Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) – Part I: post-crisis guidelines and treatment <sup>☆</sup>  <span class="so-article-trans-title" dir="auto"> Translated title: Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) – Parte I: tratamento e orientação pós-crise </span>

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Abstract

Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.

Resumo

Especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória reuniram-se com o objetivo de intensificar a colaboração entre as duas sociedades no estudo desse tema e elaborar um documento conjunto que possa guiar os especialistas de ambas as áreas. O objetivo desta série de dois artigos foi mostrar as evidências mais recentes alicerçadas na visão colaborativa entre as sociedades. Este primeiro artigo versará sobre as definições mais atuais, formas de tratamento e as orientações após a crise no perioperatório. No próximo artigo serão discutidos os principais agentes causais e a condução da investigação com testes apropriados.

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The nomenclature proposed in the October 2003 report of the Nomenclature Review Committee of the World Allergy Organization is an update of the European Academy of Allergology and Clinical Immunology Revised Nomenclature for Allergy Position Statement published in 2001. The nomenclature can be used independently of target organ or patient age group and is based on the mechanisms that initiate and mediate allergic reactions. It is assumed that as knowledge about basic causes and mechanisms improves, the nomenclature will need further review.

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Vitamin D Is Required for ILC3 Derived IL-22 and Protection From Citrobacter rodentium Infection

Yang-Ding Lin, Juhi Arora, Kevin Diehl … (2019)

Citrobacter rodentium is a gastrointestinal infection that requires early IL-22 from group 3 innate lymphoid cells (ILC3) for resistance. The role of vitamin D in the clearance of C. rodentium infection was tested in vitamin D sufficient (D+) and vitamin D deficient (D-) wildtype (WT) and Cyp27B1 (Cyp) KO mice (unable to produce the high affinity vitamin D ligand 1,25(OH)2D, 1,25D). Feeding Cyp KO mice D- diets reduced vitamin D levels and prevented synthesis of 1,25D. D- (WT and Cyp KO) mice had fewer ILC3 cells and less IL-22 than D+ mice. D- Cyp KO mice developed a severe infection that resulted in the lethality of the mice by d14 post-infection. T and B cell deficient D- Rag KO mice also developed a severe and lethal infection with C. rodentium compared to D+ Rag KO mice. D- WT mice survived the infection but took significantly longer to clear the C. rodentium infection than D+ WT or D+ Cyp KO mice. Treating infected D- Cyp KO mice with IL-22 protected the mice from lethality. Treating the D- WT mice with 1,25D reconstituted the ILC3 cells in the colon and protected the mice from C. rodentium. IL-22 treatment of D- WT mice eliminated the need for vitamin D to clear the C. rodentium infection. Vitamin D is required for early IL-22 production from ILC3 cells and protection from enteric infection with C. rodentium.

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K. Brockow, N. Franklin Adkinson, D Khan … (2014)

When drug reactions resembling allergy occur, they are called drug hypersensitivity reactions (DHRs) before showing the evidence of either drug-specific antibodies or T cells. DHRs may be allergic or nonallergic in nature, with drug allergies being immunologically mediated DHRs. These reactions are typically unpredictable. They can be life-threatening, may require or prolong hospitalization, and may necessitate changes in subsequent therapy. Both underdiagnosis (due to under-reporting) and overdiagnosis (due to an overuse of the term ‘allergy’) are common. A definitive diagnosis of such reactions is required in order to institute adequate treatment options and proper preventive measures. Misclassification based solely on the DHR history without further testing may affect treatment options, result in adverse consequences, and lead to the use of more-expensive or less-effective drugs, in contrast to patients who had undergone a complete drug allergy workup. Several guidelines and/or consensus documents on general or specific drug class-induced DHRs are available to support the medical decision process. The use of standardized systematic approaches for the diagnosis and management of DHRs carries the potential to improve outcomes and should thus be disseminated and implemented. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the World Allergy Organization (WAO), has decided to issue an International CONsensus (ICON) on drug allergy. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences and deficiencies of evidence, thus providing a comprehensive reference document for the diagnosis and management of DHRs.

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Author and article information

Contributors

Liana Maria Tôrres de Araújo Azi

Journal

Journal ID (nlm-ta): Braz J Anesthesiol

Journal ID (iso-abbrev): Braz J Anesthesiol

Title: Brazilian Journal of Anesthesiology

Publisher: Elsevier

ISSN (Print): 0104-0014

ISSN (Electronic): 2352-2291

Publication date PMC-release: 09 September 2020

Publication date Collection: Sep-Oct 2020

Publication date (Electronic): 09 September 2020

Volume: 70

Issue: 5

Pages: 534-548

Affiliations

[a ]Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, SC, Brazil

[b ]Sociedade Brasileira de Anestesiologia, Rio de Janeiro, Brazil

[c ]Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil

[d ]Associação Brasileira de Alergia e Imunologia, Brazil

[e ]Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil

[f ]Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil

[g ]Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil

[h ]Hospital Infantil Pequeno Príncipe, Curitiba, PR, Brazil

[i ]Universidade Federal do Rio de Janeiro, Hospital Universitário Gaffrée e Guinle, Rio de Janeiro, RJ, Brazil

[j ]Hospital Infantil Sabará, São Paulo, SP, Brazil

[k ]Instituto Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil

[l ]Hospital Geral de Fortaleza (HGF), Departamento de Anestesia, Fortaleza, CE, Brazil

[m ]Universidade Federal do Espírito Santo, Vitória, ES, Brazil

[n ]Hospital Nipo-Brasileiro, São Paulo, SP, Brazil

Author notes

[* ]Corresponding author. liana.araujo@ 123456ufba.br

Article

Publisher Item ID: S0104-0014(20)30150-0

DOI: 10.1016/j.bjane.2020.09.001

PMC ID: 9373446

PubMed ID: 33077175

SO-VID: bcadddfe-9ee5-42fb-b9cb-836d61481d20

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Most cited references 122

Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003.

Vitamin D Is Required for ILC3 Derived IL-22 and Protection From Citrobacter rodentium Infection

International Consensus on drug allergy.

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