• Tomonori Takazawa, Tatsuo Horiuchi, Kazuhiro Nagumo, Yuki Sugiyama, Tsubasa Akune, Yasuhiro Amano, Masataka Fukuda, Takashi Haraguchi, Chika Ishibashi, Eiki Kanemaru, Takao Kato, Keiichi Katoh, Takashi Kawano, Tsukasa Kochiyama, Michioki Kuri, Akihide Kurita, Yoshikazu Matsuoka, Takahiro Muramatsu, Masaki Orihara, Yutaka Saito, Nobukazu Sato, Toshie Shiraishi, Kaoru Suzuki, Miyuki Takahashi, Toshifumi Takahashi, Kumiko Tanabe, Akihiro Tomioka, Yukinari Tomita, Tatsuya Tsuji, Iwao Watanabe, Takashige Yamada, Nagahide Yoshida, Masao Yamaguchi, and Shigeru Saito.
• Intensive Care Unit, Gunma University Hospital, Maebashi, Japan. Electronic address: takazawt@gunma-u.ac.jp.
• Br J Anaesth. 2023 Jul 1; 131 (1): 159169159-169.

BackgroundDiagnosis of perioperative anaphylaxis is often challenging. This study describes the utility of a newly developed tool for identifying patients with a high possibility of anaphylaxis, and aimed to investigate the frequency of anaphylaxis with each drug during the perioperative period in Japan.MethodsThis study included patients with anaphylaxis of Grade 2 or higher severity during general anaesthesia at 42 facilities across Japan in 2019 and 2020. We developed and adopted a unique objective evaluation tool yielding a composite score for diagnosing anaphylaxis, which includes the results of skin tests and basophil activation tests, and clinical scores for perioperative anaphylaxis. The number of cases using each drug and the total number of anaphylaxis cases were investigated to calculate the frequency of anaphylaxis.ResultsGeneral anaesthesia was performed in 218 936 cases, which included 55 patients with suspected perioperative anaphylaxis. The developed composite score diagnosed 43 of them with a high probability of anaphylaxis. The causative agent was identified in 32 cases. Plasma histamine levels showed high diagnostic accuracy for anaphylaxis. The top causative agents were rocuronium (10 cases in 210 852 patients, 0.005%), sugammadex (7 cases in 150 629 patients, 0.005%), and cefazolin (7 cases in 106 005 patients, 0.007%).ConclusionsWe developed a composite tool to diagnose anaphylaxis, and found that the combination of tryptase levels, skin testing, and basophil activation testing results and clinical score improved the certainty of anaphylaxis diagnosis. The incidence of perioperative anaphylaxis in our study was 1 in about 5000 general anaesthesia cases.Clinical Trial RegistrationUMIN000035350.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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