Perioperative anaphylaxis in children and first successful cisatracurium desensitization

作者：Sophie Lai, Rowena S. M. Lee, Crystal K. Lam, Andrew K. H. Yik, Qin Ying Lim, Florence Choi, Donna Lynch, Kathleen Marquis, Kaiyue Zhang, Kai‐Ning Cheong, Karen Ka Yan Leung, YL Lau, V. M. Yuen, Elaine Y. L. Au, Mariana Castells, Jaime S. Rosa Duque · 发表于：Pediatric Allergy and Immunology · 年份：2025 · DOI：10.1111/pai.70066 · 被引用次数：2 · 研究领域：Food Allergy and Anaphylaxis Research、Drug-Induced Adverse Reactions、Contact Dermatitis and Allergies

BACKGROUND: Perioperative anaphylaxis (PA) is a rare life-threatening complication of anesthesia, with few descriptions of its diagnosis and outcomes in the pediatric population. Many agents can be potential culprits, and drug provocation testing (DPT) to confirm the diagnosis is limited by the nature of anesthetic drugs. PA diagnosis and culprit identification remain a challenge. For patients with limited drug options, desensitization has not been reported. This study evaluated the results of skin and laboratory testing for pediatric patients with PA and provides the protocol and outcome of the first desensitization to cisatracurium, a neuromuscular blocking agent (NMBA). METHODS: Patients ≤18 years old with PA from 2019 to 2024 were included, and medical records were retrospectively reviewed, which comprised serum tryptase levels, results of skin testing (ST), basophil activation testing (BAT), and outcomes. RESULTS: Eleven patients were included. Tryptase was elevated in seven of 10 (70%) tested patients. ST yielded positive results for nine of 10 (90%), and two of 11 (18.2%) had positive BAT. RESULTS: A culprit agent was identified in 10 of 11 (91%). The most common drugs were NMBAs (70%) and beta-lactam antibiotics (20%). One patient with a positive DPT to NMBAs and limited alternatives was successfully desensitized to cisatracurium with a 3-bag, 12-step protocol. CONCLUSION: The most common drug culprits of PA in children were NMBAs and were identified by ST. Tryptase c...