Multiple Drug Allergies: Recommendations for Perioperative Management

Abstract Life-threatening hypersensitivity reactions are more likely to occur in patients with a history of allergy, atopy or asthma. Hence in a patient provided a history of multiple drug allergies, an allergological assessment should be performed prior to surgical procedure. Drug allergies, being one of the causes of catastrophic events occurring in the perioperative period, are of major concern to anesthesiologists. Neuromuscular blocking agents are regularly used during anesthesia and are one of the most common causes of perioperative anaphylaxis. They are estimated to be responsible for 50-70% of perioperative hypersensitivity reactions. Antibiotics and latex represent the next two groups of drug allergy. In this regard, allergic reactions to propofol are rare with an incidence of 1:60,000 exposures. Although intraoperative drug anaphylaxis is rare, it contributes to 4.3% of deaths occurring during general anesthesia. These recommendations discuss pathophysiology of multiple drug allergies (MDA), preoperative evaluation and anesthesia considerations, as well as prevention and management of allergic reactions in anesthetized patients with a history of MDA.