Editor—Although rare, perioperative anaphylaxis can lead to severe cardiorespiratory dysfunction or death. Numerous agents have been identified as triggers: the most common being neuromuscular blocking drugs, latex, and antibiotics. In contrast, sedatives, local anaesthetics, and opioids rarely cause anaphylaxis. The incidence of perioperative anaphy- laxis ranges from 1:5000 to 1:25 000 and its mortality rate is 3.4%. Clinical signs are often hard to recognize because they may be masked by the effect of administered drugs. After a reaction, a clear description of the presenting clinical symptoms together with a thorough case history, in vivo tests (histamine releasing and serum tryptase tests), in vitro tests (specific IgE assay, basophil activation assay, and detection of CD63 expression in the presence of the allergen), skin tests (prick skin test, intradermal test), and drug provocation test are useful in determining the correct diagnosis.
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