Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

Summary Suspected perioperativeallergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperativesetting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperativeallergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensusprocess, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperativeallergic reactions. Statements were selected to represent areas where there is a lack of consensusin existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensusprocess have been included in the recommendations on the management of suspected perioperativeallergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperativeallergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensushas been lacking in existing guidelines.