Anaphylaxis Allergy Testing

allergy anaphylaxis testing May 26, 2025

Who’s the culprit? Anaphylaxis testing

All patients that experience an anaphylaxis event should receive follow-up evaluation to determine; firstly whether an allergy exists (IgE mediated response) and if so, what are the triggers?

So how exactly does this happen? Let’s break it down!

๐Ÿฉบ Firstly, patients should be given detailed written information from the event, outlining medications given during the anaesthetic that should be avoided until investigations and testing has been completed.

๐Ÿ“„ A detailed report of the event, including the anaesthetic chart, should be provided to the physician undertaking the testing, in order to rule out any potential alternative diagnoses and provide guidance in the identification of the triggering agent.

๐Ÿ”ฌ A number of different tests can help to identify the type of anaphylaxis - IgE or non IgE mediated - as well as to identity the culprit medication

๐Ÿ’‰ Histamine measurement:
• Mediator produced by basophils and mast cells
• Measured in plasma
• Its peak is immediate
• 15-20 minute elimination half life
• Should be measured within half an hour of anaphylaxis onset, and up to 1-2 hours after

๐Ÿงช Tryptase measurement:
• Contained predominantly in mast cells
• Measured in plasma
• Peak is between 15 minutes - 2 hours after onset of anaphylaxis
• Elimination half-life 90-120 minutes
• Ideally measured within 1-4 hours post onset
• Levels need to be compared with baseline measurement taken in the days following

๐Ÿงด Skin testing:
• Can determine the mechanism (allergic vs non-allergic reaction)
• Identifies triggering agent
• Can determine safe alternatives

๐Ÿ“‹ Whilst allergy testing and follow up evaluation occurs outside of the perioperative environment, it is important to ensure detailed and accurate documentation of the events, along with accurately timed blood testing in order to best support ongoing follow up for our patients.

Build Knowledge โœ…
Improve Safety โœ…

References:

Dewachter, P., Savic, L. (2019) Perioperative anaphylaxis: pathophysiology, clinical presentation and management. BJA education. V 19(10) pp 313-320. DOI: 10.1016/j.bjae.2019.06.002 

Mills, A.T.D.,Sice, P.J.A.,Ford, S.M. (2014). Anaesthesia-related anaphylaxis: investigation and follow-up. Continuing Education in Anaesthesia Critical Care & Pain, V14(2), Pp 57–62. https://doi.org/10.1093/bjaceaccp/mkt034

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