Allergies under the spotlight at top medical conference

A panel discussion on perioperative allergy, featuring anaesthetists from across New Zealand and Australia who are involved in anaesthetic allergy investigation, is one of the highlights of the Australian and New Zealand College of Anaesthetists’ (ANZCA) Annual Scientific Meeting in Auckland.

Auckland City Hospital’s Dr Karen Pedersen is the clinical lead for the Auckland Anaesthetic Allergy Clinic and is one of the panellists. She says the risk of an allergic reaction is a common question that anaesthetists receive from patients – and the answer isn’t simple.

“It very much depends on what operation you’re having and what sort of drugs we’re going to give you. If you were having sedation for a colonoscopy and were having propofol as your sedation, the chances you will have an allergic reaction are very low.

“But if you’re having a big operation that requires a muscle relaxant drug – which then has to be reversed – and an antibiotic to be given, suddenly your overall risk of having an allergic reaction is much higher.”

While New Zealand and Australia are two of the safest countries in the world to have an anaesthetic, Dr Pedersen says researchers in both countries work together with colleagues internationally to keep up to date with risks posed by anaesthetic allergy.

“Every time a new drug comes out there’s a potential for that to be an allergy problem. We look at data from different parts of the world and that can be different from our own data, depending on what the local population is sensitised to.

“Thorough investigation after an allergic reaction has occurred during an anaesthetic is extremely important to identify the culprit drug and find low risk alternatives for safe anaesthetic care in the future.”

According to Dr Pedersen, while the health of the patient always takes priority, and anaesthetists are highly trained to ensure the patient’s safety, often the impacts of an allergic reaction go much wider than the original event.

“The patient is often significantly traumatised. We’ve had people who will not come to have investigations done and we never know what caused their reaction. They are so frightened by what happened to them that they won’t turn up to hospital again.

“The whole cost, to the health system, to the patient and to the medical staff as well, is significant. It’s one of those rare scenarios where you have inadvertently done something that results in patient harm.

“It’s not just the anaesthetist that is affected, but all the staff involved in managing a severe allergic reaction. You come to work for a day of routine cases in the operating theatre and end up doing CPR and transferring a patient to the intensive care unit.”

Dr Pedersen says allergy is often misunderstood by the public.

“We all come across patients who have a long list of things that they are ‘allergic’ to. Most of what people report as allergy is actually a side effect of the medication, such as nausea caused by the strong painkillers or a runny tummy caused by an antibiotic.

“One of the dangers is that the really important, potentially life-threatening, true allergies get lost in all the background noise.”

More than 1800 delegates are attending the meeting, which has attracted anaesthetists and specialist pain medicine physicians from Australia, New Zealand the US and the UK to discuss the latest advances in anaesthesia, pain medicine and perioperative care.