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Intraoperative anaphylaxis to latex

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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.


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.


  1. 1

    Slater JE. Rubber anaphylaxis. N Engl J Med 1989; 320: 1126–30.

  2. 2

    Leynadier F, Pecquet C, Dry J. Anaphylaxis to latex during surgery. Anaesthesia 1989; 44: 547–50.

  3. 3

    Gerber AC, Jorg W, Zbinden S, Seger RA, Dangel PH. Severe intraopcrative anaphylaxis to surgical gloves: latex allergy, an unfamiliar condition. Anesthesiology 1989; 71: 800–02.

  4. 4

    Leynadier F, Sansarricq M, Didier JM, Dry J. Prick tests in the diagnosis of anaphylaxis to general anaesthetics. Br J Anaesth 1987; 59: 683–9.

  5. 5

    Fisher M. Intradcrmal testing after anaphylactoid reaction to anaesthetic drugs: practical aspects of performance and interpretation. Anaesth Intensive Care 1984; 12: 115–20.

  6. 6

    Gleich GH, Yunginger JW. The radioallergosorbent test: a method to measure igE antibodies, IgG blocking antibodies and the potency of allergy extracts. Bull NY Acad Med 1981; 57: 559–67.

  7. 7

    Lozynsky OA, Dupuis L, Shandling B, Gilmour RF, Zimmerman B. Anaphylactoid and systemic reactions following saline enema administration. Six case reports. Ann Allergy 1986; 56: 62–6.

  8. 8

    Fisher M McD, Outhred A, Bowey CJ. Can clinical anaphylaxis to anaesthetic drugs be predicted from allergic history? Br J Anaesth 1987; 59: 690–2.

  9. 9

    Green GR, Rosenblum A. Report of the penicillin study group: American Academy of Allergy. J Allergy Clin Immunol 1971; 48: 331–43.

  10. 10

    Reisman RE. Insect Allergy.In: Allergy: Principles and Practice. Middleton E Jr (Ed.). 3rd ed. St.Louis: The C.V. Mosby Company, 1988: 1345–64.

  11. 11

    Axelsson JGK, Johansson SGO, Wrangsjo K. IgE-mediated anaphylactoid reactions to rubber. Allergy 1987; 42: 46–50.

  12. 12

    Axelsson IGK, Eriksson M, Wrangsjo K. Anaphylaxis and angioedema due to rubber allergy in children. Acta Paediatr Scand 1988; 77: 314–6.

  13. 13

    Spaner D, Dolovich J, Tarlo S, Sussman G, Buttoo K. Hypersensitivity to natural latex. J Allergy Clin Immunol 1989; 83: 1135–7.

  14. 14

    Taylor JS. Rubber.In: Contact Dermatitis. Fisher AA (Ed.). Philadelphia: Lea & Febiger: 1986, 603–43.

  15. 15

    Nutter AF. Contact urticaria to rubber. Br J Dermatol 1979; 101: 597–8.

  16. 16

    Carrillo T, Cuevas M, Munoz T, Hinojosa M, Moneo I. Contact urticaria and rhinitis from latex surgical gloves. Contact Dermatitis 1986; 15: 69–72.

  17. 17

    Seaton A, Cherrie B.Turnbull J. Rubber glove asthma. Br Med J 1988; 296: 531–2.

  18. 18

    Myers GE, Bloom FL. Cimetidine combined with steroids and H1 antihistamines for the prevention of serious radiographic contrast material reactions. Cathct Cardiovasc Diag 1981; 7: 65–9.

  19. 19

    Watkins J. Investigation of allergic and hypersensitivity reactions to anaesthetic agents. Br J Anaesth 1987; 59: 104–11.

  20. 20

    Moudgil GC. Anaesthesia and allergic drug reactions. Can Anaesth Soc J 1986; 33: 400–14.

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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