{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:42:21Z","timestamp":1788691341649,"version":"build-2803163510"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T00:00:00Z","timestamp":1412121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,10,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>This is the first multi-centre retrospective survey from the United Kingdom to evaluate the aetiology and diagnostic performance of tryptase in anaphylaxis during general anaesthesia (GA). Data were collected retrospectively (2005\u201312) from 161 patients [mean \u00b1 standard deviation (s.d.), 50 \u00b1 15 years] referred to four regional UK centres. Receiver operating characteristic curves (ROC) were constructed to assess the utility of tryptase measurements in the diagnosis of immunoglobulin (Ig)E-mediated anaphylaxis and the performance of percentage change from baseline [percentage change (PC)] and absolute tryptase (AT) quantitation. An IgE-mediated cause was identified in 103 patients (64%); neuromuscular blocking agents (NMBA) constituted the leading cause (38%) followed by antibiotics (8%), patent blue dye (6%), chlorhexidine (5%) and other agents (7%). In contrast to previous reports, latex-induced anaphylaxis was rare (0\u00b76%). A non-IgE-mediated cause was attributed in 10 patients (6%) and no cause could be established in 48 cases (30%). Three serial tryptase measurements were available in 34% of patients and a ROC analysis of area under the curve (AUC) showed comparable performance for PC and AT. A \u2265 80% PPV for identifying an IgE-mediated anaphylaxis was achieved with a PC of &amp;gt;141% or an AT of &amp;gt;15\u00b77 mg\/l. NMBAs were the leading cause of anaphylaxis, followed by antibiotics, with latex allergy being uncommon. Chlorhexidine and patent blue dye are emerging important health-care-associated allergens that may lead to anaphylaxis. An elevated acute serum tryptase (PC &amp;gt;141%, AT &amp;gt;15\u00b77 mg\/l) is highly predictive of IgE-mediated anaphylaxis, and both methods of interpretation are comparable.<\/jats:p>","DOI":"10.1111\/cei.12424","type":"journal-article","created":{"date-parts":[[2014,7,29]],"date-time":"2014-07-29T07:25:15Z","timestamp":1406618715000},"page":"399-404","source":"Crossref","is-referenced-by-count":107,"title":["Multi-centre retrospective analysis of anaphylaxis during general anaesthesia in the United Kingdom: aetiology and diagnostic performance of acute serum tryptase"],"prefix":"10.1093","volume":"178","author":[{"given":"M T","family":"Krishna","sequence":"first","affiliation":[{"name":"Birmingham Heartlands Hospital, Birmingham, UK"},{"name":"Warwick Medical School, Warwick, UK"},{"name":"University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"York","sequence":"additional","affiliation":[{"name":"University Hospitals, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Chin","sequence":"additional","affiliation":[{"name":"University Hospital Southampton Foundation NHS Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Gnanakumaran","sequence":"additional","affiliation":[{"name":"Queens Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Heslegrave","sequence":"additional","affiliation":[{"name":"Birmingham Heartlands Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Derbridge","sequence":"additional","affiliation":[{"name":"Birmingham Heartlands Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Huissoon","sequence":"additional","affiliation":[{"name":"Birmingham Heartlands Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Diwakar","sequence":"additional","affiliation":[{"name":"Birmingham Heartlands Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Eren","sequence":"additional","affiliation":[{"name":"University Hospital Southampton Foundation NHS Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R J","family":"Crossman","sequence":"additional","affiliation":[{"name":"Warwick Medical School, Warwick, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Khan","sequence":"additional","affiliation":[{"name":"University Hospitals, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A P","family":"Williams","sequence":"additional","affiliation":[{"name":"University Hospital Southampton Foundation NHS Trust, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,10,1]]},"reference":[{"key":"2021122010092987100_cei12424-bib-0001","first-page":"263","article-title":"Anaphylaxis during anaesthesia: current aspects of diagnosis and prevention","volume":"11","author":"Fisher","year":"1994","journal-title":"Eur J Anaesthesiol"},{"key":"2021122010092987100_cei12424-bib-0002","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.annfar.2004.10.013","article-title":"Anaphylactic and anaphylactoid reactions occurring during anaesthesia in France. Seventh epidemiologic survey (January 2001\u2013December 2002)","volume":"23","author":"Mertes","year":"2004","journal-title":"Ann Fr Anesth Reanim"},{"key":"2021122010092987100_cei12424-bib-0003","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1097\/00000542-200309000-00007","article-title":"Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999\u20132000","volume":"99","author":"Mertes","year":"2003","journal-title":"Anesthesiology"},{"key":"2021122010092987100_cei12424-bib-0004","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/S0750-7658(00)88460-9","article-title":"Epidemiology of anaesthetic anaphylactoid reactions. Fourth multicenter survey (July 1994\u2013December 1996)","volume":"18","author":"Laxenaire","year":"1999","journal-title":"Ann Fr Anesth Reanim"},{"key":"2021122010092987100_cei12424-bib-0005","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1365-2222.2009.03404.x","article-title":"BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia","volume":"40","author":"Ewan","year":"2010","journal-title":"Clin Exp Allergy"},{"key":"2021122010092987100_cei12424-bib-0006","first-page":"91","article-title":"Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice","volume":"15","author":"Mertes","year":"2005","journal-title":"J Invest Allergol Clin Immunol"},{"key":"2021122010092987100_cei12424-bib-0007","first-page":"1","volume-title":"Suspected anaphylactic reactions associated with anaesthesia","author":"Association of Anaesthetists of Great Britain and Ireland (AAGBI)","year":"2003","edition":"3rd"},{"key":"2021122010092987100_cei12424-bib-0008","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1034\/j.1398-9995.2003.00280.x","article-title":"Diagnosis of immediate allergic reactions to beta-lactam antibiotics","volume":"58","author":"Torres","year":"2003","journal-title":"Allergy"},{"key":"2021122010092987100_cei12424-bib-0009","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.jaci.2011.01.038","article-title":"World Allergy Organization anaphylaxis guidelines: summary","volume":"127","author":"Simons","year":"2011","journal-title":"J Allergy Clin Immunol"},{"key":"2021122010092987100_cei12424-bib-0010","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/WOX.0b013e318211496c","article-title":"World Allergy Organization guidelines for the assessment and management of anaphylaxis","volume":"4","author":"Simons","year":"2011","journal-title":"World Allergy Organ J"},{"key":"2021122010092987100_cei12424-bib-0011","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/j.1399-6576.2007.01313.x","article-title":"Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia","volume":"51","author":"Kroigaard","year":"2007","journal-title":"Acta Anaesthesiol Scand"},{"key":"2021122010092987100_cei12424-bib-0012","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1093\/bja\/aei198","article-title":"Allergic reactions in anaesthesia: are suspected causes confirmed on subsequent testing?","volume":"95","author":"Kroigaard","year":"2005","journal-title":"Br J Anaesth"},{"key":"2021122010092987100_cei12424-bib-0013","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/bja\/aen324","article-title":"Anaphylaxis to the chlorhexidine component of Instillagel: a case series","volume":"102","author":"Parkes","year":"2009","journal-title":"Br J Anaesth"},{"key":"2021122010092987100_cei12424-bib-0014","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/j.1398-9995.2009.02248.x","article-title":"Anaphylaxis to patent blue V: a case series and proposed diagnostic protocol","volume":"65","author":"Haque","year":"2010","journal-title":"Allergy"},{"key":"2021122010092987100_cei12424-bib-0015","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.jaci.2008.04.040","article-title":"Anaphylaxis to dyes during the perioperative period: reports of 14 clinical cases","volume":"122","author":"Mertes","year":"2008","journal-title":"J Allergy Clin Immunol"},{"key":"2021122010092987100_cei12424-bib-0016","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1111\/j.1399-6576.2007.01489.x","article-title":"Systematic follow-up increases incidence of anaphylaxis during adverse reactions in anesthetized patients","volume":"52","author":"Malinovsky","year":"2008","journal-title":"Acta Anaesthesiol Scand"},{"key":"2021122010092987100_cei12424-bib-0017","doi-asserted-by":"crossref","first-page":"pAB143","DOI":"10.1016\/j.jaci.2010.12.567","article-title":"Mast cell carboxypeptidase as a confirmatory and predictive marker in allergic reactions to drugs","volume":"127","author":"Brown","year":"2011","journal-title":"J Allergy Clin Immunol"},{"key":"2021122010092987100_cei12424-bib-0018","doi-asserted-by":"crossref","first-page":"AB71","DOI":"10.1016\/j.jaci.2010.12.292","article-title":"Dipeptidyl peptidase I as a serum marker of allergic reactions to food","volume":"127","author":"Whitworth","year":"2011","journal-title":"J Allergy Clin Immunol"}],"container-title":["Clinical and Experimental Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcei.12424","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/cei\/article-pdf\/178\/2\/399\/41790959\/cei12424.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cei\/article-pdf\/178\/2\/399\/41790959\/cei12424.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T16:26:48Z","timestamp":1641054408000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cei\/article\/178\/2\/399\/6421289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10,1]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2014,10,1]]},"published-print":{"date-parts":[[2014,10,1]]}},"URL":"https:\/\/doi.org\/10.1111\/cei.12424","relation":{},"ISSN":["0009-9104","1365-2249"],"issn-type":[{"value":"0009-9104","type":"print"},{"value":"1365-2249","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2014,11]]},"published":{"date-parts":[[2014,10,1]]}}}