EARLY DIAGNOSIS OF ANAPHYLACTIC REACTIONS TO NEUROMUSCULAR BLOCKING DRUGS

Neuromuscular blocking drugs (NMB) are involved in most of theanaphylactic reactions occurring during anaesthesia. Patientsare evaluated usually 6 weeks after the reaction, by skin testing.In order to obtain an earlier diagnosis, we have measured plasmaconcentrations of histamine, tryptase and NMB-specific IgE antibodiesin 14 patients after an anaphylactoid reaction. We have comparedthe results with those of skin tests and specific IgE obtained8 weeks later. Good agreement was observed in all subjects betweenthe results of skin tests and the values for histamine and tryptase,provided that both markers were measured simultaneously. Furthermore,there was no significant difference between the concentrationsof NMB-specific IgE antibodies observed at the time of the reactionand 8 weeks later. Thus anaphylaxis to neuromuscular blockingdrugs can be demonstrated at the time of the reaction by measuringplasma concentrations of histamine, tryptase and specific IgE.In the event of the patient's death, such measurements may beuseful in identifying the likely cause.