Dennis Ledford, MD: The Importance of Recognizing Anaphylaxis

Dennis Ledford, MD

Dennis Ledford, MD: The Importance of Recognizing Anaphylaxis

As medical knowledge continues to grow, Dennis Ledford, MD, explains the importance of doctors in different fields collaborating.

Anaphylaxis is considered a life-threatening problem that could result in death following surgery.

In what was supposed to be presented during the American Academy of Allergy, Asthma & Immunology (AAAAI) 2020 Annual Meeting in Philadelphia, PA, Dennis K. Ledford, MD, University of South Florida College of Medicine and Division of Allergy and Immunology, explained in an interview with HCPLive® the importance of surgeons recognizing the threat of anaphylaxis.

HCPLive: What were you supposed to present during AAAAI?

Ledford: It was to increase awareness of the problem of anaphylaxis around anesthesia or surgery because it's not terribly common, but surgery is a common process.

It's not that unusual that doctors are going to encounter this and often it is not recognized because the circumstances of surgery often involve anesthesia that makes people have abnormal physical findings or vital signs.

And it can be misinterpreted where low blood pressure, for example, is due to the anesthesia and not an anaphylactic reaction.

We're not anesthesiologists or surgeons, we’re allergists, we'd be called to evaluate a patient after the fact, and this is sort of to provide some context for how to interrupt or evaluate some adverse events that occurred in or around surgery with one of the possibilities being an allergic reaction to something occurred during anesthesia or the preparation for the anesthesia or the surgery itself.

HCPLive: How do you educate surgeons and doctors in other fields to identify some of these issues ahead of time?

Ledford: I don't think there's a problem, anesthesiologists are very adept at handling acute changes of vital signs. And they're going to treat the patient perfectly. I don't think that's the concern.

It's really the issue is what do I do for future surgery? Was this a reaction or not to something that was done? Do I need to change? Does the anesthesiologist or surgeon need to change what to do the next time?

These are the questions that are relevant. The care during the acute event is not something that we need to be discussing. Anesthesiologists are very capable of doing that on their own.

The approach to the reaction or the symptoms of a reaction are the same, almost irrespective of what caused it. And so, the response is not going to be modified.

And the timeliness cannot be affected by a consultant who can't see the patient who immediately needs to be treated within minutes and not hours, so it's not like we can make people available to consult with the surgeon or anesthesiologist to help them with the acute event.

HCPLive: How important is collaboration in this field?

Ledford: It’s imperative we all collaborate because no one can know everything. It's just not feasible that you're going to be knowledgeable in all areas.

The only thing you can do is to interact with people who have different perspectives or knowledge bases to try to give the best care possible. I agree that there has to be collaboration that's not new.

The difference is just the magnitude or growth of what's available now and what's known makes it more of an issue that may have been 50 years ago when the amount of knowledge is less.

From our specialty, the issue is a patient comes to us who had a reaction to something or an event during surgery, what should I now do? To answer the question, and that's sort of what the focus of this workshop was, it wasn't to encourage doctors to cooperate with anesthesiologists, but it was to help enable them to know what questions to ask and what they do.

HCPLive: Are there any new drugs in the pipeline that has you excited?

Ledford: There's always new drugs and always new possibilities. So, I think things ebb and flow with what's being used and what's not being used.

I mean, latex allergy was really big problem 30 years ago, but now it's almost you don't see it because people have become aware of it and most facilities don't use latex, they use alternative materials. We hardly see it anymore.

There is a new agent to reverse paralysis after being having anesthesia and people can react to it.. So, it's relatively new people don't know about it, and it can cause problems. And that's part of the educational process to keep consultants aware.

There's nothing new in the pipeline if you were as far as therapeutics or new diagnostics that are going to change the situation.

HCPLive: How has COVID-19 impacted patients in your space?

Ledford: I see patients with asthma, so I guess it's impactful because they just come in with respiratory exacerbations and have shortness of breath, which is a manifestation of the coronavirus.

People have been having that forever as asthma is not new and viral infections are not new. It then becomes challenging when someone presents with symptoms because patients are thinking could I have coronavirus. At the same time, I can’t say they couldn’t.