1/67. Latex allergy in an orthognathic patient and implications for clinical management. A 19-year-old girl with mild asthma had had 16 months of orthodontic treatment as part of the joint orthodontic/orthognathic approach to her 9.5 mm overjet. At the time of banding her second molars she developed latex protein allergy as a reaction to the operator's non-sterile powdered latex gloves. She also gave a history of allergy to other substances as well as of eczema. The patient was confirmed as allergic to latex protein by radioallergosorbent test (RAST) for IgE, requiring precautions be taken during further orthodontic procedures as well as during the subsequent orthognathic surgery for the underlying Class II skeletal pattern. ( info) |
2/67. Contact urticaria to the MCU-2A/P gas mask. A case of contact urticaria to the silicone rubber in the MCU-2A/P gas mask is presented. Contact urticaria is a type I hypersensitivity reaction mediated by immunoglobulin e that usually manifests as localized erythema, edema, pruritus, and urticarial plaques. It can also cause systemic reactions, including anaphylaxis. Allergic reactions to silicone rubber have been increasingly reported and are of importance in medical and military personnel. The implication of such a diagnosis in an active duty military member is significant because the individual cannot be worldwide-qualified. The correct diagnosis of allergic skin reactions to personal protective gear is critical to maintaining a strong fighting force and protecting military personnel from potentially life-threatening allergic reactions. ( info) |
3/67. Latex allergy in atopic children. The incidence of positive circulating specific immunoglobulin e (IgE) antibodies to latex and evidence of clinical latex sensitivity appears to be increasing since its first description in 1979. Although heightened medical awareness may be a factor, exposure to latex products, particularly rubber gloves, has increased since the discovery of the human immunodeficiency virus (hiv). Atopic individuals are at greater risk of developing latex sensitivity. We identified seven children with atopic eczema who were known to have clinically significant latex allergy and examined the relationship of prior exposure to latex gloves. All children had significant serum levels of specific IgE to latex. Before developing clinical symptoms of latex allergy, all had been exposed to latex in the form of gloves during either inpatient or outpatient treatments of their skin. Exposure of atopic individuals to latex gloves could be a major risk factor for sensitization and could increase the incidence of serious reactions. ( info) |
| PURPOSE: Treatment with H2 receptor antagonists may cause the heart to be more susceptible to atrioventricular conduction delay when exposed to an overwhelming insult by histamine released during an anaphylactic reaction. We present the case of a woman, pretreated with ranitidine, who developed 3:1 heart block secondary to latex anaphylaxis. We propose that H2 antagonist premedication alone in patients susceptible to anaphylaxis increases their risk of heart block. CLINICAL FEATURES: A 38 yr old obese woman with cervical cancer presented for a radical hysterectomy. Systems review yielded a history of sleep apnea, orthopnea, gastroesophageal reflux, and sciatica. Medications included preoperative ranitidine, 150 mg. There was no history of atopy or allergy. Following general anesthesia induction, at the onset of the surgical procedure the patient developed a severe anaphylactic reaction which was heralded by the onset of 3:1 heart block, with decreases in SpO2, P(ET)CO2 and a decrease in systolic blood pressure to 45 mmHg. This was diagnosed as a possible latex reaction and treated using epinephrine boluses and infusion, fluids, 50 mg diphenhydramine, 50 mg ranitidine and 100 mg hydrocortisone. Following a 48 hr stay in the ICU the patient made an uneventful recovery. Allergy testing with intradermal latex injection and increased plasma tryptase levels confirmed a latex anaphylaxis. CONCLUSION: The use of H2 antagonists alone as a prophylaxis for gastroesophageal reflux may increase the risk of heart block in patients who develop anaphylaxis. ( info) |
5/67. Glucocorticosteroid treatment for cerebrospinal fluid eosinophilia in a patient with ventriculoperitonial shunt. BACKGROUND: cerebrospinal fluid (CSF) eosinophilia commonly occurs in patients with ventriculoperitoneal (VP) shunts and is associated with shunt complications such as obstruction or infection. Glucocorticosteroids (GCS) are effective in reducing eosinophilia and eosinophils in skin, nasal mucosa, and airway epithelium. Effects of GCS on CSF eosinophils has not been reported. OBJECTIVE: To demonstrate glucocorticosteroid effects on the CSF eosinophil levels and to propose that GCS may be used as a therapeutic agent for CSF eosinophilia. RESULT: A case report of a patient with congenital hydrocephalus and a VP shunt developed CSF eosinophilia associated with latex allergy and shunt malfunction. Daily treatment with 2 mg/kg of methylprednisolone was associated with reduced peripheral eosinophilia and slightly reduced CSF eosinophil counts. pulse methylprednisolone, 15 mg/kg, was associated with complete reduction of CSF eosinophils and prolonged VP shunt survival. CONCLUSION: Systemic glucocorticosteroids effectively reduce CSF eosinophils. Glucocorticosteroids may be beneficial for treatment of CSF eosinophilia associated with VP shunt malfunction. ( info) |
| BACKGROUND: A 6-year-old girl who was diagnosed with diabetes mellitus 20 months previously developed erythematous, raised lesions at the site of her insulin injections. The reactions occurred when isophane and lispro insulin were administered individually or combined but not when insulin was obtained from the bottle after the septum had been removed. OBJECTIVES: To describe latex hypersensitivity in a child with diabetes and to review the literature. DESIGN: Case report. RESULTS: Findings from intradermal testing confirmed latex hypersensitivity. A change to insulin administration by insulin pen decreased the frequency of the reactions. CONCLUSION: latex hypersensitivity should be considered in children with type 1 diabetes who develop local reactions to insulin injections. ( info) |
7/67. Allergy to local anaesthetic: the importance of thorough investigation. A case report is presented which highlights the importance of a good history in arriving at the correct diagnosis in cases where allergy to local anaesthetic is suspected. Management of the patient is discussed and the topic of 'adverse reaction' briefly reviewed. ( info) |
8/67. Current perspectives on the perioperative management of the latex-allergic patient. The increasing incidence of latex allergy necessitates thorough preanesthetic screening for risk factors, which will be delineated in this article, that are associated with latex allergy. The pathophysiology, epidemiology, and testing procedures for latex allergy will be reviewed. This case report will illustrate the management of a patient who was found to be latex-sensitive during surgery and the management of intraoperative anaphylaxis is provided. Safe perioperative care can be provided for latex-sensitive patients if latex avoidance techniques are used consistently. ( info) |
9/67. Management of the latex hypersensitive patient in the endodontic office. This case report documents the treatment of an endodontic patient who experienced a type 1 hypersensitivity reaction to latex. The dental, medical, and environmental aspects of treating latex allergic patients are reviewed. Because gutta-percha and latex rubber are similar compounds, the possible cross-reactivity of these materials is discussed. ( info) |
| I present a case of a patient with a history of cerebral palsy and asthma, living in a group home, who developed acute onset bronchospasm immediately after intubation. The patient developed hypotension 5 minutes after intubation. The bronchospasm lasted 20 minutes, and the case was complicated further by continued hypotension and a pneumothorax. A diagnosis of latex-mediated anaphylaxis was made in the intensive care unit after immunoglobin E (IgE), serum tryptase, and latex-specific IgE antibody were shown to be markedly elevated. This case report demonstrates that immediate onset of bronchospasm on intubation of an asthmatic patient is not always an asthma attack, and that other causes of bronchospasm should be considered in the differential diagnosis. patients with a history of atopy, including those with a history of asthma, have an increased risk of developing latex sensitivity. It is important to remember that more than one etiology may be responsible for this kind of bronchospasm, and that it may be difficult to differentiate between multiple etiologies of bronchospasm. ( info) |