Is it safe to do skin tests with neuromuscular blocking agents (paralyzing agents) in outpatient setting in allergy clinic?

Adverse drug reactions affect up to 10% of people. When drug reactions resembling allergy happen, they are called drug hypersensitivity reactions (DHRs). Drug hypersensitivity reactions may be allergic or nonallergic. Drug allergies are drug hypersensitivity reactions caused by the immune system.

Is it safe to do skin tests with neuromuscular blocking agents (paralyzing agents) in outpatient setting in allergy clinic?

The evidence from multiple studies appears to show that skin tests with neuromuscular blocking agents (NMBAs, paralyzing agents) can be done safely in outpatient setting in allergy clinics.

A randomized trial included 111 healthy volunteers, in two centers specializing in France. Exclusion criteria were general anesthesia in the past; atopic diseases such as hay fever, childhood asthma, and atopic dermatitis; a history of hypersensitivity reactions; and known or suspected recent use of steroids, antidepressants, neuroleptics, or antihistamines.

The participants were randomly assigned to receive two NMBAs each. Negative and positive controls and five intradermal injections in increasing concentrations were administered on the forearms and on the back. Each subject received 28 injections.

Safety

There were three cases of pruritus after injection of one of the control or test substances. In one subject, this occurred after injection of histamine on the back. Two subjects had pruritus after injection of the highest concentration of atracurium. In one subject, this occurred both on the forearm and on the back. All of these events were mild to moderate and were self-limiting.



Drug allergy management in 5 steps (click to enlarge the image).



Classification of adverse drug reactions (ADR) (click to enlarge the image).

References

https://www.ncbi.nlm.nih.gov/pubmed/15041585
https://www.ncbi.nlm.nih.gov/pubmed/21375539
http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2043034
http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1930957
http://www.adr-ac.ch/_m/cms_page_media/66/spoerl_Rocuronium%20allergy-short.pdf
https://pdfs.semanticscholar.org/8bb4/70ed2ac867420f257e7c0123b035ad3628d8.pdf

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