Trends In Anaphylaxis
May 29, 2025
The major culprits - current trends in anaphylaxis investigations
A critical component of successful anaphylaxis management โ ๏ธ is the removal of potential triggering agents ๐ซ. Patients are exposed to a variety of different medications ๐ and solutions ๐ during their time in the perioperative environment ๐ฅ, so it’s important to be able to recognise ๐ง the most common triggers ๐, as well as some that are emerging ๐ฑ or may be overlooked ๐.
We’ve done the hard work for you ๐ช - here are the most common triggers, as well as some that may be a little more inconspicuous ๐ต๏ธโ๏ธ.
๐ง Neuromuscular blocking agents
One of the most common offenders โก, the main culprits in this category are Suxamethonium and Rocuronium. It is important to remember though that although the incident rate is lower for other NMBA’s, as a whole this drug group is one of the main triggers for perioperative anaphylaxis. There is also a high rate of cross-reactivity ๐ between NMBAs, an important consideration for patients that have a documented anaphylaxis history ๐ with a NMBA.
๐ Antibiotics
The other major offender for perioperative anaphylaxis, most commonly those of the beta-lactam class such as penicillins and cephalosporins.
๐งด Chlorhexidine
The rate of anaphylaxis following chlorhexidine exposure is increasing ๐, with more and more products containing it. It is important to remember that chlorhexidine may be present in a wide variety of products used on a patient, from skin preps ๐งผ to urinary catheters ๐ฝ and impregnated central lines and dressings ๐ฉน.
๐งค Latex
Anaphylaxis rates attributed to latex are declining worldwide ๐, thought to be attributed to the shift to powder free gloves. Nevertheless, latex is still a potential triggering agent, particularly in patients that have frequent and repeated exposure ๐ to it, such as patients requiring frequent catheterisation.
๐๏ธ Contrast and dyes
While less common, contrast is still a known trigger for anaphylaxis. Dyes, in particular blue dyes ๐ have also been identified as repeat offenders for anaphylaxis.
๐ง Colloids
Colloids represent a group of fluids commonly used in the perioperative setting. Among them, gelatin-based products have the highest incidence of anaphylaxis. Bearing in mind ๐ง , gelatin is also a component of some topical hemostatic agents commonly used during surgery ๐ ๏ธ. Careful consideration must be taken in patients with certain food ๐ค or vaccine ๐ allergies, as well as those with allergies to products that contain gelatin.
While these are some of the most common and emerging culprits, it's important to remember that anaphylaxis can occur with almost any agent โ ๏ธ, and must always be considered and ruled in/out of any critical event in the operating suite ๐๏ธ.
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References:
H. M. Sadleir, R. C. Clarke, D. L. Bunning, P. R. Platt, Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011, BJA: British Journal of Anaesthesia, Volume 110, Issue 6, June 2013, Pages 981–987, https://doi.org/10.1093/bja/aes506
Yim, R. (2016) An update on perioperative anaphylaxis. WFSA. https://resources.wfsahq.org/atotw/an-update-on-perioperative-anaphylaxis/
ANZCA (2022). Perioperative anaphylaxis management guide. https://www.anzca.edu.au/getContentAsset/bfb2011e-f2a4-49ff-9f42-a93c339dd4a9/80feb437-d24d-46b8-a858-4a2a28b9b970/Anaphylaxis-guideline-BP-2022.pdf?language=en&view=1
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