Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Lene H. Garvey, Pascale Dewachter, David L. Hepner, Paul Michel Mertes, Susanna Voltolini, Russell Clarke, Peter Cooke, Tomaz Garcez, Anne Berit Guttormsen, Didier G. Ebo, Philip M. Hopkins, David A. Khan, Peter Kopac, Mogens Krøigaard, Jose Julio Laguna, Stuart Marshall, Peter Platt, Michael Rose, Vito Sabato, Paul SadleirLouise Savic, Sinisa Savic, Kathrin Scherer, Tomonori Takazawa, Gerald W. Volcheck, Helen Kolawole

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120 Citations (Scopus)


Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.

Original languageEnglish
Pages (from-to)e50-e64
Number of pages15
JournalBritish Journal of Anaesthesia
Issue number1
Publication statusPublished - Jul 2019


  • allergy
  • anaesthesia
  • Delphi process
  • epinephrine
  • guideline
  • hypersensitivity reaction
  • perioperative anaphylaxis
  • testing

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