Anaphylaxis during anesthesia: results of a 12-year survey at a French pediatric center.

BACKGROUND: Following adverse reactions to anesthesia, tests are carried out to determine the mechanism of the reaction and to identify the agent responsible. No specific data are available in France concerning such skin tests in children. METHODS: Between 1989 and 2001, we assessed hypersensitivity reactions to general anesthesia in 68 children. Thirty underwent more than one operation, for congenital malformations. Immunoglobulin (Ig)E-mediated anaphylaxis was diagnosed on skin tests combined with the clinical history. RESULTS: Grade I, II and III reactions were observed in 20, 27 and 21 children, respectively. IgE-mediated anaphylaxis was diagnosed in 51 children: 31 (60.8%) for neuromuscular blocking agents (NMBA), 14 (27%) for latex, seven (14%) for colloids, five (9%) for opioids and six (12%) for hypnotics. Vecuronium was the NMBA causing the largest number of reactions. Cross reactivity to NMBA available in France was observed in 23 of 30 children (76%), particularly for vecuronium and atracurium or pancuronium. The estimated frequency of IgE mediated anaphylactic reactions was one in 2100 operations. Based on our results, 25 children subsequently received a different anesthetic with no adverse reaction. CONCLUSIONS: As in adults, NMBA, then latex were responsible for most anaphylactic reactions during anesthesia. Our results confirm that skin tests with anesthetic agents are feasible and safe in children and improve the safety of subsequent anesthetic procedures.

Sensitization to inhalant allergens in wheezing infants is predictive of the development of infantile asthma.

Early recognition of infantile asthma in wheezing infants is a major problem for physicians. We investigated whether detection of early sensitization to inhalant allergens would be useful to identify those wheezing infants who are likely to develop asthma. A total of 67 infants (aged 1-25 months) hospitalized for a wheezing episode were initially tested for reactivity to inhalant allergens by both skin prick test and in vitro measurement of specific IgE antibodies (Phadiatop). Thirty-seven of the infants were already considered to have infantile asthma, and 30 presented only their first or second wheezing episode when included in the study. All infants were followed for a mean period of 18 months. Seventeen (25%) infants, including seven infants initially not asthmatic, had positive prick test to Dermatophagoides pteronyssinus or to cat fur. All of these children were diagnosed as suffering from infantile asthma at the end of the follow-up. Thus, skin test positivity to inhalant allergens was significantly associated with the diagnosis of infantile asthma (P < 0.05) and could be considered to be predictive of the development of infantile asthma (P < 0.03). In contrast, Phadiatop was less sensitive than skin prick tests, and only five children had positive in vitro test results, suggesting that specific IgE may primarily bind to tissue mast cells before being detectable in serum. We concluded that sensitization to inhalant allergens may distinguish wheezing infants who develop asthma from those who do not, and that skin testing may assist the early diagnosis of asthma in wheezing infants.

Nasal eosinophilia in children: its use in the nasal allergen provocation test.

This pediatric cytological and clinical study aimed at assessing the value of nasal eosinophilia during nasal provocation tests for identifying an offending allergen. The population studied comprised 50 children aged from 4 to 18 yr; 39 of these had well-characterized allergic rhinitis, which in 21 cases was combined with asthma, and the remaining 11 had nonatopic chronic rhinitis. Nasal secretions, collected by nose blowing, were stained with May-Grünwald-Giemsa or Wright stain. The percentage of nasal eosinophils was obtained by examining the cells in the whole slides. Counts were carried out on secretions collected before challenge, after insufflation of saline solution (for verification), and 40 min after insufflation into each nostril of an allergen (housedust mite extract). The nasal provocation test was considered positive when insufflation of the allergen increased nasal eosinophilia by more than 10%, provided that the prechallenge proportion of eosinophils was less than 50%. No increase in specific bronchial resistance was noted. These results indicate that nasal provocation tests are safe, even in asthmatic children.