This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dewachter, P. Articles by Mouton-Faivre, C. Search for Related Content PubMed PubMed Citation Articles by Dewachter, P. Articles by Mouton-Faivre, C.

---

LETTER TO THE EDITOR

Skin Testing Performed in Individuals Cannot be Compared with Responses from Anaphylactic Patients

Service d’Anesthésie-Réanimation et SAMU de Paris; Hôpital Necker-Enfants Malades; AP-HP, Université Paris Descartes; pascale.dewachter{at}yahoo.fr (Dewachter) Pôle d’Anesthésie-Réanimation Chirurgicale; CHU Hôpital Central; Nancy, France (Mouton-Faivre)

To the Editor:

Levy and Adkinson1 have presented a useful overview of anaphylaxis occurring in patients during cardiac surgery. However, specific concerns are warranted regarding the interpretation of skin tests with neuromuscular blocking agents (NMBAs). The three studies2–4 cited by Levy and Adkinson1 were performed in control patients who did not experience an immediate hypersensitivity reaction during the perioperative period. In such circumstances, skin tests only refer to histamine release induced by NMBAs and cannot predict an anaphylactic reaction following IV administration of NMBAs because both negative as well as positive predictive values of skin tests with NMBAs in the general population are not known.5

In contrast, skin tests performed in patients with a history of immediate hypersensitivity with a NMBA are highly reliable.6 In those patients, prick-tests followed by intradermal tests (but not only prick-tests) are necessary to identify the pathophysiological mechanism of the reaction, the culprit allergen (like NMBAs) and potential cross-reactive molecules (cross-reactivity being about 60%–70% among NMBAs). NMBAs followed by a negative reaction by skin testing may be reinjected.

In conclusion, the results of skin tests performed in individuals cannot and should not be compared with those performed in anaphylactic patients.

REFERENCES

1. Levy JH, Adkinson NF. Anaphylaxis during cardiac surgery: Implications for clinicians. Anesth Analg 2008;106:392–403[Abstract/Free Full Text]
2. Levy JH, Adelson D, Walker B. Wheal and flare responses to muscle relaxants in humans. Agents Actions 1991;34:302–8[Web of Science][Medline]
3. Levy JH, Gottge M, Szlam F, Zaffer R, McCall C. Weal and flare responses to intradermal rocuronium and cisatracurium in humans. Br J Anaesth 2000;85:844–9[Abstract/Free Full Text]
4. Dhonneur G, Combes X, Chassard D, Merle JC. Skin sensitivity to rocuronium and vecuronium: a randomized controlled prick-testing study in healthy volunteers. Anesth Analg 2004;98:986–9[Abstract/Free Full Text]
5. Ebo DG, Fisher MM, Hagendorens MM, Bridts CH, Stevens WJ. Anaphylaxis during anaesthesia: diagnostic approach. Allergy 2007;62:471–87[Web of Science][Medline]
6. French Society of Anesthesiology and Intensive Care Med. Clinical practice guidelines: reducing the risk of anaphylaxis during anaesthesia. Abbreviated text. Ann Fr Anesth Reanim 2002;21(Suppl 1):7–23

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dewachter, P. Articles by Mouton-Faivre, C. Search for Related Content PubMed PubMed Citation Articles by Dewachter, P. Articles by Mouton-Faivre, C.