Severe anaphylactic shock without exanthema in a case of unknown latex allergy and review of the literature

Abstract

We describe a case of severe anaphylactic shock without exanthema in an 8-year-old boy who was undergoing elective surgery for an ileostomy. The boy had a history of four anorectal operations in the newborn period, but no history of allergies. Sudden, profound bronchospasm and cardiorespiratory collapse occurred 30 min after the beginning of the operation. No signs of exanthema or urticaria were seen. The patient was resuscitated successfully and remained ventilated for 25 h. During this time, he needed epinephrine in dosages of 0.3-0.05 microg.kg-1.min-1. Radioallergosorbent (RAST) tests for the patient were positive Cap Class 3 and 4, and specific immunoglobulin E was highly positive, suggesting a natural rubber latex allergy as the cause of the anaphylactic shock. Ethylene oxide was negative. Eleven days later, a further operation was performed with a strict latex-free protocol in the presence of histamine 1 and 2 receptor antagonists. On this occasion, the intraoperative course was uneventful. Incidence of anaphylactic reactions, prevalence of latex sensitization, special risk groups and management are discussed.

Intraoperative latex hypersensitivity: do not overlook Penrose drains

“…The estimated incidence of anaphylaxis and anaphylactoid reactions occurring during general anesthesia is approximately 1 in 6000, with latex hypersensitivity accounting for 12.1% of these reactions [2]. Although most of latex hypersensitivity reactions are successfully managed medically, there remains a 6% mortality rate due to anaphylaxis during general anesthesia [2].…”

“…There are numerous reports of adverse perioperative reactions associated with latex use in children [1,2,6]. However, a review of the literature showed no reports of perioperative latex hypersensitivity or anaphylaxis attributed to the use of a Penrose drain.…”

Cataract surgery for natural rubber latex allergic patients

“…[5][6][7] It is now felt that the risks of a patient developing a life-threatening reaction from NRL exposure appear to be lower than originally thought. 8 Furthermore, this risk may be reducing still as equipment manufacturers continue to phase out NRL from their product line.…”

Allergic Reactions in the Perioperative Period in Children

“…Skin lesions (localized or generalized erythema, hives with or without angioedema) were expressed alongside signs in other systems [17][18][19]21 The reactions attributable to latex were published among the most severe, grade III or IV, including cardiovascular events (low blood pressure, hemodynamic shock associated with tachycardia and bradycardia, and even cardiac arrest). These cardiovascular signs were mostly associated to respiratory symptoms (wheezing, bronchospasms) and sometimes to mucocutaneous signs [12,28,29,[31][32][33][34][35][36][37][39][40][41]74,75].…”

“…(Table 2) [17,18,20,23,24]. Also, when the reactions were related to latex, most reports were carried out using an adequate allergological evaluation [12,28,29,[32][33][34]36,37,[39][40][41]74].…”