AGENTS CAUSING ANAPHYLACTIC SHOCKS DURING ANESTHESIA - 3RD FRENCH MULTICENTRIC SURVEY (1992-1994)

Since 1989, the epidemiological survey of anaphylactoid reactions occu rring during anaesthesia is obtained in France with repeated inquiries by the Perioperative Anaphylactic Reactions Study Group. The members of this group collect during the study period the cases of patients ha ving suffered from an anaphylactoid reaction and tested in their aller go-anaesthetic outpatient clinic, their characteristics (age, gender), the results of the allergological tests (mechanism, agents responsibl e for the reactions). The two previous surveys published in the Annale s francaises d'anesthesie et de reanimation in 1990 and 1993 included 1,240 and 1,585 patients respectively. The current survey concerned 1, 750 patients tested in 27 diagnostic centres, from January 1992 to Jun e 1994. The reactions occurred at all ages, predominantly between 10 a nd 50 years, the sex-ratio (F/M) was 2.4. Allergological tests carried out to diagnose an immune mechanism for the shock were cutaneous test s in ail centres (prick-tests in 21 centres, intradermal tests in 27 c entres) using the same dilutions for the tested agents and the same th reshold for positivity. Specific IgE antibodies against muscle relaxan ts, thiopentone and propofol, were measured by radio immunoassays in 2 0 centres. The leucocyte histamine release test was used in 10 centres . The immune origin of the shock - IgE dependent anaphylaxis - was dia gnosed in 1,000 patients (57.8%) and due to 1,030 agents: muscle relax ants (59.2%), latex (19%), hypnotics (5.9%) benzodiazepines (2.1%), op ioids (3.5%), plasma substitutes (5.0%), antibiotics (3.1%) and other drugs given during anaesthesia such as aprotinine and protamine (2.2%) . Suxamethonium was responsible for 39.3% of muscle relaxant anaphylax is, vecuronium for 36%, atracurium for 14.5%, pancuronium for 4.8%, ga llamine for 3.1% and alcuronium for 2.3%. The latter has been withdraw n from the French market in 1993. These differences in the incidence o f reactions are correlated with the clinical use of muscle relaxants i n France for vecuronium and atracurium, however not for suxamethonium, responsible for 39% of the reactions but representing only 5% of the muscle relaxants sold in France. The comparison with the two previous surveys confirms that the mechanism of more than half of the anaphylac toid reactions occurring during anaesthesia is of immune origin, due t o specific IgE antibodies. it is therefore essential to systematically carry out an allergologic assessment several weeks after the reaction , in order to discard for the subsequent anaestheticts the agent (s) r esponsible for anaphylaxis. If the muscle relaxants remain the first d rugs involved in shock occurring at induction, there is a significant increase in latex shock, as demonstrated by the three epidemiological surveys (0.5%, 12.5 and now 19%). The incidence of other anaesthetic a gents, antibiotics and plasma substitutes remains unchanged.