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Intraoperative anaphylaxis to latex

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Abstract

This case report describes intraoperative anaphylaxis occurring in a fourteen-year-old female with spina bifida in which latex surgical gloves were incriminated as the aetiologic agent. The patient was non-atopic but since eight years of age she had developed localized angioedema and urticarial skin reactions on exposure to rubber. She had previously undergone several uneventful surgical procedures. Forty-five minutes following induction of anaesthesia and during laparotomy for elective cholecystectomy she experienced sudden onset of increased airway pressure, oxygen desaturation, tachycardia, profound hypotension and erythema consistent with an anaphylactic reaction. Resuscitation with manual ventilation and oxygen, intravenous fluids and an epinephrine infusion was successful. Subsequent investigations for allergies demonstrated a strongly positive skin prick test and RAST to latex antigen, with negative results to anaesthetic agents, antibiotics and inhalant allergens. During two later operations prophylaxis consisting of diphen-hydramine, ranitidine and hydrocortisone appeared to prevent further reactions. Latex should be considered as a cause of life-threatening intraoperative allergic reactions in patients with a history of rubber allergy or frequent exposure to latex products.

Résumé

Le latex des gants du chirurgien semble responsable de l’anaphylaxie intra-opératoire survenue chez une fille de quatorze ans atteinte de spina-bifida. La patiente, sans autre histoire d’atopie, manifestait depuis l’âge de huit ans un urticaire avec angioedème local lors de contacts avec du caoutchouc mais elle avail subi sans probléme, diverses interventions chirurgicales. Approximativement 45 minutes après l’induction de l’anesthésie pendant une laparotomie pour cholecystectomie, il y eut chez elle une augmentation soudaine de la pression des voies respiratoires avec désaturation artérielle, hypotension grave et un érythème, le tout compatible avec un choc anaphylactique. La réanimation consista en une ventilation manuelle l’oxygène, du liquide par voie intraveineuse et une perfusion d’adrénaline. Une cuti-réaction et un test de radioallergosorbent (RAST) s’avérerènt fortement positifs pour l’antigène du latex, ralors que la réponse aux anesthésiques, antibiotiques et autres allergénes en inhalation était négative. Lors de deux interventions subsé-quentes, une prophylaxie base de diphenhydramine, de ranitidine et d’hydrocortisone fut utilisée avec succés. On devrait considerér le latex comme un agent pouvant potentiellement declencher une réaction allergique intra-opératoire sérieuse chez ceux qui sont fréquemment en contact avec lui ou qui sont allergiques au caoutchouc.

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Correspondence to Jo Swartz.

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Swartz, J., Braude, B.M., Gilmour, R.F. et al. Intraoperative anaphylaxis to latex. Can J Anaesth 37, 589–592 (1990). https://doi.org/10.1007/BF03006333

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Key words

  • allergy: anaphylaxis, latex
  • complications: anaphylaxis