Mc. Laxenaire et al., DRUGS AND OTHER AGENTS INVOLVED IN ANAPHYLACTIC SHOCK OCCURRING DURING ANESTHESIA - A FRENCH MULTICENTER EPIDEMIOLOGIC INQUIRY, Annales francaises d'anesthesie et de reanimation, 12(2), 1993, pp. 91-96
An epidemiological inquiry was carried out in departments of anaesthes
ia and immunology in French University and General Hospitals, as well
as among those who were already known to have an allergo-anaesthesia o
utpatient clinic. This inquiry aimed to find out how many patients had
undergone diagnostic investigations after as well as an anaphylactoid
reaction during an anaesthetic in 1990 and 1991, as well as the demog
raphic data, the kind of assessment, the accident mechanism and the dr
ugs involved. Twenty-one French centres replied to the questionnaire a
nd a series of 1,585 patients tested over a two-year period was thus c
ollected. There were three female patients to one male. The reactions
occurred mostly in the adult (80 %), but 9 % were observed in children
. Allergological tests for IgE-dependent anaphylaxis were the skin tes
ts (21 centres), combined with radioimmunological assays of specific s
erum antibodies to muscle relaxants (10 centres), propofol (9 centres)
, latex (5 centres), leukocyte histamine release (9 centres) and human
basophil degranulation test (4 centres). The criteria for a positive
result were the same for all centres. Among these 1,585 patients, 813
were recognized as having had a reaction of immunological origin (52 %
).The substances involved were identified in these 813 patients as bei
ng muscle relaxants (70 %), latex (12.6 %), hypnotics (3.6 %), benzodi
azepines (2.0 %), opioids (1.7 %), colloids (4.7 %), and antibiotics (
2.6 %). Suxamethonium was responsible for 43 % of the IgE-dependent re
actions involving a muscle relaxant, vecuronium for 37 %, pancuronium
for 13 %, alcuronium for 7.6 %, atracurium for 6.8 % and gallamine for
5.6 %. These results were compared with those obtained with the 1989
inquiry, including 1,240 patients from eight centres [4]. An attempt i
s made to interpret the results of these two inquiries with the muscle
relaxants, by comparing the respective number of reactions due to eac
h drug along with the figures of the French market shares for each dru
g between 1986 and 1991. By using the current allergological assessmen
t, the substance involved was formally identified in 52 % of these rea
ctions. In the remaining 48 %, the investigations gave negative result
s, and there remains doubt concerning the drug or drug combination whi
ch elicited the non specific release of histamine.