ALLERGIC AND PSEUDOALLERGIC REACTIONS TO ANESTHETICS - CLINICAL-FEATURES, RISK-FACTORS AND DIAGNOSTIC POSSIBILITIES

Nearly all drugs currently used during the course of general anaesthes ia may lead to hypersensitivity reactions of various types, There may be an acute type I allergic reactions or to a more or less severe pseu do-allergic reactions, in rare cases with lethal outcome, Routine preo perative testing appears of little predictive value, in spite of the h igh frequency of so-called risk factors (atopy, other kind of allergy) among the evaluated group of patients. Careful allergological testing should he performed 4 to 6 weeks after any incidents of suspected dru g intolerance, in order to discover the underlying causative agent,Ski n testing is of diagnostic value for neuromuscular blockers and intrav enous narcotics. RAST- and RIA-tests and/or mediator releasing tests m ay also used additionally together with all other administered drugs, all the routinely used neuromuscular blockers (suxamethonium, vecuroni um, pancuronium, alcuronium, atracurium, mivacurium) should be tested, since they often represent the cause for such reactions, For other cl asses of drugs (for example, volatile anesthetics and opioids) the cli nical relevance of skin testing still remains uncertain. For less seve re incidents seen during general anaesthesia such as pruritus, or exan thems, skin testing seems to be less relevant.