{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:45:06Z","timestamp":1788543906656,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Allergy"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Evaluation of perioperative hypersensitivity (POH) is challenging, and accurate screening tools are needed to optimize the diagnostic process. We aimed to assess and validate the diagnostic value of a published algorithm (using tryptase and clinical presentation) to identify appropriate individuals for further testing for IgE\u2010mediated POH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed the clinical presentation (tryptase elevation, cardiovascular, respiratory, skin involvement) of patients proceeding to testing for possible IgE\u2010mediated POH at a single tertiary referral centre, relative to subsequent skin testing and specific IgE results. Clinical presentations by drug class were also determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 293 consecutive patients, the use of a published algorithm based on one or more of; (i) defined increase in serum tryptase, (ii) involvement of at least two\u2010organ systems, or (iii) presentation with new urticaria and\/or angioedema; was highly sensitive [98.8% (CI95: 95.7\u201399.9%)] but less specific [34.6% (CI95: 25.7\u201344.4%)] in identifying patients testing positive on skin testing and\/or specific IgE. Presentation with cardiovascular symptoms was also sensitive [89.8%(CI95: 84.2\u201394.0%)], while the combination of respiratory symptoms and increased tryptase was most specific [85.9%(CI95:76.6\u201392.5%)]. Respiratory involvement was more common in neuromuscular blocking agent allergy, while urticaria\/angioedema was more common in antibiotic allergy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The published algorithm (of tryptase rise, two\u2010organ involvement or new urticaria\/angioedema) is highly sensitive, and appropriate as a screening tool to identify patients suitable for testing for IgE\u2010mediated POH.<\/jats:p><\/jats:sec>","DOI":"10.1111\/all.15526","type":"journal-article","created":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T14:43:26Z","timestamp":1663857806000},"page":"225-232","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Diagnostic value of a medical algorithm for investigation of perioperative hypersensitivity reactions"],"prefix":"10.1111","volume":"78","author":[{"given":"Asger","family":"Sverrild","sequence":"first","affiliation":[{"name":"Allergy, Asthma and Clinical Immunology Alfred Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Carruthers","sequence":"additional","affiliation":[{"name":"Anaesthesiology and Perioperative Medicine Alfred Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha Garuna","family":"Murthee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Singapore General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Moore","sequence":"additional","affiliation":[{"name":"Anaesthesiology and Perioperative Medicine Alfred Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3489-7595","authenticated-orcid":false,"given":"Robyn Elizabeth","family":"O'Hehir","sequence":"additional","affiliation":[{"name":"Allergy, Asthma and Clinical Immunology Alfred Health  Melbourne Victoria Australia"},{"name":"Department of Immunology and pathology, Central Clinical School Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Puy","sequence":"additional","affiliation":[{"name":"Department of Medicine, Central Clinical School Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7498-0000","authenticated-orcid":false,"given":"Mark","family":"Hew","sequence":"additional","affiliation":[{"name":"Allergy, Asthma and Clinical Immunology Alfred Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Zubrinich","sequence":"additional","affiliation":[{"name":"Allergy, Asthma and Clinical Immunology Alfred Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.13820"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.014"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lpm.2016.02.024"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2019.05.033"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.03.018"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.02.029"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.14226"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(77)91953-5"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1704500504"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2011.03.003"},{"key":"e_1_2_8_12_1","unstructured":"Diagnostic test evaluation calculator \u2010 MedCalc Software.https:\/\/www.medcalc.org\/calc\/diagnostic_test.php(accessed on 16.06.2022)."},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2021.03.050"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.13226"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000501079"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/nature14022"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aat1479"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12344"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.18176\/jiaci.0402"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.03.004"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2020.11.063"}],"container-title":["Allergy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/all.15526","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/all.15526","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/all.15526","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T10:57:28Z","timestamp":1692529048000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/all.15526"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,6]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1111\/all.15526"],"URL":"https:\/\/doi.org\/10.1111\/all.15526","archive":["Portico"],"relation":{},"ISSN":["0105-4538","1398-9995"],"issn-type":[{"value":"0105-4538","type":"print"},{"value":"1398-9995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,6]]},"assertion":[{"value":"2022-03-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}