Anaphylaxis: intradermal testing may help diagnose drug-induced episodes

Clinical bottom line (level 4)

  1. Patients with positive intradermal skin tests were more likely to have had an episode of drug-induced anaphylaxis.
Fisher : Anaesthesia and Intensive Care 1981; 9: 235-241
Expires November 2004

The study

Setting: acute hospital, Australia

165 patients (aged ?, ?% male) undergoing anaesthesia

Non-independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • drug sole agent used during anaesthesia, positive passive transfer tests, or subsequent anaesthesia using drugs with negative intradermal tests
Diagnostic test: intradermal testing

The evidence


diagnostic test drug-induced anaphylaxis no anaphylaxis LR+
(95% CI)		 LR-
(95% CI)
intradermal testing 81 1 22
(3.2 to 150) 		0.24
(0.17 to 0.35)
total 106 29

Comments

  1. The patients were preselected - the majority had a life-threatening reaction during anaesthesia within the previous 9 years, but some were referred for pre-operative assessment and others had minor skin reactions.
  2. A weak and biased reference standard makes these results much less certain.

Citation

  1. Fisher MM, : the diagnosis of acute anaphylactoid reactions to anaesthetic drugs. Anaesthesia and Intensive Care 1981; 9: 235-241
Contributor: Mike Bennett & Chris Ball, November 1999
Reviewer: Malcolm Daniel

Clinical Question.
Patient patients undergoing anaesthesia
Intervention or Exposure positive intradermal skin tests
Outcome anaphylaxis