Perioperative anaphylaxis remains a leading cause of anaesthesiarelated morbidity. When skin testing is inconclusive, drug provocation testing (challenge) is often required to prove drug safety. Standard constantrate infusions can unintentionally deliver excess dose between the moment a reaction is biologically triggered and the moment it is recognised.
This randomised, doubleblind trial at Sir Charles Gairdner Hospital’s Perioperative Challenge Clinic tests whether IRIS—a nonlinear, exponentially increasing testdose delivered via a novel dualchamber syringe and infusion pump—reduces the total dose at reaction recognition versus constant infusion. Secondary outcomes include reaction severity, duration and feasibility of routine use. Target recruitment is n=40 over 24 months, with intentiontotreat analysis and DSMB oversight.
IRIS is a singleuse, fully-automated Australian device listed on the ARTG. It leverages the parallel log–dose–response of immediate hypersensitivity—dose ratios for equal severity are approximately constant across patients—to create orderofmagnitude spacing early in the infusion and cut excess dose if a reaction emerges. If effective, IRIS could lessen severe reactions, ICU admissions and surgical cancellations while fitting existing infusion workflows, particularly in scenarios previously suited to test dosing. ANZCTR: ACTRN12624001002572.
Dr Peter Platt, Dr Russell Clarke, Sir Charles Gairdner Hospital, Western Australia.
The project was awarded A$40,350 funding through the ANZCA research grants program for 2026.