Publication Date

2-2026

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Abstract

Introduction: Perioperative anaphylaxis is a rare life-threatening event. Its evaluation poses complex considerations inherent to the use of multiple medications. Patient presentation: A healthy 11-year-old boy developed anaphylaxis shortly after discharge home from first lifetime surgery for orchiopexy. Perioperative medications included rocuronium, propofol, fentanyl, bupivacaine, sugammadex, ondansetron, dexamethasone, dexmedetomidine, and ketorolac. No antibiotics. After surgery, he consumed fast food dinner and ice cream. Within 2 hours after discharge home, he returned to our Emergency Department (ED) with facial and tongue angioedema, hives, and respiratory distress. He received multiple doses of intramuscular epinephrine and briefly required epinephrine drip in the ED. Tryptase was 3.9. He was admitted to the general pediatric service for 24-hour observation. Due to uncertain recall of general tree nut consumption, tree nut panel was obtained which was non-contributory. He had skin prick and intradermal (ID) testing to all suspected medications used intraoperatively except for ketorolac and dexmedetomidine. ID testing was positive for rocuronium, otherwise negative. Since his event, he tolerated ibuprofen, acetaminophen, methylprednisolone and ondansetron. Additionally, he passed in clinic challenge to oral ketorolac. Discussion: In perioperative anaphylaxis, the most common offending agents are antibiotics and neuromuscular blocking agents (NMBAs). With positive intradermal testing, rocuronium is the most suspected agent for this patient and will need to be avoided along with other NMBAs. Challenges to other medications with negative testing were recommended to be done in the operating room. Patient outcomes: This case highlights the importance of careful review of history and appropriate medication skin testing in evaluating perioperative anaphylaxis.

Disciplines

Allergy and Immunology | Pediatrics

Notes

Presented at 2026 American Academy of Allergy Asthma & Immunology (AAAAI) Meeting; Philadelphia, PA; February 27-March 2, 2026.

Perioperative anaphylaxis in a healthy adolescent after first lifetime surgery

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