ArticlePediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology2025
Perioperative anaphylaxis in children and first successful cisatracurium desensitization.
Article in Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Pharmacovigilance and toxicological studies on safety signals associated with the combined use of propofol and midazolam.BMC anesthesiology · 2026Article
- Perioperative anaphylaxis in children and first successful cisatracurium desensitization.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2025Article
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16 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundPerioperative anaphylaxis (PA) is a rare life-threatening complication of anesthesia, with few descriptions of its diagnosis and outcomes in the pediatric population. Many agents can be potential culprits, and drug provocation testing (DPT) to confirm the diagnosis is limited by the nature of anesthetic drugs. PA diagnosis and culprit identification remain a challenge. For patients with limited drug options, desensitization has not been reported. This study evaluated the results of skin and laboratory testing for pediatric patients with PA and provides the protocol and outcome of the first desensitization to cisatracurium, a neuromuscular blocking agent (NMBA).
methodsPatients ≤18 years old with PA from 2019 to 2024 were included, and medical records were retrospectively reviewed, which comprised serum tryptase levels, results of skin testing (ST), basophil activation testing (BAT), and outcomes.
resultsEleven patients were included. Tryptase was elevated in seven of 10 (70%) tested patients. ST yielded positive results for nine of 10 (90%), and two of 11 (18.2%) had positive BAT.
resultsA culprit agent was identified in 10 of 11 (91%). The most common drugs were NMBAs (70%) and beta-lactam antibiotics (20%). One patient with a positive DPT to NMBAs and limited alternatives was successfully desensitized to cisatracurium with a 3-bag, 12-step protocol.
conclusionThe most common drug culprits of PA in children were NMBAs and were identified by ST. Tryptase correlated with PA. BAT served as adjunctive diagnostic tests. Desensitization to cisatracurium was possible.
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