patient selection and closely collaborated anaesthetist–immunologist care in the perioperative setting.