Differences between perioperative/perianesthesia anaphylaxis and anaphylaxis in other settings

Manifestations of anaphylaxis	In other settings	In perioperative settings
Upper respiratory tract/laryngeal edema	Throat tightness, change in voice quality	Difficulty with intubation
Lower respiratory tract/bronchospasm	Shortness of breath, wheezing, repetitive cough	Increase in ventilatory pressure needed to inflate lungs
		Increase in end-tidal CO₂
		Decrease in arterial oxygen saturation
Cardiovascular system/hypotension	Dizziness, tunnel vision Collapse without warning signs uncommon	Cardiovascular collapse common (first detected manifestation in one-half of cases)
		Arrhythmias and cardiac arrest are more common
Skin	Flushing, itching, or urticaria (present in >90% of cases)	Cutaneous signs and symptoms may be absent or present but hidden by surgical drapes
		Patient cannot report itching

In the perioperative setting, patients are usually sedated or anesthetized and unable to report some of the milder and earlier signs of an allergic reaction. In addition, many exposures are intravenous. For these reasons, patients are more likely to present with cardiopulmonary symptoms, rather than cutaneous symptoms.

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Differences between perioperative/perianesthesia anaphylaxis and anaphylaxis in other settings