Allergy and Anaphylaxis in Perioperative Period; Recent Advances

Abstract

Excessive or inappropriate immune responses sometimes lead to host tissue damage resulting from prolonged or repeated antigen exposure. These reactions, called hypersensitivity reactions, cause tissue injury by the release of chemical substances that attract and activate cells and molecules resulting in inflammation. These reactions are classified into four hypersensitivity types depending upon the mechanism(s) that underlie the tissue damage. The first three types involve antigen-antibody reactions, while the fourth is antibody-independent, involving cell-mediated immune responses only. Anesthesiologists administer a diversity of parenteral drugs in the perioperative period, including blood products and drugs, or manage patients during exposure to multiple foreign substances, all of which have the potential to produce a spectrum of adverse reactions. Allergic reactions are one type of an adverse reaction, and the most severe form is anaphylaxis. Unfortunately, patients may not always know they have been sensitized to a drug or protein by previous exposure. Intraoperative anaphylaxis, especially after anesthesia induction, is problematic because the patient is exposed to multiple drugs in an extremely short period—