An update on allergy and anaphylaxis in pediatric anesthesia


This update represents a well presented summary of current knowledge on paediatric perioperative allergy. Some of the highlights from the paper include;

  • Poorly known incidence of paediatric anaphylaxis world wide with a reported incidence in studies ranging from 1:1000 in the European APRICOT study to 1:37000 in the United Kingdom’s NAP 6 survey.
  • Pointers of how to distinguish true allergies from adverse drug reactions. This is highlighted in the context of the increasing number of children labelled with multiple drug allergies without definitive evidence and how this impacts on healthcare.
  • Discussion of old and emergent allergens:
    • Propofol is rarely associated with anaphylaxis and there is a lack of evidence to link it to food allergy including egg, soy or peanuts. This is useful knowledge in the child with multiple food allergies in which propofol suitability is debated.
    • Chlorhexidine anaphylaxis was often not recognised according to the NAP 6 survey and thus requires anaesthetists to be vigilant and consider it as a potential trigger. This is an ingredient in multiple substances used by medical and nursing staff and thus it may be considered rare to have surgery without this potential trigger.
    • Sugammadex allergy is emerging but little is known at this stage. However, it may be due to a cross reactivity with another substance, such as rocuronium.
  • A summary of the immediate management of anaphylaxis in the paediatric in addition to follow up testing.

Take home message

With the increasing number of paediatric patients labelled with allergies, this paper forms a useful resource on this topic. It dispels some myths and gives practical strategies for management of these patients in the perioperative period.

Reviewed by: Sorcha Evans