Teicoplanin over 16 tines culprit antibiotic in allergic reaction – twice other antibiotics. It seems to be a UK thing in terms of practice.
Test doses don’t serve any real purpose.
Since most anaphylaxis occurs within 5-10 mins a suggestion is to administer before anesthesia induction.
B-Blockers and ACEIs as well as older sicker patients and those with coronary artery disease have more hypotension and do worse.
Obese patients figured highly in mortality cases.
Hypotension is the presenting sign in half. Most severe cases may not show skin rash. Bronchospasm more an initial feature of Succinylcholine, which is also responsible for twice the anaphylaxis rate of non-depolarizing agents. Rocuronium leads the latter pack, followed by Atracurium and Mivacurium. No cases with Vecuronium or Cisatracurium.
There is a potential and debated relationship between Rocuronium allergy and Pholcodine, an opioid cough suppressant especially used in Australia which could sensitize subjects.
Chlorhexidine identified as responsible agent in 9%, often presenting with hypotension that is delayed and missed as diagnosis.
Fluid and epinephrine are the go to treatments not steroids and antihistamines which only play a corollary role. Sugammadex is not at this point an evidence based treatment for Rocuronium allergy. CPR was not started in many cases when it should have been.
Patent Blue dye (used in sentinel node locating in breast surgery) also a significant allergy culprit.