{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T10:16:06Z","timestamp":1780568166116,"version":"3.54.1"},"reference-count":62,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Perioperative anaphylaxis (PA) is a rare life\u2010threatening complication of anesthesia, with few descriptions of its diagnosis and outcomes in the pediatric population. Many agents can be potential culprits, and drug provocation testing (DPT) to confirm the diagnosis is limited by the nature of anesthetic drugs. PA diagnosis and culprit identification remain a challenge. For patients with limited drug options, desensitization has not been reported. This study evaluated the results of skin and laboratory testing for pediatric patients with PA and provides the protocol and outcome of the first desensitization to cisatracurium, a neuromuscular blocking agent (NMBA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients \u226418\u2009years old with PA from 2019 to 2024 were included, and medical records were retrospectively reviewed, which comprised serum tryptase levels, results of skin testing (ST), basophil activation testing (BAT), and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven patients were included. Tryptase was elevated in seven of 10 (70%) tested patients. ST yielded positive results for nine of 10 (90%), and two of 11 (18.2%) had positive BAT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A culprit agent was identified in 10 of 11 (91%). The most common drugs were NMBAs (70%) and beta\u2010lactam antibiotics (20%). One patient with a positive DPT to NMBAs and limited alternatives was successfully desensitized to cisatracurium with a 3\u2010bag, 12\u2010step protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The most common drug culprits of PA in children were NMBAs and were identified by ST. Tryptase correlated with PA. BAT served as adjunctive diagnostic tests. Desensitization to cisatracurium was possible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pai.70066","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T07:13:50Z","timestamp":1742714030000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Perioperative anaphylaxis in children and first successful cisatracurium desensitization"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1727-4847","authenticated-orcid":false,"given":"Sophie H. Y.","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Adolescent Medicine Queen Mary Hospital  Hong Kong Special Administrative Region China"},{"name":"Department of Paediatrics and Adolescent Medicine The University of Hong Kong  Hong Kong Special Administrative Region China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowena S. 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