![]() The incidence of perioperative anaphylaxis was 1 in 6,531 procedures, with 5% of cases near fatal and 2% fatal ( 10, 11). The most recent US data of perioperative anaphylaxis was published by Gonzalez-Estrada and colleagues, using the National Inpatient Sample from 2005–2014 ( 10, 11). The most common agents implicated in perioperative anaphylaxis are antibiotics, neuromuscular blocking agents (NMBA), sugammadex (an NMBA reversal agent), chlorhexidine, and latex ( 2). Both IgE and non-IgE mediated mechanisms have been recognized ( 2). It is most common in females, and can be more severe due to many characteristics unique to the perioperative setting, including sedated patients who are draped for surgery ( 9). Perioperative anaphylaxis is an acute, systemic, life threatening reaction that occurs during the operative period. It also includes a discussion surrounding the use of perioperative cephalosporins in the setting of penicillin allergy, the evidence surrounding pre-operative penicillin allergy evaluations, and highlights directions for future study. This review covers a brief description of the epidemiology of both perioperative anaphylaxis and penicillin allergy, the epidemiology of perioperative anaphylaxis attributable to penicillin-based antibiotics, and the approach to the patient with perioperative anaphylaxis due to a penicillin-based antibiotic, including in pregnancy. ![]() Since penicillin allergy is common, and surgical procedures in the US exceed 50 million per year ( 4), it is worthwhile to consider penicillin allergy in the context of perioperative anaphylaxis and vice versa. Penicillin allergy is commonly reported, occurring in about 10% of the population ( 1), while perioperative anaphylaxis is rare, with severe episodes estimated to occur in 1 in 10,000 surgical procedures ( 2), though this latter figure may be an underestimate ( 3). ![]()
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