Allergy and anaphylaxis during anaesthesia in children

Allergy and anaphylaxis during anaesthesia in children play a significant role with respect to anaesthesia-related morbidity and mortality. Natural latex is a major trigger, and especially children with congenital malformations can aquire a latex hypersensitivity in the first years of life. Other major trigger substances are muscle relaxants, which play a significant role in adults. The rapid recognition of anaphylaxis is crucial with respect to prognosis and can be difficult in the perioperative context. Clinical symptoms such as skin reactions, bronchospasm and circulatory dysregulation are variable in children under general anaesthesia and may also occur isolated. First line therapy consists of forced fluid resuscitation and administration of epinephrine. After an allergic episode, a specific allergy testing should be performed by an allergist. Precaution measures must be taken to avoid any antigen contact, e.g. by implementating a protocol for latexfree environment.