Childhood
allergy is common, and increasing. Many children are incorrectly labeled as having
allergy or
adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of
hypersensitivity reactions and the implications for
anesthesia of
food allergy, atopy, and family history of
allergy in children. The epidemiology of
anaphylaxis is discussed. We discuss the common triggers of perioperative
anaphylaxis in children and explore emerging triggers including
chlorhexidine and
sugammadex. Accurate data on pediatric perioperative
anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of
anaphylaxis under
anesthesia are discussed. We review the process of expert
allergy testing following a suspected case of
anaphylaxis to guide future safe
anesthesia administration. The preoperative consultation is an opportunity for referral for
allergy testing to allow de-labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first-line therapeutic agents.