Focus on the agents most frequently responsible for perioperative anaphylaxis.

Adverse reactions (ARs) to drugs administered during general anesthesia may be very severe and life-threatening, with a mortality rate ranging from 3 to 9%. The adverse reactions to drugs may be IgE and non-IgE-mediated. Neuromuscular blocking agents (NMBA) represent the first cause of perioperative reactions during general anesthesia followed by latex, antibiotics, hypnotic agents, opioids, colloids, dyes and antiseptics (chlorhexidine). All these substances (i.e. NMBA, anesthetics, antibiotics, latex devices) may cause severe systemic non-IgE-mediated reactions or fatal anaphylactic events even in the absence of any evident risk factor in the patient's anamnesis. For this reason, in order to minimize perioperative anaphylactic reactions, it is important to have rapid, specific, sensitive in vitro diagnostic tests able to confirm the clinical diagnosis of acute anaphylaxis.

Diagnosis of latex allergy: the importance of hev B 11.

We present the cases of 5 patients with a positive clinical history of cutaneous symptoms due to contact with latex products. A latex allergological assessment was made through skin prick tests (SPTs) both with commercial latex extracts and extemporaneous glove extracts, and serum-specific IgE to latex and glove-use tests. In addition, serum-specific IgE to recombinant allergens for Hevea brasiliensis was dosed. Molecular diagnostics in association with the glove-use test and, to a lesser extent, the SPTs with glove eluate are useful diagnostic tests to confirm the diagnosis of latex allergy in patients with mucocutaneous symptoms.

Acquired angioedema with C1 inhibitor deficiency associated with anticardiolipin antibodies.

Acquired angioedema (AAE) with C1 inhibitor deficiency is often associated to B cell lymphoproliferative disorders or autoimmune diseases. We report a case of AAE associated with IgM anti-cardiolipin antibodies, with frequent edematous attacks, that disappeared completely after a slight immunosuppression and danazol therapy.

Parecoxib as an alternative in COX-2 hypersensitivity.

The group of non-steroidal anti-inflammatory drugs (NSAIDs) is commonly involved in hypersensitivity reactions. In clinical practice the physician is often faced with the need to choose an alternative anti-inflammatory agent for a patient who has suffered a hypersensitivity reaction to a NSAID. The most common approach to choosing the safest NSAID is to perform a challenge test. Parecoxib is the first injectable COX-2 selective inhibitor indicated for the treatment of acute postoperative pain. The authors report the case of a patient with a history of cutaneous adverse reactions to different classes of NSAIDs, including selective COX-2 inhibitors, who underwent and tolerated challenge with parecoxib.