Objective: To identify culprit agents in patients evaluated for suspected perioperative hypersensitivity and to assess the safety of subsequent anesthetic procedures guided by allergological evaluation.

Materials and Methods: This retrospective observational study included 34 patients referred with suspected perioperative hypersensitivity. All patients underwent a standardized allergological work-up including skin prick tests, intradermal tests, and drug provocation tests when appropriate. Reaction severity was classified according to the Ring and Messmer scale. Patients were categorized as having a confirmed culprit or idiopathic reactions.

Results: Of the 34 patients, 23 were female (67.6%), and the mean age was 50.8 ± 14.9 years. Reactions most frequently occurred during the emergence phase (14/34, 41.2%), followed by the induction phase (13/34, 38.2%). Patients reacting during the emergence phase were significantly older (median 61 years) than those reacting during induction or maintenance (p=0.001). A culprit agent was identified in 13 patients (38.2%), and a total of 15 culprit agents were identified in this group; antiseptics were the most frequent (6/15, 40.0%), particularly chlorhexidine (5/15, 33.3%). A history of atopy was more frequent in the confirmed group (4/13, 30.8% vs. 0/21, 0%; p=0.015). All patients underwent subsequent surgery under an evaluation-guided anesthesia plan, and no immediate hypersensitivity reactions occurred at first re-exposure.

Conclusion: Antiseptics, especially chlorhexidine, were the most frequently identified cause of perioperative hypersensitivity in this cohort. Advanced age and delayed reaction onset may help guide suspicion toward cutaneous sensitizers. A standardized allergological evaluation is essential for ensuring safe future anesthetic exposure.