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Prick‐test evaluation to anaesthetics in patients attending a general allergy clinic

Background and objectives: To analyse the prevalence of positive prick‐tests to all medicaments normally checked in allergy units when a patient is suspected of being allergic to anaesthetics. To establish the degree of agreement between the antecedents of a previous history of an allergic reaction to a medicament and the positive result, or not, to the specific prick‐test for the said medicament. Methods: This was a prospective study, during 2003 and 2004, which analysed 473 patients referred by their doctors to allergy units to make retrospective diagnoses of an allergy to a drug. The prick‐test was done using the undiluted drug. All patients were tested for 41 drugs. These include antibiotics, trimethoprim–sulphamethoxazole, non‐steroidal anti‐inflammatory drugs (NSAIDs) and perioperative drugs (PD): neuromuscular blocking drugs, latex, iodine, local anaesthetics, hypnotics, opioids and coadjuvants. Cohen's Kappa Index was used to determine the degree of agreement. Results: 71.5% of patients studied presented a positive prick‐test. The largest number of positive cases was found in antibiotics (56.4%), followed by PD (15.6%), NSAIDs (14.4%) and trimethoprim–sulphamethoxazole (12.7%). Among PD, the highest prevalence of positive prick‐tests was found for neuromuscular blocking drugs (5.3%). Agreement between the substance suspected of causing the allergic reaction and the positive prick‐test was excellent for penicillin (Kappa = 0.74) and other antibiotics (Kappa = 0.721) and good for NSAIDs (Kappa = 0.47) and iodine (Kappa = 0.54). Conclusions: The prevalence of patients with positive prick‐tests to PD occurred in 15.6% in this prospective cohort. Neuromuscular blocking drugs were found to have the highest prevalence of positive prick‐tests. There is positive agreement when the substance responsible for the allergic reaction is suspected, otherwise agreement is low.