Expert: Ronald Levy, M.D. - 3/4/2010

Question
Hello - I am scheduled for a mastectomy which, needless to say, involves GA. I am concerned about a severe allergic reaction because I have a history of anaphylactic shock in reaction to various foods (mostly 10-15 years ago...), a more distant history of a simpler allergic reaction to certain antibiotics (pennicillin (sp?), sulfadrugs), and, most concerning, I had some sort of issue during labor/delivery (when they gave the epidural, I believe), for which they administered epinepherine.

I don't want to be alarmist, but I am concerned about this. How do I best handle this? Do we just find out via the surgery if this is going to be a problem? Is there any way to test in advance? Should the anasthesiologist take some special precautions?

Please advise...I appreciate your help..

Answer
First of all let me deal with the labor/delivery issue. The epinephrine was not an allergic reaction. In fact, epinephrine is the drug we give to treat an anaphylactic reaction. It is naturally produced in the body and causes increased heart rate and blood pressure. You may know it as adrenaline. The food allergies are also not related. The antibiotics could be real and it would be helpful to know the specific one but if not, there are several antibiotics we can give that you are unlikely to be allergic to.

So to answer your question, in one respect, the best place to have an allergic reaction is in the operating room because we have all the drugs etc we need to treat it readily handy. You are not being an alarmist and you most certainly should tell your anesthesiologist about the allergies you've had. There is no way to test in advance and the only precautions we take is to not give you what we know causes allergies and to be that much more vigilant if we notice a change in vital signs that it might be allergic in nature.

Good luck,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston