Key Takeaways
- Cases of anaphylaxis have risen by 33%
- Anaphylaxis is especially dangerous in perioperative settings where sterile drapes hide visible skin reactions, and sedated patients cannot report their symptoms
- Chlorhexidine has emerged as an increasingly frequent trigger
The Shocking Truth
Anaphylactic shock — a rare but life-threatening allergic reaction — is becoming a growing concern in health care. Triggered when the immune system overreacts to substances like medications, it can occur through touch, inhalation, ingestion, or injection. The condition is especially dangerous in the perioperative setting where sterile drapes can hide visible skin reactions, and sedated or anesthetized patients are unable to report symptoms.
Cases of anaphylactic shock in ambulatory settings increased by 14% between 2021 and 2022.
Being Triggered
Chlorhexidine, an antiseptic used in surgical prep and catheter coatings, has emerged as an increasingly frequent trigger. Despite its widespread use, anesthesiologists only suspect it in 28% of cases. The use of neuromuscular blocking agents (NMBAs), rocuronium and succinylcholine, also contribute to rising cases. Antibiotics such as penicillin and amoxicillin are well-documented triggers of anaphylaxis; however, potential triggers span a broad spectrum, including insect venom, nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, opioids, vaccines, and various foods.
What Hospitals Can Do
As anaphylaxis prevalence climbs, the need for vigilance is high. Every health care professional, regardless of specialty, must be equipped to recognize and act on the earliest signs of anaphylaxis. Epinephrine remains the gold standard for treatment, but emerging therapies like Omalizumab and allergen-specific immunotherapy offer hope for the future. Like everything in patient safety, reducing harm requires systemic approach (practices, policies, and technologies) and careful, multidisciplinary case reviews of adverse drug events.
Is your hospital ready to respond effectively to an anaphylactic event? Ensure your clinical staff are prepared to:
- Recognize signs and symptoms early
- Stop ongoing infusions immediately to prevent further exposure to the triggering substance
- Provide oxygen as needed (nasal cannula or mask)
- Preserve airway patency through proper patient positioning
- Activate rapid response teams without delay
- Administer medications according to prescribed protocols
Proactive training can save lives!
Questions or comments about this article should be directed to Kamali Jones, safety & reliability clinical advisor, at kjones@hqinstitute.org
