Allergic reactions occurring during the immediate perioperative period are most commonly attributable to which class of drugs?

Allergic reactions occurring during the immediate perioperative period are most commonly attributable to which class of drugs?

• A. Muscle relaxants
• B. Local anesthetics
• C. Antibiotics
• D. Opioids

Answer: (A)

Immediate perioperative allergic reactions are most often caused by the neuromuscular blocking agents used to facilitate intubation. These muscle relaxants, such as succinylcholine and the nondepolarizing agents, frequently trigger IgE-mediated hypersensitivity or non–IgE-mediated mast cell degranulation via quaternary ammonium ions. The rapid onset during induction and the routine, repeated exposure to these drugs in many patients help explain why they’re the leading culprits. While antibiotics, local anesthetics, and opioids can cause reactions, true immediate perioperative anaphylaxis is less commonly due to them compared with muscle relaxants.

Immediate perioperative allergic reactions are most often caused by the neuromuscular blocking agents used to facilitate intubation. These muscle relaxants, such as succinylcholine and the nondepolarizing agents, frequently trigger IgE-mediated hypersensitivity or non–IgE-mediated mast cell degranulation via quaternary ammonium ions. The rapid onset during induction and the routine, repeated exposure to these drugs in many patients help explain why they’re the leading culprits. While antibiotics, local anesthetics, and opioids can cause reactions, true immediate perioperative anaphylaxis is less commonly due to them compared with muscle relaxants.