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Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom : aetiology and diagnostic performance of acute serum tryptase
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Krishna, M. T., York, M., Chin, T., Gnanakumaran, G., Heslegrave, J., Derbridge, C., Huissoon, A., Diwakar, L., Eren, E., Crossman, Richard, Khan, N. and Williams, A. P. (2014) Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom : aetiology and diagnostic performance of acute serum tryptase. Clinical & Experimental Immunology, Volulme 178 (Number 2). pp. 399-404. doi:10.1111/cei.12424 ISSN 0009-9104.
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Official URL: http://dx.doi.org/10.1111/cei.12424
Abstract
This is the first multi-centre retrospective survey from the United Kingdom to evaluate the aetiology and diagnostic performance of tryptase in anaphylaxis during general anaesthesia (GA). Data were collected retrospectively (2005-12) from 161 patients [mean ± standard deviation (s.d.), 50 ± 15 years] referred to four regional UK centres. Receiver operating characteristic curves (ROC) were constructed to assess the utility of tryptase measurements in the diagnosis of immunoglobulin (Ig)E-mediated anaphylaxis and the performance of percentage change from baseline [percentage change (PC)] and absolute tryptase (AT) quantitation. An IgE-mediated cause was identified in 103 patients (64%); neuromuscular blocking agents (NMBA) constituted the leading cause (38%) followed by antibiotics (8%), patent blue dye (6%), chlorhexidine (5%) and other agents (7%). In contrast to previous reports, latex-induced anaphylaxis was rare (0·6%). A non-IgE-mediated cause was attributed in 10 patients (6%) and no cause could be established in 48 cases (30%). Three serial tryptase measurements were available in 34% of patients and a ROC analysis of area under the curve (AUC) showed comparable performance for PC and AT. A ≥ 80% PPV for identifying an IgE-mediated anaphylaxis was achieved with a PC of >141% or an AT of >15·7 mg/l. NMBAs were the leading cause of anaphylaxis, followed by antibiotics, with latex allergy being uncommon. Chlorhexidine and patent blue dye are emerging important health-care-associated allergens that may lead to anaphylaxis. An elevated acute serum tryptase (PC >141%, AT >15·7 mg/l) is highly predictive of IgE-mediated anaphylaxis, and both methods of interpretation are comparable.
Item Type: | Journal Article | ||||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Science > Statistics Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Clinical & Experimental Immunology | ||||||||
Publisher: | Wiley-Blackwell Publishing Ltd. | ||||||||
ISSN: | 0009-9104 | ||||||||
Official Date: | November 2014 | ||||||||
Dates: |
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Volume: | Volulme 178 | ||||||||
Number: | Number 2 | ||||||||
Page Range: | pp. 399-404 | ||||||||
DOI: | 10.1111/cei.12424 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
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