Anaphylaxisduring skin test with vecuronium

Introduction

To the Editor, During perioperative periods anaphylactic reactions are not uncommon events. Their prevalence is estimated to be 1 in every 10,000–20,000 anaesthetic cases.¹ Neuromuscular blocking drugs (NMBD) are the most causative agents in such events, contributing to 69.2% of the cases.² Natural rubber latex (NRL, or cis-1,4-polyisoprene) was the second most implicated agent. Antibiotics and anaesthesia induction drugs are the other drugs leading to anaphylaxis. The evaluation is based on serum tryptase levels, skin prick and intradermal tests, basophil activation assays and drug specific IgE levels. Although skin tests with anaesthetic agents are known to be safe and feasible, we have reported a boy with an anaphylactic reaction to vecuronium during the intradermal test. We were consulted at the paediatric surgery about an 18-month-old boy with Hirschsprung disease for oxygen desaturation (90%) just a few minutes after induction of anaesthesia. This was the second operation that he had undergone for his disease and propofol 20mg iv, vecuronium 1mg iv and sevoflurane were administered. Ampicillin had been administered intravenously, 20min before the operation. There was no other reason for considering anaphylaxis such as hypotension (his blood pressure was 95/60mmHg), skin eruption, angio-oedema or gastrointestinal symptoms. He had no family or personal history of allergy. Serum tryptase levels were within normal ranges (8.4μg/L) (normal range: 3.5–11.4μg/L). The specific IgE of latex, penicillin, and egg white were negative. Six weeks later he was referred to our allergy department in order to detect the possible causes of intraoperative anaphylaxis and to determine potentially safe alternative...