Case Scenario

Sampathi, Venkata; Lerman, Jerrold

doi:10.1097/aln.0b013e3182084a58

Cited by 25 publications

(18 citation statements)

References 36 publications

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“…Further reasons for reducing the use of natural latex rubber were high-risk groups, such as patients with atopic syndrome or Spina bifida, surgery in infancy, and medical personnel [12]. However, prevalence is still high, and allergic reactions to natural latex rubber represent potentially life-threatening intraoperative complications [13].…”

Section: Discussionmentioning

confidence: 99%

Anaphylactic reaction 5 minutes after the start of surgery: a case report

et al. 2015

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BackgroundNatural latex rubber products have been known to cause severe anaphylactic reactions during surgery. Even 25 years after the first description of anaphylactic reactions in the literature, natural latex rubber products are still used in pediatric surgery.Case presentationThe following article describes the case of a healthy 4.5-year old Caucasian boy who simultaneously developed severe hypotension, tachycardia and bronchospasm during surgery for congenital strabismus sursoadductorius under uneventful anesthesia. An allergy test conducted afterwards showed natural latex rubber as the trigger for this severe intraoperative anaphylactic reaction.This case was special because of the absence of any previous clinical or anamnestical evidence of natural latex rubber allergy. The fact that the child had been previously exposed to natural latex rubber – because the boy’s mother used disposable gloves for her work as a cosmetician at home – was only discovered later. Such contact may have had a slight sensitizing effect that manifested after the initial contact with the conjunctiva through the surgeon’s natural latex rubber gloves.ConclusionNatural latex rubber products have caused severe anaphylactic reactions time and again. Diagnosis is impeded by the highly variable clinical symptoms of anaphylaxis, the non-responsivity of patients, anesthesia-induced changes in blood pressure, surgical drapes, and blood loss. Therefore, use of alternative products and implementation of the right course of action in clinical routine seems to be even more important than raising awareness for allergies to natural latex rubber.

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Section: Discussionmentioning

confidence: 99%

Anaphylactic reaction 5 minutes after the start of surgery: a case report

et al. 2015

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“…16 In a prospective survey, latex was the main cause of perioperative anaphylactic reactions in children (76%). 17–19 History is the main tool to investigate a latex sensitivity. Children submitted to multiple surgical procedures, such as for spina bifida, especially at a very young age, are at an increased risk of latex sensitization.…”

Section: Preoperative Assessment and Risk Factors Evaluationmentioning

confidence: 99%

“…ballons) or rubber dam are responsible of lips and tongue swelling, itching, rash or angioedema. 19,20 Asking for allergy to some fruits ( e.g. avocado, banana, kiwi, chestnut) and vegetables ( e.g.…”

Section: Preoperative Assessment and Risk Factors Evaluationmentioning

confidence: 99%

“…tomato, bell pepper, carrot) has been suggested to be helpful to detect an increased risk of latex sensitivity since there is evidence of cross-sensitivity between several shared antigens. 19 …”

Section: Preoperative Assessment and Risk Factors Evaluationmentioning

confidence: 99%

“…Therefore high risk children should be identified through history 19,20 and allergic tests should be performed only in this group of patients. 36 If the clinical history concerning allergies is positive or equivocal, the patient should be referred to an experienced allergologist to perform preoperative tests.…”

Section: Preoperative Assessment and Risk Factors Evaluationmentioning

confidence: 99%

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Update on Perioperative Management of the Child with Asthma

2012

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Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

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Latex Allergy

Gawchik

2011

Mount Sinai J Medicine

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Allergy to natural rubber latex is an important clinical condition that occurred after the institution of universal precautions to protect healthcare workers. A rapid increase and production of both examination and surgical gloves resulted in an epidemic of allergy to latex protein. Healthcare workers in both the medical and dental environments, as well as specific groups of individuals including those with spina bifida, myelodysplasia, and food allergies (banana, kiwi, avocado, and others), were at increased risk of sensitization. Clinical symptoms in the latex allergic individual ranged from type I hypersensitivity reaction including rhinoconjunctivitis, asthma, and systemic reaction to type IV hypersensitivity reaction, which occur from the chemicals added during the manufacturing process. Diagnosis of latex allergy is based on a clinical history that correlates the development of symptoms in relationship to exposure. In the United States there are no skin tests approved by the Food and Drug Administration. Therefore a combination of clinical judgment and serologic testing such as ImmunoCAP and Immulite is helpful. The primary treatment of latex allergy is avoidance of exposure to the latex protein.

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Case Scenario

Cited by 25 publications

References 36 publications

Anaphylactic reaction 5 minutes after the start of surgery: a case report

Anaphylactic reaction 5 minutes after the start of surgery: a case report

Update on Perioperative Management of the Child with Asthma

Latex Allergy

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