The following is a summary of “Association Between Early Patient Characteristics and IgE-Mediated Allergy in the Perioperative Setting,” published in the May 2024 issue of Allergy & Immunology by Dewachter, et al.

Timely recognition of perioperative anaphylaxis, an acute and potentially life-threatening hypersensitivity reaction, is critical. However, diagnosing it at the bedside can be challenging due to the variability in clinical presentation. For a study, researchers sought to characterize the early manifestations of perioperative immediate hypersensitivity, focusing on cutaneous phenotypes and identifying risk factors associated with IgE-mediated allergy.

Retrospective data on adults suspected of perioperative immediate hypersensitivity across two academic medical centers were analyzed. Multivariable logistic regression assessed the associations among patient, clinical, and paraclinical characteristics and IgE-mediated allergy.

Of the 145 enrolled patients, 99 (68.3%) had IgE-mediated allergy, while 46 (31.7%) were categorized as non-allergic. The presence of cutaneous vasoconstriction phenotype, characterized by pallor, piloerection, thelerethism, and sweating with or without cyanosis within minutes of drug exposure, was strongly associated with IgE-mediated allergy (adjusted odds ratio [aOR] = 28.02; 95% CI, 4.41-305.18), indicating a life-threatening reaction. Other early factors linked to allergy included low end-tidal carbon dioxide levels (≤25 mm Hg) (aOR = 5.45; 95% CI, 2.39-26.45), low mean arterial pressure (≤60 mm Hg) (aOR = 3.82; 95% CI, 1.28-17.31), and early cutaneous vasodilation (erythema, urticaria, and/or angioedema) (aOR = 2.78; 95% CI, 0.73-20.54). The late cutaneous vasodilation following hemodynamic stabilization further supported the diagnosis of allergy (aOR = 23.67; 95% CI, 4.94-205.09). A predictive model comprising three readily available variables (cutaneous phenotype, low mean arterial pressure, and low end-tidal carbon dioxide) demonstrated an area under the curve of 0.91.

The cutaneous vasoconstriction phenotype was strongly associated with an increased risk of life-threatening IgE-mediated allergy in the perioperative setting, serving as a potential hallmark of perioperative anaphylaxis.

Reference: sciencedirect.com/science/article/abs/pii/S221321982400165X