Drug challenge testing: a critical step in the investigation of neuromuscular blocking agent hypersensitivity.

Littlejohns, A.; Hopkins, PM.; Savic, S.; Mistry, A.; Savic, L.

Drug challenge testing: a critical step in the investigation of neuromuscular blocking agent hypersensitivity.

All Authors

Littlejohns, A.

Hopkins, PM.

Savic, S.

Mistry, A.

Savic, L.

LTHT Author

Littlejohns, Anna
Hopkins, Philip
Savic, Louise

LTHT Department

Theatres & Anaesthetics
Anaesthetics

Publication Date

2025

Item Type

Editorial

Abstract

Neuromuscular blocking agents are a common cause of perioperative hypersensitivity. The sensitivity and specificity of skin tests and in vitro tests in this context have not been determined conclusively, which poses a barrier to accurate diagnosis. Use of challenge testing represents a promising development in this field and a key tool in confirming tolerance to an alternate neuromuscular blocking agent for use in future anaesthesia. However, its use is currently limited to specialised centres, and a standardised approach to testing has not yet been established. This article summarises the role of challenge testing to neuromuscular blocking agents and highlights the advantages and disadvantages of the different approaches.