Compounds that may be released in a reaction: histamine, heparin, prostaglandin D2 and other vasoactive substances
Recommendations for preventing a histamine release reaction:
(1) Do not administer histamine-releasing drugs in the peri-operative period.
(2) Do not administer drugs suspended in histamine-releasing solvents (such as polyoxylated castor oil).
(3) Administer H1 and H2 blocking agents (dimetindene, cimetidine, others).
(4) Consider administering a prostaglandin synthetase inhibitor.
(5) Avoid undue stress and sedate the patient.
(6) Administer drugs slowly.
(7) Have epinephrine and resuscitation equipment readily available.
(8) Carefully monitor the patient for early signs of a reaction (temperature, ECG, blood pressure).
(9) Avoid temperature extremes.
(10) Minimize rubbing and pressure on the skin.
If the histamine-releasing potential of a drug is uncertain, then consider intradermal skin testing to see if a local reaction can be elicited. This needs to be standardized as much as possible, with a positive reaction for an injected volume of 0.1 ml being a wheal that:
(1) appears within 10 minutes of injection
(2) lasts 30 minutes or longer
(3) measures at least 10 mm in diameter
Laboratory tests can be used to monitor serum and urine prior to surgery. Elevated levels may indicate a patient who may benefit from more aggressive monitoring and management.
(1) serum and urine histamine
(2) serum tryptase activity
(3) urinary prostaglandin D2
Additional risk factors to consider:
(1) previous history of a reaction during anesthesia
