Diagnosis of Immediate Perioperative Hypersensitivity Reactions and the Role of Drug Provocation Testing

Keywords:

Allergy, anaphylaxis, perioperative hypersensitivity, POH, diagnosis, drug provocation testing, drug challenge, review


Published online: Mar 18 2026

https://doi.org/10.56126/77.1.07

Vlaeminck N.1, Saldien V.1, Sabato V.2,3, Ebo D. G.2,3

1 University of Antwerp, Faculty of Medicine and Health Sciences, Department of Anaesthesiology, and Antwerp University Hospital, Antwerp, Belgium
2 University of Antwerp, Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Antwerp,Belgium
3 Department of Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium

Abstract

Perioperative hypersensitivity (POH) constitutes an unpredictable but significant risk during anesthesia with an estimated incidence of 1:5.000 to 1:10.000 and an estimated mortality of 3.4-3.8%. Accurate diagnosis is crucial to prevent re-exposures to the causative agent and to clear other drugs for use in future procedures. In this narrative review we summarize recommendations for the treating anesthesiologist and review established diagnostic investigations. Finally, we examine the rationale for implementing drug provocation tests as the final investigation.

ActaAnaesthBelg-77-1-cover

About this issue

Volume 77, issue 1.

Mar 2026.

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