ANESTHETIC MANAGEMENT IN PATIENTS WITH MULTIPLE DRUG ALLERGIES

Abstract

Drug allergy, or an allergic drug reaction, is an adverse drug reaction (ADRs) that result from a specific immunologic response to a medication. ADRs are broadly categorized into predictable (type A) and unpredictable (type B) reactions. Predictable reactions are usually dose dependent, are related to the known pharmacologic actions of the drug, and occur in otherwise healthy individuals. They are estimated to comprise approximately 80% of all ADRs. Unpredictable reactions are generally dose independent, are unrelated to the pharmacologic actions of the drug, and occur only in susceptible individuals. Multiple drug allergy syndrome is a clinical condition characterized by a propensity to react against different chemically unrelated drugs, mainly antibiotics. In most cases, the syndrome presents as acute urticaria, angioedema or both upon administration of offending compounds. Every agent used during the perioperative period may be involved. Neuromuscular blocking agents (NMBAs) represent the most frequently incriminated substances ranging from 50 to 70%, followed by latex (12 to 16.7%) and antibiotics (15%). Dyes, hypnotic agents, local anesthetics, opioids, colloids, aprotinin, protamine, chlorhexidine, or nonsteroidal anti-inflammatory drugs are less frequently involved.