{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T09:14:23Z","timestamp":1774516463878,"version":"3.50.1"},"reference-count":7,"publisher":"Oceanside Publications Inc.","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["allergy asthma proc"],"published-print":{"date-parts":[[2021,5,1]]},"abstract":"<jats:p>Identifying the culprit medication in cases of perioperative anaphylaxis can be extremely challenging. A detailed and accurate history, coupled with the appropriate testing, plays a key role in discovering the etiology of perioperative anaphylaxis. We present the case of a 48-year-old\n woman with a cranial meningioma who was scheduled for surgery. Chlorhexidine, midazolam, lidocaine, propofol, fentanyl, rocuronium, and furosemide were administered during the perioperative period. She developed hypotension, urticaria, bronchospasm, and other symptoms of anaphylaxis soon after\n general anesthesia. The serum tryptase level obtained during anaphylaxis was 119 ng\/mL (normal, &lt;11.4 ng\/mL). Epinephrine was administered, and the surgery was canceled, with no cause identified. For the next surgical attempt, she was pretreated with diphenhydramine and ranitidine, and\n the neuromuscular blocker was withheld. Again, she developed hypotension consistent with anaphylaxis, and epinephrine was administered. She was referred for consultation. A detailed and accurate history was obtained. The baseline serum tryptase level was 6.4 ng\/mL. Skin-prick puncture tests\n were completed, and a diagnosis was made. The surgical team was instructed to avoid the culprit medication, and the cranial surgery was successful. Although difficult, cases of perioperative anaphylaxis can be solved with a detailed history, keen detective work, and appropriate testing.<\/jats:p>","DOI":"10.2500\/aap.2021.42.200060","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T01:06:00Z","timestamp":1616461560000},"page":"257-259","source":"Crossref","is-referenced-by-count":10,"title":["A 48-year-old female with perioperative anaphylaxis"],"prefix":"10.2500","volume":"42","author":[{"given":"Nicholas C.","family":"Kolinsky","sequence":"first","affiliation":[{"name":"From the Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard F.","family":"Lockey","sequence":"additional","affiliation":[{"name":"University of South Florida Morsani College of Medicine, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1355","reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12948-018-0094-7","article-title":"Focus on the agents most frequently responsible for perioperative anaphylaxis","volume":"16","author":"Di Leo","year":"2018","journal-title":"Clin Mol Allergy"},{"key":"B2","doi-asserted-by":"crossref","first-page":"152","DOI":"10.4103\/0970-9185.155140","article-title":"Perioperative chlorhexidine allergy: Is it serious?","volume":"31","author":"Abdallah","year":"2015","journal-title":"J Anesthesiol Clin Pharmacol"},{"key":"B3","first-page":"5930","article-title":"Life-threatening anaphylactic shock due to chlorhexidine on the central venous catheter: a case series","volume":"7","author":"Weng","year":"2014","journal-title":"Int J Clin Exp Med"},{"key":"B4","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1111\/all.12466","article-title":"Standardized testing with chlorhexidine in perioperative allergy - a large single-center evaluation","volume":"69","author":"Opstrup","year":"2014","journal-title":"Allergy"},{"key":"B5","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1016\/j.lpm.2016.02.024","article-title":"Epidemiology of perioperative anaphylaxis","volume":"45","author":"Mertes","year":"2016","journal-title":"Presse Med"},{"key":"B6","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.bja.2018.04.014","article-title":"Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6)","volume":"121","author":"Harper","year":"2018","journal-title":"Br J Anaesth"},{"key":"B7","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/cod.12298","article-title":"Chlorhexidine in cosmetic products \u2013 a market survey","volume":"72","author":"Opstrup","year":"2015","journal-title":"Contact Dermatitis"}],"container-title":["Allergy and Asthma Proceedings"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ingentaconnect.com\/content\/ocean\/aap\/2021\/00000042\/00000003\/art00018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T09:24:56Z","timestamp":1621502696000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ingentaconnect.com\/content\/10.2500\/aap.2021.42.200060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":7,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,5,1]]}},"alternative-id":["1088-5412(20210501)42:3L.257;1-"],"URL":"https:\/\/doi.org\/10.2500\/aap.2021.42.200060","relation":{},"ISSN":["1088-5412"],"issn-type":[{"value":"1088-5412","type":"print"}],"subject":[],"published":{"date-parts":[[2021,5,1]]}}}