Paediatric perioperative hypersensitivity reactions: Analysis of the French GERAP network database.

BACKGROUND: Perioperative hypersensitivity (POH) reactions are rare but potentially life-threatening and remain poorly characterised in children. We analysed the largest available French paediatric cohort to describe the epidemiology, causal agents, temporal trends and phenotypes. METHODS: We pooled data from paediatric patients (<18 years) included in six previously published GERAP surveys (1997-2012) and the GERAP computerised database (2017-2024), all evaluated in centres of the GERAP network according to current guidelines. The primary objective was to compare POH phenotypes with and without causal agent identification. RESULTS: Of 4605 POH reactions recorded, 461 (10%) occurred in children (median age 14 [10-16] years; 47% female). Reactions were grade 1 in 50%, grade 2 in 23%, grade 3 in 26% and grade 4 in 1%. The causal agent was identified in 199 (43%) cases, mainly neuromuscular blocking agents (NMBAs) (31%), latex (30%) and antibiotics (16%). Identification was more frequent in anaphylaxis than in isolated cutaneous reactions (61% vs. 25%, p < .001). Latex-related reactions disappeared after 2017. Patients in whom a causal agent was identified had more severe reactions (grade 3-4: 46% vs. 13%; p < .001), more cardiovascular and respiratory involvement, and higher acute serum tryptase (median 16.0 vs. 4.0 μg/L; p < .001) than those without identification. CONCLUSIONS: Paediatric POH are not uncommon and may be life-threatening. All suspected reactions, including isolated cutaneous signs, warrant referral to specialised allergy centres given the still low identification rate and the continuing burden of NMBA- and antibiotic-related reactions.