@article{ec944604e0e54d54bed38160bccdef48,
title = "The use of drug provocation testing in the investigation of suspected immediate perioperative allergic reactions: current status",
abstract = "Suspected perioperative allergic reactions are often severe. To avoid potentially life-threatening re-exposure to the culprit drug, establishing a firm diagnosis and identifying the culprit is crucial. Drug provocation tests are considered the gold standard in drug allergy investigation but have not been recommended in the investigation of perioperative allergy, mainly because of the pharmacological effects of drugs such as induction agents and neuromuscular blocking agents. Some specialised centres have reported benefits of provocation testing in perioperative allergy investigation, but the literature on the subject is limited. Here we provide a status update on the use of drug provocation testing in perioperative allergy, including its use in specific drug groups. This review is based on a literature search and experiences of the authors comprising anaesthesiologists and allergists with experience in perioperative allergy investigation. In addition, 19 participating centres in the International Suspected Perioperative Allergic Reaction Group were surveyed on the use of provocation testing in perioperative allergy investigation. A response was received from 13 centres in eight European countries, New Zealand, and the USA. Also, 21 centres from the Australian and New Zealand Anaesthetic Allergy Group were surveyed. Two centres performed provocation routinely and seven centres performed no provocations at all. Nearly half of the centres reported performing provocations with induction agents and neuromuscular blocking agents. Drug provocation testing is being used in perioperative allergy investigation in specialised centres, but collaborations between relevant specialties and multicentre studies are necessary to determine indications and establish common testing protocols.",
keywords = "allergy, anaphylaxis, challenge testing, drug hypersensitivity, drug provocation test, perioperative period",
author = "Garvey, {Lene H.} and Ebo, {Didier G.} and Mogens Kr{\o}igaard and Sinisa Savic and Russell Clarke and Peter Cooke and Pascale Dewachter and Tomaz Garcez and Guttormsen, {Anne B.} and Hopkins, {Philip M.} and Hepner, {David L.} and Khan, {David A.} and Helen Kolawole and Peter Kopac and Stuart Marshall and Mertes, {Paul Michel} and Peter Platt and Michael Rose and Vito Sabato and Paul Sadleir and Louise Savic and Kathrin Scherer and Tomonori Takazawa and Volcheck, {Gerald W.} and Susanna Voltolini and Laguna, {Jose J.}",
note = "Funding Information: PD: i) has received lecture and travel fees from MSD France (Courbevoie, France). ii) has received lecture and travel fees from Bracco Imaging France (Courcouronnes, France). iii) Agence Nationale de S{\'e}curit{\'e} du M{\'e}dicament et des Produits de Sant{\'e} (Saint-Denis, France), Expert for a task force group dedicated to “neuromuscular blocking agents and anaphylactic reactions” (until 2016). iv) belongs until October 2019 to a MSD Expert Board on “neuromuscular blocking agents and fast-tracking anesthesia”. LHG: Consultant & adjudication committee member for Merck, New Jersey USA & Consultant & adjudication committee member for Novo Nordisk Denmark. PMH: is an Editorial Board Member of BJA. PMM: Scientific advisor for the ALPHO study (NCT02250729), funded by a consortium of pharmaceutical companies: Zambon, Urgo, Pierre Fabre, Boots, Hepatoum, Biocodex, Sanofi, LBR, GSK, APL, Bells Healthcare, Pinewood, T & R, Ernest Jackson. PK has received lectures fees from Novartis Pharma Services Inc, Shire Pharmaceuticals Group Plc.SM is in receipt of an Australian National Health and Medical Research Council (NHMRC) ECR Fellowship for the investigation of cognitive aids in emergencies. All other authors confirm that they have no interests to declare. Publisher Copyright: {\textcopyright} 2019 British Journal of Anaesthesia Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",
year = "2019",
month = jul,
doi = "10.1016/j.bja.2019.03.018",
language = "English",
volume = "123",
pages = "e126--e134",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Elsevier",
number = "1",
}