Anaphylaxis following remimazolam administration during induction of anaesthesia

Editor—Anaphylaxis is a severe, life-threatening generalised hypersensitivity reaction that occurs rapidly following contact with a trigger. 1 Muraro A. Roberts G. Worm M. et al. Anaphylaxis: guidelines from the European academy of allergy and clinical immunology. Allergy. 2014; 69: 1026-1045 Crossref PubMed Scopus (759) Google Scholar ,2 Cardona V. Ansotegui I.J. Ebisawa M. et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020; 13100472 Abstract Full Text Full Text PDF Scopus (289) Google Scholar Although the incidence of anaphylaxis during general anaesthesia ranges from 1:10 000 to 1:20 000, 3 Laxenaire M.C. Mertes P.M. Anaphylaxis during anaesthesia. Results of a two-year survey in France. Br J Anaesth. 2001; 87: 549-558 Abstract Full Text Full Text PDF PubMed Scopus (312) Google Scholar ,4 Mertes P.M. Malinovsky J.M. Jouffroy L. et al. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011; 21: 442-453 PubMed Google Scholar it is often fatal, with a reported mortality rate of 3–9%. 4 Mertes P.M. Malinovsky J.M. Jouffroy L. et al. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011; 21: 442-453 PubMed Google Scholar Remimazolam, a novel ultra-short-acting benzodiazepine, has recently been licenced as a sedative or general anaesthetic. Its efficacy and safety have been demonstrated in various clinical fields, whereas associated anaphylaxis has rarely been reported. 5 Tsurumi K. Takahashi S. Hiramoto Y. Nagumo K. Takazawa T. Kamiyama Y. Remimazolam anaphylaxis during anesthesia induction. J Anesth. 2021; 35: 571-575 Crossref PubMed Scopus (12) Google Scholar ,6 Uchida S. Takekawa D. Kitayama M. Hirota K. Two cases of circulatory collapse due to suspected remimazolam anaphylaxis. JA Clin Rep. 2022; 8: 18 Crossref PubMed Scopus (4) Google Scholar