ANAPHYLAXIS DURING ANESTHESIA - USE OF RADIOIMMUNOASSAYS TO DETERMINE ETIOLOGY AND DRUGS RESPONSIBLE IN FATAL CASES

Skin (intradermal or prick) testing is usually used to investigate anaphylactoid reactions that occur during anesthesia. 1-4 Testing is usually carried out at least 1 month after the reaction with the intention of confirming the diagnosis, implicating the responsible drug and, ultimately, making subsequent anesthesia safe. 1 In the deceased patient confirmation of an anaphylactic etiology may be relevant in establishing the cause of death and may have medicolegal significance. Establishing that the cause of a reaction was indeed anaphylactic is therefore of value, particularly when the post mortem findings following anaphylaxis are relatively nonspecific 5 and since an anesthetic related problem is a more common cause of mortality. 6 Since skin testing cannot be used in the case of the deceased subject, the examination of sera, taken before or after death, for the presence of specific immunoglobulin E (IgE) antibodies may be a valuable diagnostic aid. Here, we present results of studies on two patients who experienced fatal drug-induced anaphylaxis during anesthesia and in whom confirmation of diagnosis by radioimmunoassay for drug-specific IgE antibodies, performed with sera taken prior to anesthesia, led to a change in the provisional post mortem diagnosis. This study was also noteworthy in that one of the subjects had serum antibodies to both the muscle relaxant drug and the induction agent used.