LAILA SABINO GARRO
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conferenceObject Perioperative Anaphylaxis: Clinical Features of 51 Patients(2012) GARRO, L. S.; RODRIGUES, A. T.; RIBEIRO, M. R.; AUN, M. V.; KALIL, J.; MOTTA, A. A.; GIAVINA-BIANCHI, P.Rationale: Perioperative anaphylaxis is an important and life-threatening adverse reaction in clinical practice. We aimed to evaluate the prevalence and the etiology of perioperative anaphylaxis referred to an outpatient clinic specialized in adverse drug reactions (ADRs). Methods: We evaluated 806 patients with history of ADRs through the questionnaire “European Network for Drug Allergy” (ENDA) from October 2006 to June 2011. Patients with a history of perioperative anaphylaxis were selected. The diagnostic criteria for anaphylaxis were based on the World Allergy Organization Guidelines. Etiological investigation was made with skin tests for latex, neuromuscular blockers (NMBs), antibiotics, hypnotics, opioids and local anesthetics. Drug provocation tests (DPTs) for antibiotics, NSAIDs, local anesthetics and latex were also performed. Serum specific IgE was tested for antibiotics (Penicillin, Ampicillin and Amoxicillin) and latex. Results: We identified 51 (6%) patients with a history of perioperative anaphylaxis. Among them, 16 patients (31%) had hypersensitivity reactions with positive cutaneous test, 14 patients (27%) abandoned the investigation and 8 patients (16%) completed the investigation with all tests being negative. Currently 12 patients (23%) are still under investigation. The main cause of perioperative anaphylaxis was latex allergy (22%), followed by NMBs hypersensitivity (6%). Three patients had positive tests for two different agents. Conclusions: Latex allergy was the main cause of perioperative anaphylaxis in this study. The importance of testing all the possible agents involved was demonstrated by the occurrence of three cases with positive test for two agents.conferenceObject Incidence of Intraoperative Anaphylaxis in A University General Hospital in Brazil(2013) GARRO, Laila Sabino; CARMONA, Maria Jose Carvalho; SOARES, Iracy Silvia Correa; AUN, Marcelo Vivolo; RIBEIRO, Marisa Rosimeire; RODRIGUES, Adriana Teixeira; KALIL, Jorge; GIAVINA-BIANCHI, Pedro; MOTTA, Antonio AbilioRATIONALE: The epidemiology of intraoperative anaphylaxis is un-known in Brazil. We aimed to evaluate the incidence and clinical features of anaphylaxis during anesthesia in a University General Hospital in Sao Paulo, Brazil. METHODS: A cross-sectional, observational study analyzing data fromvoluntary notification sent by anesthesiologists, about occurrence of intraoperative anaphylaxis during the period between January and December 2010. The diagnostic criteria for anaphylaxis were based onthe World Allergy Organization Guidelines. We analyzed the incidence of intraoperative anaphylaxis, clinical features, severity of anaphylaxis, types of surgical procedures, classification of anesthetic risk (American Society of Anesthesiologists - ASA), culprit agent cited by the anesthesiologist and type of treatment provided. RESULTS: The incidence of intraoperative anaphylaxis was 69:10.000 surgeries. The mean age of patients with anaphylaxis was 36.7 years-old and 57% were women. The most common procedures associated with anaphylaxis were the abdominal non-vascular (17.1%) and urologic (17.1%) surgeries. Skin symptoms were the most prevalent (85.7%) and all patients who presented cardiovascular shock were classified as ASA II (42.9%) or ASA III (57.1%). Epinephrine was used preferentially in anaphylaxis grade 3 (72.7%), while a few patients with anaphylaxis grades 1 and 2 took the drug (2.1% and 16.7, respectively). The most commonly etiologic drugs cited by the anesthesiologists were the neuromuscular blocking agents (22.9%). CONCLUSIONS: Our incidence of intraoperative anaphylaxis was higher than in other studies reported in the literature. These data are a warning signal to encourage measures to reduce the incidence of these severe reactions.conferenceObject Is Severity Of Drug Induced Anaphylaxis Dependent Of Its Etiology?(2012) AUN, M. V.; RODRIGUES, A. T.; RIBEIRO, M. R.; GARRO, L. S.; KALIL, J.; MOTTA, A. A.; GIAVINA-BIANCHI, P.Rationale: Adverse drug reactions (ADR) are common in clinical practice. Drug induced anaphylaxis is severe and responsible for most of deaths due to ADRs, although its prevalence is unknown. We describe a sample of drug induced anaphylaxis and analyze their etiology, severity and the use of epinephrine. Methods: Retrospective cohort of patients with history of ADRs who had answered a standardized questionnaire. We included patients with a diagnosis of anaphylaxis through international diagnostic criteria. We evaluated gender and age variables, the causative agent, clinical features, frequency of anaphylactic shock and the use of epinephrine in the treatment. Results: We evaluated 806 patients, of whom 122 (15.1%) met the criteria of anaphylaxis. The average age was 38.9 years and 81.9% were female. The probable etiology was defined in 88 patients (72.1%), and nonsteroidal anti-inflammatory drugs (NSAIDs) were involved in 67%, followed by latex, local anaesthetics and antibiotics. Epinephrine was used in 33.6% of reactions. There has been hypotension and/or shock in 31.1%. Anaphylactic shock accounted for 60% of latex anaphylaxis, 50% of those due to antibiotics and 22.4% of NSAIDs induced anaphylaxis. Conclusions: The number of drug induced anaphylaxis is high, although the diagnosis of anaphylaxis is neglected and epinephrine is underutilized. NSAIDs were the drugs most commonly implicated, but antibiotics were not as involved as previously described. Latex was an important agent in perioperative anaphylaxis. Cases of anaphylactic shock were associated to IgE-mediated hypersensitivity mechanism, as we observed in latex and antibiotics allergies.