Philip M. Hopkins (Author), Peter J. Cooke (Author), Russel C. Clarke (Author), Anne Berit Guttormsen (Author), Peter R. Platt (Author), Pascale Dewachter (Author), D. Ebo (Author), Tomaz Garcez (Author), Lene Heise Garvey (Author), David L. Hepner (Author), Peter Kopač (Author)

Abstract

Background: Grading schemes for severity of suspected allergic reactions have been applied to the perioperative setting, but there is no scoring system that estimates the likelihood that the reaction is an immediate hypersensitivity reaction. Such a score would be useful in evaluating current and proposed tests for the diagnosis of suspected perioperative immediate hypersensitivity reactions and culprit agents. Methods: We conducted a Delphi consensus process involving a panel of 25 international multidisciplinary experts in suspected perioperative allergy. Items were ranked according to appropriateness (on a scale of 1-9) and consensus, which informed development of a clinical scoring system. The scoring system was assessed by comparing scores generated for a series of clinical scenarios against ratings of panel members. Supplementary scores for mast cell tryptase were generated. Results: Two rounds of the Delphi process achieved stopping criteria for all statements. From an initial 60 statements, 43 were rated appropriate (median score 7 or more) and met agreement criteria (disagreement index <0.5); these were used in the clinical scoring system. The rating of clinical scenarios supported the validity of the scoring system. Although there was variability in the interpretation of changes in mast cell tryptase by the panel, we were able to include supplementary scores for mast cell tryptase. Conclusion: We used a robust consensus development process to devise a clinical scoring system for suspected perioperative immediate hypersensitivity reactions. This will enable objectivity and uniformity in the assessment of the sensitivity of diagnostic tests.

Keywords

alergy and immunology;anesthesia;anaphylaxis;drug hypersensitivity;drug-related side effects and adverse reactions;perioperative period;surgery;operative surgical procedures;

Data

Language: English
Year of publishing:
Typology: 1.01 - Original Scientific Article
Publisher: Elsevier
UDC: 616-097
COBISS: 2048509297 Link will open in a new window
ISSN: 1471-6771
Parent publication: British journal of anaesthesia
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Other data

Secondary keywords: Allergy and immunology;Anesthesia;Anaphylaxis;Drug hypersensitivity;Drug-related side effects and adverse reactions;Perioperative period;Surgery;Surgical procedures, operative;Alergija in imunologija;Anestezija;Anafilaksija;Preobčutljivost za zdravila;Stranski in škodljivi učinki zdravil;Perioperativno obdobje;Kirurgija;Operativni kirurški postopki;
Source comment: Soavtor iz Slovenije: P. Kopac; Nasl. z nasl. zaslona; Opis vira z dne 4. 6. 2019;
Pages: str. e29-e37
Volume: ǂVol. ǂ123
Issue: ǂiss. ǂ1
Chronology: Jul. 2019
DOI: 10.1016/j.bja.2019.02.029
ID: 12066577