The following is a summary of “Neuromuscular blocking agent re-exposure in a retrospective cohort with neuromuscular blocking agent–associated anaphylaxis,” published in the November 2023 issue of Allergy & Immunology by Jeong, et al.

Neuromuscular blocking drugs (NMBAs) are one of the main reasons why people get hypersensitivity during surgery. It’s not clear if skin test negativity can promise the safety of NMBAs that are given through the body’s circulatory system, but skin test positivity may help find reactive NMBAs. For a study, researchers sought to find out how safe other NMBAs are in real life by testing them on skin samples from people who might have anaphylaxis caused by NMBAs. Patients at National University Hospital who were thought to have had anaphylaxis caused by NMBA were gathered from June 2009 to May 2021, and their features and results were studied.

Out of the 282,707 people who got NMBAs, 47 (0.017%) were thought to have had allergies. In 95.7% of cases, cardiovascular symptoms were seen, while in 59.6% of cases, skin symptoms were seen. 83% had been under general anesthesia before, but 17% had never used NMBA. In skin tests, 94.6% of people were positive for any NMBA (81.1% for culprit NMBAs), and 75.7% were also positive for other NMBAs. This is because NMBAs have chemical structures that are similar to each other. For example, 85.3% of people were positive for rocuronium, and 0.814 were positive for vecuronium. This is compared to 50% positive for cisatracurium, 0.015 for succinylcholine, and 12.5% positive tests for succinylcholine. 

15 patients had surgery after an NMBA skin test came back negative. Eighty-one percent (12/15) of them survived the surgery without any problems, but thirty-three percent (3/15) had low blood pressure. The fact that NMBAs respond with each other in skin tests may be because their chemical structures are similar. The risk of recurring anaphylaxis has not been removed, even though skin tests for possible NMBA-induced anaphylaxis have a high success rate of coming back negative.

Source: sciencedirect.com/science/article/abs/pii/S1081120623004477