Allergic Reactions in the Perioperative Period in Children

Victor Gonzalez-Uribe, Elsy Maureen Navarrete-Rodriguez, Juan José Sienra-Monge and Blanca Estela Del Rio-Navarro

Background: There have been reported some reviews and position papers of international societies concerning to perioperative hypersensitivity reactions in adult patients, However the information in the pediatric patient is very limited. Objectives: Updated review on the identification, diagnosis and management of perioperative hypersensitivity reactions in pediatrics. Methods: Search of the literature from 1980 through Medline database. Results: The correct treatment of perioperative hypersensitivity reactions are based on the suspected diagnosis, signs and symptoms, and time of occurrence. Latex, neuromuscular blocking agents (NMBA) and antibiotics are most often associated with immediate hypersensitivity reactions in anesthetic / surgical events. The Ring-Messmer classification can help to categorize perioperative hypersensitivity reactions and provide proper treatment. The adrenaline is the first-line drug in the management of hypersensitivity reactions grade II or higher by Ring-Messmer classification/ or when the patient meets clinical anaphylaxis scenarios; adrenaline administration and aggressive fluid therapy as first-line treatment is responsibility of surgeons and anesthesiologists. Late assessment corresponds to the allergist / clinical immunologist to discern the hypersensitivity mechanism, confirm a diagnosis, and provide prevention setting applicable to each patient. Conclusion: Pediatric perioperative hypersensitivity reactions are rare but with serious consequences. Unlike the adult patient, the latex is the most common agent, therefore, reduction in use becomes a preventive measure.