The primary culprits in perioperative allergic reactions are antibiotics and neuromuscular blocking agents (NMBAs). While the incidence of reactions to antibiotics is on an upward trajectory globally, NMBAs continue to hold sway as a predominant allergen in nations such as France, Belgium, Australia, and the United Kingdom. Concurrently, we observe a decline in latex-related reactions, a testament to the efficacy of preventive strategies. The escalating utilization of blue dyes in oncological surgeries and chlorhexidine as an antiseptic are likely contributors to the increased incidence of hypersensitivity to these substances.
Antibiotics, particularly beta-lactam antibiotics like penicillins and cephalosporins, stand at the forefront of IgE-mediated perioperative anaphylaxis, with vancomycin also implicated for direct histamine release from mast cells. Though less frequently, quinolones are gaining attention as emerging offenders.
NMBA agents have a dual pathway to anaphylaxis—both IgE-mediated and through direct mast cell activation. A gender disparity exists in NMBA sensitivity, predominantly affecting women in three out of four reactions, which is likely tied to cross-reactivity with substances found in cosmetics and certain medications.
Chlorhexidine's role in perioperative anaphylaxis is gaining prominence, implicated across a range of medical and non-medical products. This substance pervades a range of nonmedical items, including toothpaste, antiseptic mouthwashes, bathing solutions, and lozenges, setting the stage for patient sensitization through regular exposure.
Blue dyes such as isosulfan blue and patent blue V, which are used in lymph node mapping, can also cause mild to severe reactions.
| Agent | Key points |
|---|---|
| Antibiotics | Reactions are rising globally; beta-lactams such as penicillins and cephalosporins lead IgE-mediated cases, vancomycin causes direct histamine release, and quinolones are emerging offenders |
| Neuromuscular blocking agents | Act through both IgE-mediated and direct mast cell activation; remain predominant in France, Belgium, Australia, and the United Kingdom; women account for three of four reactions |
| Chlorhexidine | Growing contributor; sensitization builds through routine exposure in toothpaste, antiseptic mouthwashes, bathing solutions, and lozenges |
| Blue dyes | Isosulfan blue and patent blue V, used for lymph node mapping in oncologic surgery, can cause mild to severe reactions |
| Latex | Declining, reflecting the success of preventive strategies, but still a concern where latex products remain in use |
