DRUGS AND OTHER AGENTS INVOLVED IN ANAPHYLACTIC SHOCK OCCURRING DURING ANESTHESIA - A FRENCH MULTICENTER EPIDEMIOLOGIC INQUIRY

An epidemiological inquiry was carried out in departments of anaesthesia and immunology in French University and General Hospitals, as well as among those who were already known to have an allergo-anaesthesia outpatient clinic. This inquiry aimed to find out how many patients had undergone diagnostic investigations after as well as an anaphylactoid reaction during an anaesthetic in 1990 and 1991, as well as the demographic data, the kind of assessment, the accident mechanism and the drugs involved. Twenty-one French centres replied to the questionnaire and a series of 1,585 patients tested over a two-year period was thus collected. There were three female patients to one male. The reactions occurred mostly in the adult (80 %), but 9 % were observed in children. Allergological tests for IgE-dependent anaphylaxis were the skin tests (21 centres), combined with radioimmunological assays of specific serum antibodies to muscle relaxants (10 centres), propofol (9 centres), latex (5 centres), leukocyte histamine release (9 centres) and human basophil degranulation test (4 centres). The criteria for a positive result were the same for all centres. Among these 1,585 patients, 813 were recognized as having had a reaction of immunological origin (52 %).The substances involved were identified in these 813 patients as being muscle relaxants (70 %), latex (12.6 %), hypnotics (3.6 %), benzodiazepines (2.0 %), opioids (1.7 %), colloids (4.7 %), and antibiotics (2.6 %). Suxamethonium was responsible for 43 % of the IgE-dependent reactions involving a muscle relaxant, vecuronium for 37 %, pancuronium for 13 %, alcuronium for 7.6 %, atracurium for 6.8 % and gallamine for 5.6 %. These results were compared with those obtained with the 1989 inquiry, including 1,240 patients from eight centres [4]. An attempt is made to interpret the results of these two inquiries with the muscle relaxants, by comparing the respective number of reactions due to each drug along with the figures of the French market shares for each drug between 1986 and 1991. By using the current allergological assessment, the substance involved was formally identified in 52 % of these reactions. In the remaining 48 %, the investigations gave negative results, and there remains doubt concerning the drug or drug combination which elicited the non specific release of histamine.