The incidences of allergy to general anesthetics ranges between 1/350 in IRAQ. The incidence of peranesthetic allergic reactions estimated in 2006 in IRAQ was 1/9000, all drugs confounded, and the incidence of allergic reactions to NMBA was evaluated to be 1/6500 anesthesia. Allergic reactions can be benign or fatal in some cases (6%).¹

The problem of the development of adverse reactions as a result of the use of diagnostic and medicinal products in medicine is becoming increasingly relevant.² So, according to different authors, such reactions are observed in 10-30% of the population; in 3% of cases, they are the reason for visiting doctors, in 5% - the cause of hospitalization, in 3% - the cause of intensive care, in 12% - they lead to an increase Significant in patients' length of stay in the hospital, and in 1% of patients overall can be the cause of death.³

The frequency of true drug allergy (LA) only in the population ranges from 1 to 2%, which may Annually lead to 100- 2000 deaths from drug anaphylactic shock.⁴ Among subjects treated frequently and for a long time, LA is already observed in 15% of cases.⁵ Also, the clinical manifestations of LA interfere or interfere with the professional activities of medical personnel, incl. 17% of junior nurses, 30-45% of intermediate and senior nurses, and 6-30% of physicians of various specialties. ^6-13

According to the World Health Organization, (2004) the mortality rate in drug therapy ranks fifth in the world after cardiovascular diseases, oncology, lung diseases, and injuries and is 0.1%, while in surgical interventions, it is ten times lower (0.01%).¹⁴ 

This paper aims to knowing the Prevalence of patients allergic to general anaesthesia.

Patient Sample

A cross-sectional study was conducted on patients in different hospitals in Iraq, where 40 patients were collected, and the study was devoted to knowing the Prevalence of patients allergic to general anaesthesia.

Study Design

Design of the study was systematic by conducting a survey of the Prevalence of allergic to general anaesthesia, in which 20 patients were collected by relying on the electronic record in the hospital, and the inclusion criteria were positive history of patients such as allergic rhinitis and asthma and patients with Antihistamines. In addition, pregnant women and patients under 18 years of age were excluded.

To diagnose hypersensitivity to this group of drugs, it is recommended to use a skin test, in particular, an intradermal test and a prick test with different concentrations of muscle relaxants.

LA during anesthesia often occurs in the form of anaphylactic shock, bronchospasm or laryngospasm, and skin manifestations; the diagnosis is rather complicated and requires a thorough examination of the immunosensitivity of patients; this problem with anesthesia is associated with great difficulties since during anesthesia, the patient is under medical anesthesia and muscle relaxation, which greatly complicates the assessment of the clinical course of LA during surgery. And by evaluating the clinical symptoms through which the allergy was diagnosed in relation to other medicines.

A positive dosage of the IgE specific to antibiotics was also used to confirm the diagnosis. However, a negative result didn't eliminate the diagnosis knowing the low sensibility of the IgE.

Through cooperation with the relevant committees for the purpose of obtaining the required approvals for collecting patient data.

Statistical Analysis

Statistical analysis was carried out based on the SPSS IBM SOFT 25 program and Microsoft Excel 2013, where the statistical differences between groups of patients were calculated; in addition to that, the value and prevalence were calculated.

Table 1: Distribution of patients according  to age

Table 2: Results of patients according to prick test

Table 3: Prevalence of allergy to patients

 Table 4: Outcomes result of allergy with prick test

Table 5: Relative risk

Table 6: Mean and SD of Age of patients

Twenty patients were collected from the hospital, where a cross-sectional study was conducted on patients. In Table 1, in which patients are distributed in consideration of age, we find between 25 years to 50 years, and through the statistical analysis, SPSS IBM SOFT mean value and SD were for age 33±6.1, as shown in the table below. The percentage of male patients was more than females, and the patients were distributed according to gender (males 12 patients with 60% 4% and females eight patients with 40%) as shown in Figure 1.

Positive results of the prick test It showed a high percentage of Meperidine for six patients, and positive results were distributed according to gender: 3 male patients and three female patients, and Morphine for four patients, according to sex (3 male patients and one female patient) as shown in table 7.

Table 7: Distribution of Prick test according to sex

The most common allergens associated with anesthesia were Meperidine, which was present in 9 patients, then Morphine in 5 patients, especially patients with asthma, and Vecuronium in 3 patients, especially those who were allergic to the following factors: Asthma, allergy, Atopy, NSAID and Propofol, Etomidate for 4 Patients.

An article published in the Singapore Medical Journal in 2008 mentioned that 65% of patients are actually allergic to the NMBA.¹⁵

This result matches the value found in other studies. This is best explained by the presence of quaternary ammonium common to all NMBA, which is responsible for this kind of allergy.

According to studies, hypersensitivity to non- anesthesia drugs cannot cause intraoperative anaphylaxis. But any life-threatening reaction during anesthesia administered early can be sensitive [Mertes, P.M et al., 2014].¹⁶

According to studies, risk factors for allergic hypersensitivity associated with anesthesia include the gender and age of the patient, the presence of a history of other types of allergies, and external factors [Demoly, P. et al., 2001; Johansson et al., 2005]. ^17,18

We conclude from this study that scientific studies of sensitivity to general anesthesia are very few, and NMBA is the most common in Iraq.

More than 50% of patients who reported anaphylactic reactions to neuromuscular blocking agents had not previously received these drugs. This means that IgE antibodies that the body makes as a result of contact with other compounds participate in the formation of such an allergic reaction.

1. Ebo DG, Fisher MM, Hagendorens MM, Bridts CH, Stevens WJ. Anaphylaxis during anaesthesia: diagnostic approach. Allergy. 2007;62(5):471-87. doi:10.1111/j.1398-9995.2007.01318.x.
2. Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Martell JA, Platts-Mills TA, Ring J, Thien F. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113(5):832-6. doi:10.1016/j.jaci.2003.12.591.
3. Savic LC, Kaura V, Yusaf M, Hammond-Jones AM, Jackson R, Howell S, Savic S, Hopkins PM. Incidence of suspected perioperative anaphylaxis: a multicenter snapshot study. J Allergy Clin Immunol Pract. 2015;3(3):454-5. doi:10.1016/j.jaip.2015.01.009.
4. Husby S. Dietary antigens: uptake and humoral immunity in man. APMIS Suppl. 1988;1:1-40. doi:10.1111/j.1600-0463.1988.tb05621.x.
5. Bischoff SC. Role of mast cells in allergic and non-allergic immune responses: comparison of human and murine data. Nat Rev Immunol. 2007;7(2):93-104. doi:10.1038/nri2018.
6. Abbas AK, Lichtman AH. Basic immunology: functions and disorders of the immune system. 3rd ed. Philadelphia: Elsevier Health Sciences; 2008.
7. Low AE, McEwan JC, Karanam S, North J, Kong KL. Anaesthesia-associated hypersensitivity reactions: seven years' data from a British bi-specialty clinic. Anaesthesia. 2016;71(1):76-84. doi:10.1111/anae.13220.
8. Kolawole H, Marshall SD, Crilly H, Kerridge R, Roessler P. Australian and New Zealand anaesthetic allergy group/Australian and New Zealand College of anaesthetists perioperative anaphylaxis management guidelines. Anaesth Intensive Care. 2017;45(2):151-8. doi:10.1177/0310057X1704500206.
9. Kroigaard M, Garvey LH, Gillberg L, Johansson SG, Mosbech H, Florvaag E, Harboe T, Eriksson LI, Dahlgren G, Seeman-Lodding H, Takala R. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol Scand. 2007;51(6):655-70. doi:10.1111/j.1399-6576.2007.01313.x.
10. Dybendal T, Guttormsen AB, Elsayed S, Askeland B, Harboe T, Florvaag E. Screening for mast cell tryptase and serum IgE antibodies in 18 patients with anaphylactic shock during general anaesthesia. Acta Anaesthesiol Scand. 2003;47(10):1211-8. doi:10.1046/j.1399-6576.2003.00238.x.
11. Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002;57(1):45-51. doi:10.1034/j.1398-9995.2002.1s7a10.x.
12. Mertes PM, Laxenaire MC, Lienhart A, Aberer W, Ring J, Pichler WJ, Demoly P. Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice. J Investig Allergol Clin Immunol. 2005;15(2):91-101. doi:10.1034/j.1398-9995.2002.1s7a10.x.
13. Tamayo E, Álvarez FJ, Castrodeza J, Yánez J, Arnaiz P, Lajo C, Soria S. Self-reported drug allergies and the diagnostic work-up in the surgical population. J Eval Clin Pract. 2010;16(5):902-4. doi:10.1111/j.1365-2753.2010.01487.x.
14. Gomes E, Cardoso MF, Praca F, Gomes L, Marino E, Demoly P. Self-reported drug allergy in a general adult Portuguese population. Clin Exp Allergy. 2004;34(10):1597-601. doi:10.1111/j.1365-2222.2004.02069.x.
15. MacPherson RD, Willcox C, Chow C, Wang A. Anaesthetist's responses to patients' self-reported drug allergies. Br J Anaesth. 2006;97(5):634-9. doi:10.1093/bja/ael222.
16. Mertes PM, Laxenaire MC, Lienhart A, Aberer W, Ring J, Pichler WJ, Demoly P; Working Group for the SFAR; ENDA; EAACI Interest Group on Drug Hypersensitivity. Reducing the risk of anaphylaxis during anaesthesia: guidelines for clinical practice. J Investig Allergol Clin Immunol. 2005;15(2):91-101. doi:10.1034/j.1398-9995.2002.1s7a10.x.
17. Demoly P, Bousquet J. Epidemiology of drug allergy. Curr Opin Allergy Clin Immunol. 2001;1(4):305-10. doi:10.1097/00130832-200108000-00012.
18. Johansson SG, Florvaag E, Öman H, Poulsen LK, Mertes PM, Harper NJ, Garvey LH, Gerth van Wijk R, Metso T, Irgens A, Dybendal T. National pholcodine consumption and prevalence of IgE-sensitization: a multicentre study. Allergy. 2010;65(4):498-502. doi:10.1111/j.1398-9995.2009.02234.x.