A Seventeen-Year Review of Peri-Operative Anaphylaxis in a Pediatric Hospital

RATIONALE: While serious adverse events are unusual during surgery (0.4% of cases), allergic reactions are among the major factors that contribute to peri-operative morbidity and mortality. The literature on peri-operative anaphylaxis is limited, especially concerning the pediatric population. The study was designed to examine the characteristics of those patients who have adverse allergic peri-operative outcomes and examine the most common agents in pediatrics.METHODS: Charts were collected based on selected ICD-9 codes and previous consults for retrospective chart review. Demographic data (sex, age, ethnicity), diagnosis, timing of symptoms, allergic history, offending agent, history of exposures, and treatment were evaluated. Fifty cases were identified and 39 charts from 1992-2008 met inclusion criteria. Thirty-nine age-and-gender matched controls were selected from surgical patients between 3/2010 - 5/2010.RESULTS: The incidence of peri-operative anaphylaxis remained stable over the past 17 years (1 in 10,000). Asthma history (OR=4.3, 95% CI: 1.4 - 13.3, p=0.0095), family history (OR=23.8, 95% CI: 2.9 - 191.6, p<0.0001), food allergy (OR=9.8, 95% CI: 1.2 - 82.7, p=0.03), home medications (OR=3.3, 95% CI: 1.3 - 8.4, p=0.01), oral steroid use (OR=28.1, 95% CI: 1.6 - 500.0, p=0.001), and previous anesthesia (OR=7.2, 95% CI: 2.3 - 22.1, p=0.0003) were significant risk factors. Of the 39 events where a causal agent was found, neuromuscular blocking agents (NMBA) and latex accounted for 19 of the anaphylactic events.CONCLUSIONS: Asthma, family history of atopy, and previous anesthesia are associated with increased risk of peri-operative anaphylaxis while NMBAs and latex comprise the majority of causal agents. RATIONALE: While serious adverse events are unusual during surgery (0.4% of cases), allergic reactions are among the major factors that contribute to peri-operative morbidity and mortality. The literature on peri-operative anaphylaxis is limited, especially concerning the pediatric population. The study was designed to examine the characteristics of those patients who have adverse allergic peri-operative outcomes and examine the most common agents in pediatrics. METHODS: Charts were collected based on selected ICD-9 codes and previous consults for retrospective chart review. Demographic data (sex, age, ethnicity), diagnosis, timing of symptoms, allergic history, offending agent, history of exposures, and treatment were evaluated. Fifty cases were identified and 39 charts from 1992-2008 met inclusion criteria. Thirty-nine age-and-gender matched controls were selected from surgical patients between 3/2010 - 5/2010. RESULTS: The incidence of peri-operative anaphylaxis remained stable over the past 17 years (1 in 10,000). Asthma history (OR=4.3, 95% CI: 1.4 - 13.3, p=0.0095), family history (OR=23.8, 95% CI: 2.9 - 191.6, p<0.0001), food allergy (OR=9.8, 95% CI: 1.2 - 82.7, p=0.03), home medications (OR=3.3, 95% CI: 1.3 - 8.4, p=0.01), oral steroid use (OR=28.1, 95% CI: 1.6 - 500.0, p=0.001), and previous anesthesia (OR=7.2, 95% CI: 2.3 - 22.1, p=0.0003) were significant risk factors. Of the 39 events where a causal agent was found, neuromuscular blocking agents (NMBA) and latex accounted for 19 of the anaphylactic events. CONCLUSIONS: Asthma, family history of atopy, and previous anesthesia are associated with increased risk of peri-operative anaphylaxis while NMBAs and latex comprise the majority of causal agents.