D2.96 - Perioperative Anaphylaxis in Sri Lanka: Evaluation in a Low-Resource Setting

Perioperative anaphylaxis is a life-threatening complication of anaesthesia where failure to identify culprit drugs may result in recurrent reactions. Data from Sri Lanka remains limited. This study aimed to evaluate identification of culprit drugs and determine safe alternative medications in a low resource setting.

This retrospective diagnostic cohort study included patients with documented perioperative anaphylaxis referred to the Institute of Allergology and Immunology Clinic, University of Sri Jayewardenepura, Sri Lanka, between January 2024 and February 2026. Patients were evaluated by skin prick testing (SPT) and intradermal testing (IDT) according to available EAACI guidelines, including identification of safe alternatives. Descriptive statistical analysis was performed.

Thirty-eight patients were evaluated (73.7% female; median age 41.5 years). The overall positivity rate of testing was 21.1% (120/570). At least one confirmed sensitisation was identified in 35 patients (92.1%). Among perioperatively administered medications, beta-lactam antibiotics were the predominant allergen group (73.7%), with cefuroxime (55.3%) and co-amoxiclav (42.1%) as leading triggers, demonstrating cross-reactivity in 23.7% of patients. Neuromuscular blocking agent sensitisation occurred in 34.2%, attributable exclusively to atracurium; vecuronium was tolerated in all atracurium-sensitised patients tested, offering a reliable alternative. NSAID sensitisation occurred in 31.6%. Allergy testing enabled identification of at least one safe perioperative alternative in all sensitised patients.

Beta-lactam antibiotics, particularly cefuroxime, was the leading perioperative anaphylaxis trigger. Structured SPT and IDT testing enabled accurate culprit identification and safe drug substitution, improving perioperative patient safety. This supports development and adoption of dedicated perioperative allergy testing pathways in low resource settings.