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Not medical advice. Possible anaphylaxis: use epinephrine and call 911.Read the full note

Epitope Health teaches what published research and FDA labels say, and how strong that evidence is. It cannot know your situation, and nothing here is a diagnosis, a dose for one person, or a decision about whether a food, medicine or procedure suits one person. Those decisions belong with a licensed clinician who can examine you.

If a reaction is happening now, use epinephrine if it has been prescribed and call 911. After surgery, trouble breathing or chest pain needs 911. If you are thinking about harming yourself, call or text 988, any time.

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For clinicians

Allergic reactions during anesthesia: what causes them and what to tell your team

How often anaphylaxis happens during surgery, the usual culprits, and why food allergies and propofol come up.

3 minute read, written for clinicians7 sources, each checked word for wordLibrary checked October 18, 2026

A first aid kit, a stethoscope and blister packs of tablets on a blue surface

This is the clinician view. It keeps every sentence of the plain guide and adds, for each section, the study design and citations of its sources. Every added sentence is cited and checked like the rest. Back to plain language.

In short

  • Anaphylaxis during anesthesia is rare, about 1 in 10,000 anesthetics in the UK national audit.E2Good1
  • The most common culprits were antibiotics and muscle relaxants, followed by chlorhexidine and blue dye.E2Good1
  • Investigating a reaction afterward is complicated by the many drugs given at once.E2Good2

How sure each claim is:E1StrongE2GoodOfficial textReviewWhat the grades meanUnderlined words open a definition

How often, and what causes it?

The UK Sixth National Audit Project estimated life-threatening allergic reactions at about 1 in 10,000 anesthetics.E2Good1

Of 199 identified culprits, 94 were antibiotics, 65 muscle relaxants (neuromuscular blocking agents), 18 chlorhexidine (a skin antiseptic) and 9 Patent Blue dye.E2Good1

The audit received no reports of anaphylaxis caused by local anesthetics or latex.E2Good1

Reactions to muscle relaxants and antibiotics began quickly, while reactions to chlorhexidine and blue dye were delayed.E2Good1

An 8-year national survey in France found muscle relaxants (58%), latex (20%) and antibiotics (13%) the most common causes. It found more reactions than earlier estimates.E2Good3

The evidence in this section (2 sources)
SourceDesignGradeCitations (NIH iCite)
1 Harper NJN, Br J Anaesth, 2018Observational studyE2Good326 (RCR 20.84)
3 Mertes PM, J Allergy Clin Immunol, 2011Observational studyE2Good276 (RCR 11.62)

What the drug labels say

The rocuronium label warns that severe, sometimes fatal, anaphylactic reactions to neuromuscular blocking agents have been reported.Official text4

The sugammadex label reports serious hypersensitivity reactions, including anaphylaxis.Official text5

The propofol label lists a history of anaphylaxis to eggs, egg products, soybeans or soy products among its contraindications.Official text6

A food allergy, a past reaction during a procedure, or alpha-gal syndrome belongs on the list for the anesthesia team.

Alpha-gal syndrome can involve reactions to gelatin and to medications sourced from non-primate mammals.Review7

The evidence in this section (4 sources)
SourceDesignGradeCitations (NIH iCite)
4 Fresenius Kabi USA, LLC, 2026FDA labelOfficial textNot tracked
5 Merck Sharp & Dohme LLC, 2026FDA labelOfficial textNot tracked
6 Fresenius Kabi USA, LLC, 2025FDA labelOfficial textNot tracked
7 Wilson JM, Allergy, 2024Expert reviewReview49 (RCR 10.19)

After a reaction

A European position paper notes that reactions during surgery are rare. It explains why working out the cause is hard. Many drugs are given at once, the drugs have strong effects, and many other conditions can look like an allergic reaction.E2Good2

It gives recommendations for investigating these reactions, to help clinicians plan and carry out testing.E2Good2

The evidence in this section (1 source)
SourceDesignGradeCitations (NIH iCite)
2 Garvey LH, Allergy, 2019Consensus statementE2Good192 (RCR 13.21)

Questions you might bring to your anesthesia team

  1. I have had a reaction during a past procedure: has it been investigated, and should it be before this surgery?
  2. I have egg, soy or other food allergies, or alpha-gal syndrome: how does that change the plan?
  3. Which antibiotic and skin antiseptic will be used?

Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, a practicing nurse anesthesiologist (CRNA), is pending. This line changes when the review is done.

Sources

Each source opens on PubMed, DailyMed or the publisher's page. Under each one are the exact words from it that this page relies on, copied word for word and checked against the original.

  1. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Harper NJN, Br J Anaesth, 2018. E2Good Observational studyPMID 29935567; DOI 10.1016/j.bja.2018.04.014; cited 326 times, relative citation ratio 20.84 (NIH iCite, 2026-10-18)
    The words this page rests on
    The estimated incidence was ≈1:10 000 anaesthetics.
    The distribution of 199 identified culprit agents included antibiotics (94), neuromuscular blocking agents (65), chlorhexidine (18), and Patent Blue dye (9).
    There were no reports of local anaesthetic or latex-induced anaphylaxis.
    Onset was rapid for neuromuscular blocking agents and antibiotics, but delayed with chlorhexidine and Patent Blue dye.
  2. An EAACI position paper on the investigation of perioperative immediate hypersensitivity reactions. Garvey LH, Allergy, 2019. E2Good Consensus statementPMID 30964555; DOI 10.1111/all.13820; cited 192 times, relative citation ratio 13.21 (NIH iCite, 2026-10-18)
    The words this page rests on
    Perioperative immediate hypersensitivity reactions are rare. Subsequent allergy investigation is complicated by multiple simultaneous drug exposures, the use of drugs with potent effects and the many differential diagnoses to hypersensitivity in the perioperative setting.
    The aims of this position paper were to provide recommendations for the investigation of immediate-type perioperative hypersensitivity reactions and to provide practical information that can assist clinicians in planning and carrying out investigations.
  3. Anaphylaxis during anesthesia in France: an 8-year national survey. Mertes PM, J Allergy Clin Immunol, 2011. E2Good Observational studyPMID 21497888; DOI 10.1016/j.jaci.2011.03.003; cited 276 times, relative citation ratio 11.62 (NIH iCite, 2026-10-18)
    The words this page rests on
    The most common causes were neuromuscular blocking agents ([NMBAs]; n = 1067; 58.08%), latex (n = 361; 19.65%), and antibiotics (n = 236; 12.85%).
    The incidence of allergic reactions during anesthesia, estimated on a national basis, is higher than previously estimated.
  4. Rocuronium Bromide Injection, Prescribing Information. Fresenius Kabi USA, LLC, 2026. Official text FDA label
    The words this page rests on
    Severe anaphylactic reactions to neuromuscular blocking agents, including Rocuronium Bromide Injection, have been reported. These reactions have, in some cases (including cases with Rocuronium Bromide Injection), been life threatening and fatal.
  5. BRIDION (sugammadex) injection, Prescribing Information. Merck Sharp & Dohme LLC, 2026. Official text FDA label
    The words this page rests on
    Potentially serious hypersensitivity reactions, including anaphylaxis, have occurred in patients treated with BRIDION.
  6. DIPRIVAN (propofol) injectable emulsion, Prescribing Information. Fresenius Kabi USA, LLC, 2025. Official text FDA label
    The words this page rests on
    DIPRIVAN is contraindicated in patients with a known hypersensitivity to propofol or any of DIPRIVAN components. DIPRIVAN is contraindicated in patients with a history of anaphylaxis to eggs, egg products, soybeans or soy products.
  7. Tick bites, IgE to galactose-alpha-1,3-galactose and urticarial or anaphylactic reactions to mammalian meat: The alpha-gal syndrome. Wilson JM, Allergy, 2024. Review Expert reviewPMID 38193233; DOI 10.1111/all.16003; cited 49 times, relative citation ratio 10.19 (NIH iCite, 2026-10-16)
    The words this page rests on
    The syndrome, mediated by IgE antibodies against the oligosaccharide galactose-alpha-1,3-galactose (alpha-gal), can also involve reactions to visceral organs, dairy, gelatin and other products, including medications sourced from non-primate mammals.