• Br J Anaesth · Oct 2024

    Sugammadex hypersensitivity: a multicentre retrospective analysis of a large Australian cohort.

    Sugammadex hypersensitivity is between 1 in 12,5000 and 1 in 50,000 perioperative exposures.

    pearl
    • Danielle Crimmins, Helen Crilly, Christian van Nieuwenhuysen, Kate Ziser, Syeda Zahir, Gemma Todd, Leanne Ryan, David Heyworth-Smith, Liam Balkin, Annabelle Harrocks, and Anton W G Booth.
    • Department of Anaesthesia, Princess Alexandra Hospital - Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Queensland Anaesthetic Reaction Clinic, Brisbane, QLD, Australia. Electronic address: Danielle.Crimmins@health.qld.gov.au.
    • Br J Anaesth. 2024 Oct 14.

    BackgroundSugammadex hypersensitivity is an emerging safety concern. We aimed to describe the clinical and diagnostic features of perioperative hypersensitivity to sugammadex, and secondarily to provide an estimate of perioperative sugammadex hypersensitivity incidence in Australia.MethodsWe retrospectively analysed cases of hypersensitivity to sugammadex diagnosed by positive intradermal or skin prick testing at six perioperative allergy clinics in Australia. We included all grades of hypersensitivity and compared life-threatening with non-life-threatening presentations. Incidence of hypersensitivity events was estimated relative to the estimated number of sugammadex administrations across two health services between January 1, 2010 and June 30, 2023.ResultsThirty cases were included (15 life-threatening and 15 non-life-threatening). The most common clinical signs were hypotension (n=25, 83.3%) and flushing/erythema (n=21, 70%). The median time to recognition of hypersensitivity was 5 (interquartile range 2-7.5) min. Five cases were recognised 10-30 min after administration. Serum tryptase was measured in 28 (93.3%) patients. Tryptase was positive in 15 (100%) life-threatening cases and nine (69.2%) non-life-threatening cases. The estimated incidence of sugammadex hypersensitivity was 0.004% (95% confidence interval 0.002-0.008%).ConclusionsSugammadex hypersensitivity presents similarly to other causes of perioperative hypersensitivity, however recognition can be delayed. The combination of positive serum tryptase and positive skin tests suggests an IgE-mediated mechanism of hypersensitivity. The estimated incidence of sugammadex hypersensitivity in Australia is lower than earlier reports.Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

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    pearl
    1

    Sugammadex hypersensitivity is between 1 in 12,5000 and 1 in 50,000 perioperative exposures.

    Daniel Jolley  Daniel Jolley
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    1

    Very interesting study out of Brisbane, revising previous estimates that suggested sugammadex hypersensitivity could be as high as 1 in 2,500. Crimmins et al. found in their data the incidence was 5-20 times less common (95% CI).

    Daniel Jolley  Daniel Jolley
     
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