Although screening tests to prevent
anaphylaxis during anaesthesia have been advocated, such tests are unlikely to have significant impact on reducing the incidence of
anaphylaxis during anaesthesia. This is due to the low prevalence of the disease, the diversity of drugs used in anaesthesia and the incidence of false positive and negative tests. The suggested risk factors of
allergy, i.e. atopy,
asthma, family history, female sex, previous exposure,
vasectomy, use of
zinc protamine sulfate insulin and
allergy to
cosmetics, eggs, fish and non-anaesthetic drugs are not valid. Although all have theoretical or real associations with
anaphylaxis during anaesthesia the majority of patients with such a history undergo uneventful anaesthesia. Fruit
allergy,
anaphylaxis to
cephalosporins and
penicillin,
barbiturate allergy,
gelatin allergy and
allergy to
metabisulphite and eggs require consideration in avoiding particular drugs. The incidence of anaesthetic
anaphylaxis can be reduced by avoiding
latex exposure in patients with
spina bifida or
latex allergy, and preventing second reactions in patients with a history of
anaphylaxis, or major undiagnosed or undocumented adverse events during anaesthesia. Determining the cause of an adverse event and the
drug responsible, and adequately communicating those findings can reduce second reactions. Avoiding neuromuscular blocking drugs (NMBDs) in patients who have reacted to an NMBD, and use of non-intravenous techniques should also reduce the incidence of second reactions. Desensitisation, and blocking with monovalent
quaternary ammonium compounds may allow improved safety of NMBDs and pretreatment with
antihistamines and
corticosteroids may block or ameliorate the severity of reactions, but there is currently little evidence to support their routine use.