Supplementary Material for: Perioperative Hypersensitivity Reactions: An Analysis of Affected Patients, Responsible Agents, and Conducted Diagnostics at a Tertiary Allergology University Center in Switzerland

Introduction: Perioperative hypersensitivity reactions (POH) are rare occurrences, but they can lead to life-threatening complications. The culprits for POH vary between countries. In about 25% of the cases, the causative agent of POH remains unknown.
Objective: Data on POH and its causes in Switzerland are sparse. The aim of this study was to address this gap and provide insights into POH in Switzerland.
Methods: In this retrospective monocentric study, we analyzed data from 106 patients referred for POH evaluation to a tertiary Allergology University Center in Switzerland. We analyzed data about clinical characteristics, culprit drugs, and performed diagnostic tests (specific IgEs, basophil activation tests, skin tests, provocation tests).
Results: The majority of POH patients were female (56.6%, n=60). Allergic comorbidities were frequently present (68.9%, n=73), a previous episode of POH was reported in 16.0% (n=17).
A trigger was diagnostically confirmed or strongly suspected in 76.4% (n=81) of the cases. The most common confirmed or suspected triggers were neuromuscular blocking agents (NMBA) and antibiotics (predominantly cephalosporins), each accounting for 26.5% (n=27) of the reactions. This was followed by antiseptics (9.8%, n=10) and opioids (9.8%, n=10). Latex accounted for less than three percent of the reactions.
For the confirmed triggers, identification primarily relied on positive skin test results (73.0%, n=46), although different tests sometimes yielded varying results.
Conclusions: In Switzerland, antibiotics (mostly cephalosporins), and NMBA are among the most common triggers of POH. By combining skin tests and in vitro diagnostics, culprit drugs of POH could be identified in more than 75.0% of the cases.

引言：围手术期超敏反应（Perioperative Hypersensitivity Reactions, POH）虽属罕见事件，但可引发危及生命的并发症。该反应的致病诱因存在国别差异，约25%的病例中，其致病原仍未明确。
研究目的：目前瑞士地区关于围手术期超敏反应及其致病诱因的相关数据较为匮乏。本研究旨在填补这一研究空白，深入剖析瑞士境内的围手术期超敏反应情况。
研究方法：本研究为回顾性单中心研究，纳入了瑞士某高校附属三级变态反应学中心接收的106例因围手术期超敏反应接受评估的患者。研究人员对患者的临床特征、可疑致病药物相关数据进行分析，并开展了多项诊断检测，包括特异性IgE检测、嗜碱性粒细胞活化试验、皮肤试验及激发试验。
研究结果：本研究纳入的围手术期超敏反应患者中，女性占比最高（56.6%，n=60）。多数患者合并过敏性疾病（68.9%，n=73），16.0%的患者既往曾出现围手术期超敏反应发作（n=17）。
76.4%的病例可经诊断确认或高度怀疑致病诱因（n=81）。最常见的确诊/疑似诱因为神经肌肉阻滞剂（Neuromuscular Blocking Agents, NMBA）与抗生素（以头孢菌素类为主），两类诱因各占总反应事件的26.5%（n=27）。随后依次为消毒剂（9.8%，n=10）与阿片类药物（9.8%，n=10），乳胶引发的反应占比不足3%。
对于已确认的致病诱因，其识别主要依赖皮肤试验结果呈阳性（占比73.0%，n=46），不过不同检测方法有时会得出不一致的结果。
研究结论：在瑞士境内，抗生素（以头孢菌素类为主）与神经肌肉阻滞剂是围手术期超敏反应最为常见的两大诱因。通过联合皮肤试验与体外诊断检测，可在超过75.0%的病例中明确围手术期超敏反应的致病药物。