D1.375 - Retrospective Analysis of Perioperative Hypersensitivity Reactions: Single-Center Experience

Data on perioperative hypersensitivity reactions (PHRs) in the pediatric population are limited. This study aimed to evaluate the clinical characteristics, diagnostic work-up, and subsequent anesthesia outcomes of children referred with a history of PHR.

Children referred to the Ege University Faculty of Medicine Pediatric Allergy Clinic due to PHR between October 2021 and August 2025 were retrospectively reviewed. Demographic data, clinical findings, and laboratory results including skin prick tests (SPT), intradermal tests (IDT), basal serum tryptase levels, and latex-specific IgE were recorded. Tolerance to subsequent anesthesia procedures was also assessed.

A total of 23 patients were included; 14 (60%) were male, with a median age of 93 months (range: 6–200). Nine patients (39%) had a history of allergic disease, and eight (34.7%) were receiving multiple medications due to chronic conditions. Cutaneous manifestations were observed in 19 patients (82.5%), cardiovascular symptoms in 9 (39.1%), and respiratory findings in 6 (26.1%); no cardiac arrest occurred. According to the Ring and Messmer classification, reactions were graded as I in 11 patients, II in 9, and III in 3. Adrenaline was administered to 10 patients, and 3 required postoperative intensive care.

At least one causative agent was identified in 13 patients (56.5%). SPT and IDT identified responsible agents in 7 patients each. The most frequently identified agents were ketamine, midazolam, and latex. Basal serum tryptase levels were normal in all tested patients. Alternative anesthetic agents were defined, and no recurrent perioperative reactions were observed in 17 patients during subsequent anesthesia exposures.

Patients requiring adrenaline were significantly older at the time of reaction (median 123 vs. 78 months; p=0.045) and had higher lymphocyte counts (p=0.027). No differences were observed between groups regarding sex, allergy history, multiple drug use, total IgE levels, or frequency of cutaneous findings.

Ketamine, midazolam, and latex were the most common triggers of pediatric PHRs. Careful evaluation of personal and familial drug allergy history, combined with appropriate diagnostic testing and multidisciplinary management, is essential to ensure safe anesthesia in children with suspected perioperative hypersensitivity.