Available online 13 October 2022

Hypersensitivity reactions are abnormal adverse reactions to stimuli that are usually tolerated by the general population. Reactions range from mild mucocutaneous changes to life-threatening generalized hypersensitivity reactions known as anaphylaxis. Common triggering agents in anaesthesia include antibiotics, neuromuscular blocking agents and chlorhexidine. It is not uncommon to come across patients with a history of allergy or anaphylaxis in the perioperative period. These patients should ideally have an immunological work-up prior to further exposure to anaesthesia. In the emergency setting, where there is insufficient time for work-up, modification of anaesthetic techniques through minimizing the number of drugs used, selecting drugs with the least allergic potential and lowest risk of cross-reactivity would reduce the patient's risk of an adverse reaction. The diagnosis of a hypersensitivity reaction or anaphylaxis is clinical and essential managements include prompt intravenous adrenaline, fluid resuscitation and initiating cardiopulmonary resuscitation for systolic blood pressure <50 mmHg even in the absence of cardiac arrest.

Adrenaline

anaphylaxis

hypersensitivity

mast cell tryptase

© 2022 Published by Elsevier Ltd.