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Australian and New Zealand Anaesthetic Allergy Group Perioperative Anaphylaxis Investigation Guidelines

Nambour General Hospital, Nambour, Princess Alexandra Hospital, Brisbane, Queensland, The Tweed Hospital, Tweed Heads, Royal North Shore Hospital, Sydney, New South Wales, Flinders Medical Centre, Adelaide, South Australia, Auckland City Hospital, New Zealand. These guidelines are published on behalf of the Australian and New Zealand Anaesthetic Allergy Group with their permission and at their request. No peer review of the guidelines has been undertaken by Anaesthesia and Intensive Care.

No editorial correction or styling has been undertaken.

Summary

These guidelines are a consensus document developed by a working party of the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) to provide an approach to the investigation of perioperative anaphylaxis. They focus primarily on the use of skin testing as it is the investigation with the greatest clinical utility for the identification of the likely causative agent and potentially safer alternatives. The practicalities and process of skin testing, its limitations, and the place of other tests are discussed. These guidelines also address the roles of graded challenge and in vitro testing. The implications of anaphylaxis associated with neuromuscular blocking agents, beta-lactam antibiotics, local anaesthetic agents and chlorhexidine are discussed. Evidence for the recommendations is derived from literature searches using the words skin test, allergy, anaphylaxis, anaesthesia, and each of the individual agents listed in these guidelines. The individual articles were then reviewed for suitability for inclusion in these guidelines. Where evidence was not strong, as is the situation for many perioperative agents, expert consensus from the ANZAAG working party was used. These guidelines are intended for use by specialists involved in the investigation of perioperative allergy. They have been approved following peer review by members of ANZAAG and are available on the ANZAAG website: http://www.anzaag.com/anaphylaxis-management/testing-guidelines.pdf.

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