Introduction: Anaphylaxis is a life-threatening hypersensitivity reaction, with an elevated risk in perioperative settings due to the numerous drugs used. Diagnosing perioperative anaphylaxis is challenging as anesthetics can mask cutaneous symptoms, delaying its recognition. This study investigated the changes in causative drugs, patient characteristics, treatment, and diagnostic tests for perioperative anaphylaxis over time, in Japan, before the Japanese guidelines were established.
Methods: This review, registered in PROSPERO, adhered to PRISMA guidelines. Literature from Japanese (Ichushi) and international (PubMed) databases were reviewed, focusing on perioperative anaphylaxis cases in Japan from 1982 to 2016. Articles lacking detailed clinical data or involving past anaphylactic events without current symptoms were excluded.
Results: We analyzed 294 cases of perioperative anaphylaxis reported in Japan. Latex, biological products, and neuromuscular blocking agents (NMBAs) were the primary causative agents. Symptoms most commonly occurred under general anesthesia and included cardiovascular and skin reactions. Intradermal tests were used to identify causative agents, and although intradermal tests have a high positivity rate, their implementation rate showed a tendency to decrease. The percentage of cases in which adrenaline was administered increased, but remained at about 60% in the 2010s.
Conclusion: This study clarifies the changes in causes, diagnosis, and treatment of perioperative anaphylaxis, highlighting the variability in responses before guideline establishment. The findings might contribute to establishing optimal diagnostic and treatment methods.
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