Allergic reactions during anesthesia: diagnosis and treatment

The term “anaphylaxis” is composed by “a na”, meaning “not or contrary to” and “phylaxis”, meaning “protection”. Thus repeated exposure to a toxin may cause harm instead of prophylaxis or immunization. An anaphylactic reaction or anaphylaxis is an immediate type hypersensitivity reaction to a substance or drug, causing acute life-threatening symptoms in two or more organ systems. Immunoglobulin IgE antibodies are involved. The reaction is independent of the pharmacological actions and the dose of the substance or drug. An anaphylactoid reaction is clinically indistinguishable from an anaphylactic reaction, but is not mediated by IgE antibodies. As a consequence a definite diagnosis can only be made after investigation (7,17,18,23,25,30,34,38). Before investigation of a reaction the term “suspected anaphylactic reaction” should be used (36-38). However, in the literature there is a lot of confusion about the terminology (28) while during last years it has been suggested to abandon the term anaphylactoid. During anesthesia many different drugs are used in rapid succession: not only anesthetics, but also antibiotics, fluids, nonsteroidal anti-inflammatory drugs and other compounds (e.g. disinfectants, latex etc.). Most of them are given intravenously and in bolus, bypassing the body’s primary immune filters and presenting high concentrations of antigen directly to the mast cells and basophils. So it is difficult to say which drug caused the suspected reaction or that the reaction was the result from the additive side effects of several drugs injected simultaneously (40).