Allergy to neuromuscular blocking agents in children

Neuromuscular blocking agents are the agents most frequently involved in peri-operative anaphylaxis, being more important than other drugs or latex; the incidence of these reactions is reported to be 1/6500 operations under anaesthesia. Suxamethonium and rocuronium are muscle relaxants with the highest risk of anaphylaxis. Their divalent ammonium quaternary ionic molecular structure of curate favours allergic sensitisation. The symptoms of anaphylaxis due to muscle relaxants are usually severe. Risk factors are a previous sensitisation and the female sex. The diagnosis of an allergic reaction is made with blood tests (plasma tryptase and histamine levels and specific IgE antibody assays) and skin prick and intradermal tests. The results of these tests must always be considered along with the clinical history, even if a coherent clinical history is not obtained. The recommendations for a subsequent anaesthesia in a child allergic to a curate relaxant should be based on the results of the skin tests, including those obtained with cross-reacting agents. All curate relaxants eliciting a positive skin test should be avoided. (C) 2003 Editions scientifiques et medicales Elsevier SAS. Tous droits reserves.