Atropine


Atropine is a widely used premedication drug for the prevention of vagal bradycardia and especially in strabismus surgery.
 
Incidence
Uncommon for anaphylactic shock.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: erythematous rashes (face, neck, chest).
 
Diagnostic methods
Cutaneous testing.
 
Intradermal skin-tests at 1/100 are positive in a few cases.
 
Specific IgE has not been detected.
 
The Prausnitz-Küstner test is positive in a few cases.
 
Mechanisms
Positive results of skin tests and Prausnitz-Küstner test suggest an IgE-mediated mechanism.
 
Management
Avoidance.
 
Strabismus surgery may be performed with hyoscine or glycopyrronium after skin tests.

References

  1. Moyano P, Ribas M, Ricos M, Giralt P, Gancedo V.A, "Anestesia en dos casos de alergia a la atropina en la cirurgia del estrabismo", Rev. Esp. Anestesiol. Reanim., 1997; 44 (7): 290-1.
  2. Aguilera L, Martinez-Bourio R, Cid C., Arino J.J, Saez de Eguilaz J.L, Arizaga A, "Anaphylactic reaction after atropine", Anaesthesia., 1988; 43 (11):
    955-7.
  3. Dundee J.W, Mirakhur R.K, "Hypersensitivity to atropine", Br. J. Anaesthesia, 1978; 50: 866.

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.