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Management of Anaphylaxis in Dental Practice
Takashi GotoDDS, PhD
Article Category: Other
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
DOI: 10.2344/anpr-70-02-16
Page Range: 93 – 105

According to the World Allergy Organization (WAO) Anaphylaxis Guidance 2020, anaphylaxis is defined as “a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death.” 1 Severe anaphylaxis is characterized by potentially life-threatening compromise in the airway, breathing, and/or circulation. 1 Moreover, anaphylaxis may occur without typical skin features or cardiovascular shock being present. 1 The primary pathogenesis of anaphylaxis is an immediate immunoglobulin (Ig) E-mediated allergic

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Suspected Intraoperative Anaphylaxis to Gelatin Absorbable Hemostatic Sponge
Joonyoung JiDMD, MSc and
Edward J. BarrettDDS, MSc, DipPaed, FRCD(C)
Article Category: Other
Volume/Issue: Volume 62: Issue 1
Online Publication Date: Jan 01, 2015
DOI: 10.2344/0003-3006-62.1.22
Page Range: 22 – 24

Life-threatening anaphylactic reactions are rare events in anesthesia. It is estimated that the incidence of allergy under anesthesia is 1:6000 to 1:20,000 but is most likely underreported in the literature with suboptimal accuracy, completeness, and varying reporting protocols. 1 – 5 It is well known that muscle paralyzers are the most commonly implicated agent with anaphylaxis under general anesthesia. 6 However, the patient is exposed to a wide variety of anesthetic, surgical, and supportive agents in the operating theater. As such, not

A Case of Anaphylaxis in Which a Basophil Activation Test Was Used to Identify the Suspected Agent
Takashi GotoDDS, PhD,
Shintaro HayashiDDS,
Hiroko TsuganeDDS, PhD,
Mitsuo IinumaDDS, PhD, and
Satoru SakuraiDDS, PhD
Article Category: Brief Report
Volume/Issue: Volume 67: Issue 3
Online Publication Date: Sep 29, 2020
DOI: 10.2344/anpr-67-03-05
Page Range: 172 – 173

discharge of secretions from the previously placed orogastric tube) signs suggestive of an allergic reaction, although other cutaneous and oral signs, such as erythema, urticaria, and intraoral edema, were not observed. He was clinically diagnosed with anaphylaxis, intravenous boluses of epinephrine (initial dose 50 μg; subsequent doses 25 μg × 6 times; total dose 200 μg) were administered, and his vital signs then stabilized. Further dental treatment under general anesthesia was deferred at that time, and a subsequent blood test revealed elevated β-tryptase levels

Figure 3.; Changes in Blood Concentrations of Histamine and Tryptase After the Onset of Anaphylaxis When anaphylaxis occurs, mast cells and basophils release histamine and tryptase. To diagnose anaphylaxis, blood samples should be collected at 2 times: the onset of anaphylaxis and after 24 hours. Histamine and tryptase levels should be compared.
Takashi Goto
Figure 3.
Figure 3.

Changes in Blood Concentrations of Histamine and Tryptase After the Onset of Anaphylaxis

When anaphylaxis occurs, mast cells and basophils release histamine and tryptase. To diagnose anaphylaxis, blood samples should be collected at 2 times: the onset of anaphylaxis and after 24 hours. Histamine and tryptase levels should be compared.

Figure 2.; Management of Anaphylaxis in the Dental Office Anaphylaxis should be recognized at an early stage, epinephrine should be administered intramuscularly, and the patient should be transported immediately to a hospital. *Implement steps 3–5 promptly and simultaneously.1
Takashi Goto
Figure 2.
Figure 2.

Management of Anaphylaxis in the Dental Office

Anaphylaxis should be recognized at an early stage, epinephrine should be administered intramuscularly, and the patient should be transported immediately to a hospital.

*Implement steps 3–5 promptly and simultaneously.1

Figure 1.; Skin Involvement and Anaphylaxis (a) Skin findings developed after the oral administration of antibiotics and analgesics following the extraction of a third molar. (b) Skin findings on the face and ears immediately developed after the induction of general anesthesia. Lower left figure: At the onset of anaphylactic shock. Lower right figure: After treatment of anaphylactic shock.
Takashi Goto
Figure 1.
Figure 1.

Skin Involvement and Anaphylaxis

(a) Skin findings developed after the oral administration of antibiotics and analgesics following the extraction of a third molar. (b) Skin findings on the face and ears immediately developed after the induction of general anesthesia. Lower left figure: At the onset of anaphylactic shock. Lower right figure: After treatment of anaphylactic shock.

Two Cases of Rocuronium-Induced Anaphylaxis/Anaphylactic Shock Successfully Treated With Sugammadex
Mayumi HashimotoDDS,
Aiji Sato (Boku)DDS, PhD,
Naoko TachiDDS, PhD,
Yoko OkumuraDDS,
Kanenori KadoiDDS,
Jun HaradaMD, PhD, and
Masahiro OkudaMD, PhD
Article Category: Case Report
Volume/Issue: Volume 66: Issue 3
Online Publication Date: Jan 01, 2019
DOI: 10.2344/anpr-66-01-07
Page Range: 151 – 155

Anaphylactic shock, a severe complication during general anesthesia, is a rapidly occurring severe allergic reaction that may be fatal. Causative agents include drugs, foods, insects, latex, and even exercise. The incidence of allergic reactions due to drugs is 1% to 3% of exposures, but the frequency of anaphylaxis is much lower. 1 The frequency of anaphylaxis during general anesthesia has been reported to be between 1:5,000 and 20,000 cases. Muscle relaxants are the most common causative drugs during general anesthesia, and it is

Benzodiazepine Allergy With Anesthesia Administration: A Review of Current Literature
Elliot HaybargerDMD,
Andrew S. YoungDDS, and
Joseph A. Giovannitti JrDMD
Article Category: Research Article
Volume/Issue: Volume 63: Issue 3
Online Publication Date: Jan 01, 2016
DOI: 10.2344/16-00019.1
Page Range: 160 – 167

was considered to be the first true anaphylaxis to diazepam was published in the British Medical Journal. The mechanism was attributed to a common metabolite, desmethyldiazepam, the antigenic moiety for cross-allergenicity in benzodiazepines. 6 Years later, 1 report of diazepam allergy describes a case involving a healthy 28-year-old nurse with no significant past medical history or allergies presenting for gastroscopy. Here, a relatively brief and nonspecific case of hypersensitivity was reported including only that the patient showed signs of “generalized

Hypotension Without Skin Symptoms at Local Anesthesia in Dental Treatment: Anaphylaxis? Or Vasovagal Reaction?
Takuro SanukiDDS, PhD,
Naotaka KishimotoDDS, PhD,
Hidetaka KurodaDDS, PhD, and
Kanta KidoDDS, PhD
Article Category: Article Commentary
Volume/Issue: Volume 70: Issue 2
Online Publication Date: Jun 28, 2023
DOI: 10.2344/anpr-70-03-02
Page Range: 91 – 92

In 2020, the World Allergy Organization Anaphylaxis (WAOA) Guidance document was published that updated the definition of and amended the criteria for diagnosing anaphylaxis ( Table ). The WAOA definition now reads as follows: “Anaphylaxis is a serious systemic hypersensitivity reaction that is usually rapid in onset and may cause death. Severe anaphylaxis is characterized by potentially life-threatening compromise in airway, breathing and/or the circulation, and may occur without typical skin features or circulatory shock being present.” 1

Figure. ; Basophil activation test (BAT) results. Activated basophil counts for the negative control (2.8%), positive control (35.2%), flomoxef (2.2%), rocuronium (3.2%), and rubber dam sheet (54.7%) challenges. Stimulation of naïve basophils with the rubber dam sheet elicited a strong positive result (1-hour contact; sample concentration, 1/1250). Evaluation criteria for activated basophils were as follows: <6% negative, 6–10% false-positive, 10–15% weakly positive, 15–20% positive, and >20% strongly positive.
Takashi Goto,
Shintaro Hayashi,
Hiroko Tsugane,
Mitsuo Iinuma, and
Satoru Sakurai
Figure. 
Figure. 

Basophil activation test (BAT) results. Activated basophil counts for the negative control (2.8%), positive control (35.2%), flomoxef (2.2%), rocuronium (3.2%), and rubber dam sheet (54.7%) challenges. Stimulation of naïve basophils with the rubber dam sheet elicited a strong positive result (1-hour contact; sample concentration, 1/1250). Evaluation criteria for activated basophils were as follows: <6% negative, 6–10% false-positive, 10–15% weakly positive, 15–20% positive, and >20% strongly positive.