SHM Converge Scientific Abstract ePoster Gallery-Peri-Operative Anaphylaxis and Cold-Induced Urticaria

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This case report describes a 17-year-old girl who developed peri-operative anaphylactic shock during planned L4-L5 discectomy. Shortly after receiving multiple anesthetic agents and cefazolin, and after intubation and proning, she developed hypotension and facial edema. She required epinephrine, antihistamines, fluids, steroids, and PICU care. Her serum tryptase was markedly elevated, confirming anaphylaxis.<br /><br />Initially, the cause was unclear. Her history was notable for cold-triggered hives and sneezing from cold showers and cold foods, raising concern for cold-induced urticaria as a possible contributor, especially because the operating room and IV fluids may have been cold. She had no prior drug allergies.<br /><br />At follow-up, allergy testing was performed after the appropriate waiting period. Ice-cube testing for cold urticaria and skin prick testing to several anesthetic drugs were negative, and ampicillin IgE was normal. The reaction was ultimately considered most likely due to cefazolin, a common cause of peri-operative anaphylaxis. She was advised to avoid beta-lactam antibiotics until evaluation was complete and, for future surgery, to use a non-beta-lactam antibiotic, maintain a neutral operating room temperature, and warm all IV fluids and medications.<br /><br />Eight weeks later, she underwent repeat surgery successfully with these precautions. She received gentamicin and vancomycin for prophylaxis, was kept normothermic with active warming, and tolerated the procedure without complications.<br /><br />The authors emphasize that peri-operative anaphylaxis is most often caused by antibiotics such as cefazolin, but cold-induced urticaria should also be considered when there is a history of cold-triggered symptoms. A complete allergy workup after 4–6 weeks is important to identify the cause and guide safe future procedures.

Asset Subtitle

Gauri Misra

Meta Tag

Author List Anna Nowak-Wegrzyn, Gauri Misra, Jason Hu

Category Clinical Vignettes

Concept Anaphylactic Shock

Concept Cefazolin

Concept Neuromuscular Blocking Agent

Concept Cold-Induced Urticaria

Concept Tryptase

Distinguished Non-Finalist

Presenter Organization Nyu

Presenting Author Gauri Misra

Track Pediatric

Keywords

peri-operative anaphylaxis

cefazolin

cold-induced urticaria

anaphylactic shock

anesthetic allergy

serum tryptase

skin prick testing

beta-lactam antibiotics

normothermia

allergy workup

Anaphylactic Shock

Cefazolin

Neuromuscular Blocking Agent

Cold-Induced Urticaria

Tryptase