Severe anaphylactic reaction to latex rubber surgical gloves

Publisher Website
Google Scholar
Abstract
Case report A 31 year old woman became ill on her way home from a hospital consultation. Her face and eyelids swelled, her throat felt tight, and she became short of breath with wheezing. Her general practitioner arrived to find her moribund; diagnosed anaphylaxis; and injected adrenaline, chlorpheniramine, and hydrocortisone. She survived a respiratory arrest during transfer to hospital. The woman's medical history included delayed hypersensitivity reactions to nickel and several operations (including appendicectomy, herniorrhaphy, right salpingo - oophorectomy, two laparoscopies, and four caesarean sections). During a consultation about an abscess at the site of a stitch the woman's gynaecologist had examined her vaginally while wearing a latex rubber glove; the anaphylactic reaction occurred about 10 minutes later. In retrospect, she recalled a less severe episode of facial swelling and wheezing after blowing up some balloons. Immediate hypersensitivity to latex rubber was thought to have caused her anaphylactic reaction. The woman recovered fully within 24 hours and was discharged from hospital with syringes preloaded with adrenaline (0.5 ml 1/1000) for intramuscular injection and 240 mg of terfenadine to take orally at the onset of any attack. A blood sample taken 36 hours after the anaphylactic reaction showed normal C3 and C4 concentrations and a C1 esterase inhibitor concentration of 0.12 g/l (reference range 0.15-0.35 g/l), which excluded idiopathic angio-oedema. The patient was subsequently noted to be dermatographic and had a positive hypersensitivity reaction 10 minutes after a prick test with a 1 cm square piece of a latex rubber glove but no reaction when a control polythene glove was used. Prick testing with natural rubber latex showed a 5 mm weal and 15 mm flare; no reactions were obtained in six control subjects. A resuscitation trolley, a syringe preloaded with adrenaline, and a plastic airway were close by during these tests. Patch tests with various rubber chemicals gave negative results, though those with nickel and cobalt gave positive results. Four months later the woman developed wheezing and shortness of breath 30 minutes after her son directed the flow of air from a deflating rubber whoopee cushion (a joke cushion) at her face. She injected adrenaline, and the resulting reaction was less severe than the previous reaction, but admission to hospital was still required.
Keywords

This publication has 4 references indexed in Scilit: