Perioperative anaphylaxis due to intravenous tranexamic acid following cutaneous exposure

Tranexamic acid (TXA) is widely used to prevent surgical bleeding; further, it has been recently applied in cosmetic dermatology. TXA-induced anaphylaxis is very rare; however, most reported cases occur upon initial administration. This case report describes a 41-year-old man with atopic dermatitis who developed TXA-induced anaphylaxis during induction of general anesthesia for spinal surgery. Intradermal testing using TXA yielded reproducible positive reactions, while other tested drugs yielded negative results. His medical history revealed repeated episodes of dermatitis 1 year prior after applying a topical skin-lightening cream containing TXA. This suggested that prior percutaneous exposure may have contributed to sensitization. Our findings suggest a possible relationship between prior topical exposure to TXA and perioperative anaphylaxis. Although TXA-induced anaphylaxis is extremely rare, the increasing use of TXA in both surgical and cosmetic contexts may increase opportunities for exposure. Therefore, clinicians should be aware of this potential risk.