Perioperative allergy: Review and good practice guide

Perioperative allergy is a rare event (1 out of 10,000 anaesthetics) with extensive symptoms and rapid evolution. Although well known to anesthesiologists, its low incidence can result in its emergency management being sometimes incomplete. The aim of this review is to present a complete synthesis of perioperative allergy, including physiology, epidemiology, risk factors and clinical manifestations. Diagnostic and therapeutic management tools are also detailed. The main allergens found belong to the classes of neuromuscular blocking drugs and antibiotics. The main clinical manifestations are cutaneous, respiratory and cardiovascular, possibly leading to cardio-respiratory arrest. Complementary biological blood tests must be taken without delay and subsequent referral to a specialized diagnostic consultation is essential. The therapeutic mana-gement of anaphylaxis includes hemodynamic and respiratory resuscitation, and prolonged monitoring in the ICU or post-anesthesia care units. The current recommendations of the Societe francaise d'anesthesie et de reanimation need to be updated in order to harmonize with international guidelines.