Case Studies

 Case 4.2 Latex-induced anaphylaxis

A 38-year-old woman was referred for investigation following an anaphylactic reaction whilst visiting a relative in hospital. She gave a 5-year history of recurrent conjunctival oedema and rhinitis when blowing up balloons for her children's birthday parties. In the year prior to admission, three successive visits to her dentist triggered marked angioedema of her face on the side opposite to that requiring dental treatment. The swellings took 48h to subside.

On the day of admission, she visited a critically ill relative in hospital. The patient was being reverse barrier nursed and visitors were required to wear gown and gloves. About 20min after putting on the gloves her face and eyes became swollen, she felt wheezy and developed a pounding heart beat and light-headedness. Her tongue started to swell and she was taken to the Emergency Department where she was given intramuscular epinephrine (adrenaline) and intravenous hydrocortisone. She recovered rapidly but was kept under observation overnight.

She had no history of atopy or other allergies. Ten years earlier she had undergone a series of operations for ureteric reflux and in the preceding 2 years had received colposcopic laser treatment for cervical intraepithelial neoplasia (CIN).

Examination was unremarkable. However, skin-prick testing to a crude latex extract produced a very strong reaction and her antigen-specific IgE antibody level to latex was significantly elevated at 57U/ml (RAST class 6).

The diagnosis was that of latex-induced anaphylaxis probably induced by her repeated urinary tract operations.

She was advised to avoid contact with all materials containing latex, and warned that she could react to certain foods (see Table 4.3). The diagnosis has important implications for any further dental, surgical or anaesthetic procedures. It was suggested that she wear a Medic Alert™ bracelet, in case she required future emergency surgery, and carry a self-injectable form of epinephrine.