Anesthesia allergies are a rare but serious condition that can result in symptoms ranging from mild skin rashes to life-threatening anaphylaxis. For most people, anesthetic agents and medical equipment used during anesthesia are entirely safe. However, roughly 1 in 10,000 surgical procedures involves a severe reaction to anesthesia (3). While it isn’t possible to completely cure an anesthesia allergy in modern medicine, there are ways to manage anesthesia allergies by working with an anesthesiologist and allergist (4). Furthermore, patients with anesthesia allergies may benefit from ongoing developments in areas such as rapid drug desensitization, allergy shots, and sublingual immunotherapy in the future.

Anesthesia allergies can be triggered by any drugs or substances used during anesthesia. Some of the most common triggers for anesthesia allergies include neuromuscular blocking agents (NMBAs), latex, antiseptics, and intravenous dyes (3). An allergy to a particular medication or certain foods can put a patient at higher risk of having an adverse reaction during anesthesia (3). For example, being allergic to certain fruits is associated with a higher risk of a latex allergy, and people with allergies to certain classes of medications are more likely to be allergic to similar drugs (3). However, in many cases, it’s impossible to predict an allergic reaction during anesthesia. Fortunately, there are strategies for risk reduction and emergency management, and research continues on how much science can do to cure an anesthesia (or other) allergy.

The perioperative care team can take various preventative measures before surgery to reduce the risk of an allergic reaction to anesthesia (4). Standard procedure for surgery involves the anesthesiologists evaluating the clinical history to assess any previous history of allergies or adverse drug reactions during medical procedures (4). If a reaction does occur, it is critical that the care team promptly recognize the reaction, the severity of the reaction, and the drug that triggered the reaction (4). Epinephrine, vasoactive drugs, vasopressin, and various other drugs can be used as a first line of treatment to stop the reaction and reduce its severity (4). Once the reaction is under control and the patient sufficiently recovers, the patient can work with an allergy specialist to determine the cause of the reaction and evaluate their clinical history (4).

Several therapies are currently used to treat other types of allergies. For example, allergen immunotherapy injections or “allergy shots” are used to reduce the severity of allergic reactions in patients with allergy-related runny or stuffy nose and asthma (1). These treatments do not “cure” allergies altogether; however, they can effectively reduce the amount and severity of symptoms (1). Sublingual immunotherapy is an alternative version of allergen immunotherapy in which the treatment medicine is placed under the tongue instead of injected (2). Allergen immunotherapy increases the patient’s immunity to the allergen by exposing them to minuscule amounts of the allergen over time, often over several years (2).

Rapid drug desensitization is another technique that induces temporary tolerance to a drug for patients who have adverse drug reactions (6). This treatment allows patients with hypersensitivities to particular medications–including anaphylaxis–to receive necessary treatment for their illness safely (6). Over the years, research has shown that rapid drug desensitization is safe and effective for treating drug hypersensitivity reactions (6). Further developments could provide the benefits of rapid drug desensitization and allergy immunotherapy to patients with allergies to anesthetic agents. Though current allergy treatments do not fully cure them and are not geared towards anesthesia, research will continue to explore and expand this field.

References

1. “Allergy Shots–What You Need to Know.” Yale Health, https://yalehealth.yale.edu/topic/allergy-shots-what-you-need-know
2. Boltansky, Howard. “Sublingual Immunotherapy–Allergy Drops.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/conditions-and-diseases/seasonal-allergies/could-allergy-drops-be-the-key-to-allergy-relief
3. Elterman, Kelly. “Can You Be Allergic to an Anesthetic?” GoodRX, May 23 2022, https://www.goodrx.com/conditions/anesthesia/allergic-to-anesthesia
4. Laguna, J J et al. “Practical Guidelines for Perioperative Hypersensitivity Reactions.” Journal of investigational allergology & clinical immunology vol. 28,4 (2018): 216-232. doi:10.18176/jiaci.0236
5. Patton, K and D.C. Borshoff. “Adverse Drug Reactions.” Anaesthesia, vol. 73, no. S1, 03 Jan 2018, pp. 76-84. https://doi.org/10.1111/anae.14143
6. del Carmen Sancho, Maria et al. “Desensitization for hypersensitivity reactions to medications.” Chemical immunology and allergy vol. 97 (2012): 217-33. doi:10.1159/000335637
7. Vega, Arantza et al. “Use of Rapid Drug Desensitization in Delayed Hypersensitivity Reactions to Chemotherapy and Monoclonal Antibodies.” Frontiers, 14 Jan 2022, https://doi.org/10.3389/falgy.2021.786863