アレルギーと治療のジャーナル

概要

Skin Prick Test in the Diagnosis of Allergy in the Perioperative Period-8 Year Experience

Grażyna Michalska-Krzanowska

Epidemiological studies indicate an increase in allergies in the perioperative period. Some allergens can be lifethreatening. One of the most difficult and time-consuming issues in practical allergology is to diagnose the reactioninducing agent, particularly in the perioperative period. The paper presents various aspects of the diagnosis of allergy highlighting the usefulness of skin prick testing. The study involved 52 patients (42 women and 10 men). They were selected out of 72,380 patients anaesthetized for surgeries in 2003 and 2010. The physical examination of patients who experienced allergy determined the location, extent and severity of side effects. The tests were always conducted after inserting an intravenous catheter, under full safety conditions. A positive reaction after allergen application occurred in the form of a wheal of 3 mm or more in diameter and erythema. Patients were subjected to skin prick tests and intradermal tests using all anaesthetic drugs, including NMBAs, applied during anaesthesia (according to the anaesthesia protocol). Four patients (7.69 %) had positive SPT to latex, which showed clearly that it was the causative factor of the reaction. One of the patients (1.92 %) had positive SPT to atracurium, the others to augmentin and pethidine. Three patients (5.76%) had positive SPT to NMBA (atracurium, cisatracurium, rocuronium) (wheal size greater than 3 mm compared to the negative control). Positive intradermal test results to NMBA were identified in 27 patients (51.92 %). Patients received a written notice of the occurrence of suspected anaphylactic reaction during anaesthesia, the potential cause and the implemented therapeutic procedure. Increased dermographism made the skin tests in patients difficult to interpret, and therefore the following results were also taken into account: tryptase, specific IgE and clinical symptoms manifested during anaesthesia, recorded in patient records. Detailed history, skin prick testing, laboratory methods, and double-blind placebo-controlled challenges are still the gold standard for the diagnosis of hypersensitivity, although sometimes results can lead to difficulties of interpretation or can be even misleading.