Acute Peritoneal Eosinophilia in a Child With Prune-Belly Syndrome Following Peritoneal Dialysis Catheter Placement

Peritoneal eosinophilia, although uncommon, was reported after placement of catheters for peritoneal dialysis. We describe a 7-year-old African-American boy with prune-belly syndrome who developed acute onset of peritoneal eosinophilia after placement of a peritoneal dialysis catheter. Peripheral-blood eosinophilia also was noted with the peritoneal eosinophilia, but was not correlative. Intraperitoneal and systemic corticosteroid therapy led to successful resolution of peritoneal eosinophilia. Radioallergosorbent tests indicated sensitization to latex. Unrecognized latex sensitization should be considered in any child with multiple urological surgeries who develops sudden onset of peritoneal eosinophilia.

Early exposure to latex products mediates latex sensitization in spina bifida but not in other diseases with comparable latex exposure rates

BACKGROUND

The high prevalence of latex sensitization in patients with spina bifida (SB) has been attributed to repeated and early exposure to latex products. Other diseases such as gastroschisis/omphalocoele and post-haemorrhagic/congenital hydrocephalus are also associated with repeated and early latex exposure.

OBJECTIVE

The aim of the study was to evaluate whether the high prevalence of latex sensitization in patients with SB is rather related to the underlying disease itself than to disease-associated known risk factors.

METHODS

We compared children with SB (n=35), children with gastroschisis/omphalocoele (G/O, n=20) and children with post-haemorrhagic/congenital hydrocephalus (PH, n=45). All children with SB and PH had a ventriculo-peritoneal shunt since a very young age. Patients who underwent three or less surgical procedures matched in terms of age, number of operations, atopy and gender distribution, and were analysed for IgE sensitization rates to latex.

RESULTS

In the SB group, 16 of 35 patients (46%) showed elevated latex-specific IgE antibodies in contrast to one of 20 patients (5%) in the G/O group and four of 45 patients (8.9%) in the PH group (P<0.0005 and P<0.005, Fisher's exact test). Comparing matched control groups (<or=3 operations), the effects remained significant (P<0.05 and P<0.01).

CONCLUSION

This study suggests that the SB population bears a disease-associated propensity for latex sensitization. This effect cannot be explained exclusively by a higher number of operations and differences related to atopy, age or gender.

Differential expression of allergens on the internal and external surfaces of latex surgical gloves

BACKGROUND

Differences in latex allergen sensitization profiles have been described between children undergoing repeated surgical interventions and health care workers. The purpose of this study was to determine whether such sensitization profiles are associated with differences in the expression of latex allergen between the internal and external surfaces of surgical gloves.

METHODS

Extracts were obtained from whole surgical gloves as well as from their external and internal surfaces. The extracts were centrifuged, filtered, concentrated, dialyzed and lyophilized. The protein profile of the extracts was analyzed using hydrophobic interaction chromatography (HIC) and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Immunoblotting was performed using sera from two patients with confirmed latex allergy. Latex recombinant allergen-specific IgE in these two patients was determined using a fluorescence enzyme immunoassay (FEIA) method. Latex allergen quantification was determined on both glove surfaces using an ELISA method.

RESULTS

HIC and SDS-PAGE showed qualitative and quantitative differences in proteins between the internal and external glove surfaces, with the former being much richer in proteins. Immunoblotting of glove extracts using sera from two latex-allergic health workers showed differences between glove surface extracts. ELISA quantification of latex allergens demonstrated that the internal glove surface had high amounts of Hev b 5 and Hev b 6.02 whereas the external surface showed Hev b 1, Hev b 3, and Hev b 6.02.

CONCLUSIONS

Our results reveal substantial differences in the composition of latex allergen profiles between the internal and external surfaces of surgical latex gloves, which may suggest a relationship between latex allergen localization and sensitization routes in different risk groups.

Perioperative anaphylaxis from locally applied rifamycin SV and latex

A patient developed severe anaphylaxis during irrigation of a wound with rifamycin SV. The temporal relationship between application of rifamycin SV, the positive skin test and basophil activation test for rifamycin SV strongly supported diagnosis of anaphylaxis from the locally applied antibiotic. However, after operation the patient had two anaphylactic reactions with pruritus, urticaria and angio-oedema after routine care by a nurse, and these were probably caused by natural rubber latex. This case report has several messages. First, it is not widely appreciated that topically applied drugs and related compounds can elicit life-threatening anaphylaxis. Second, it illustrates patients can present with more than one allergy. Finally, it provides an opportunity to summarize the applications of flow cytometry-assisted quantification of in vitro activated basophils in diagnosing the cause of anaphylaxis during anaesthesia.

[Airbone contact dermatitis caused by latex exposure: a clinical case]

We describe the case of a nurse who showed eczematous lesions wide-spread over the neck and face. She worked as a attendant to a surgical chamber and wore vinyl gloves because of previous episodes of contact dermatitis caused by rubber gloves. The allergologic examination demonstrated that total IgE was 69.8 kU/1, both the Skin prick tests and the patch test for latex were positive. Persisting her dermatological symptomatology, in the suspicion of a airborne contact dermatitis, the nurse was removed and addressed to administrative functions for detecting the clinical follow-up. Fortunately, the eczematous manifestations spontaneously disappeared immediately after her transfer. In this case the presence of eczema mainly on air-exposed areas was interpreted as a sign of airborne contact dermatitis to latex. The case is reported in that the clinical picture is not very common.

Latex-induced anaphylactic reaction in a child with spina bifida

Allergy to natural rubber latex presents a unique challenge in the emergency department. Latex allergy in children is most commonly identified in patients who have undergone multiple operations for neural tube defects or genitourinary anomalies. We report a life-threatening anaphylactic reaction to latex in a patient with spina bifida even with latex-free precautions.

[Anesthesia for cesarean section in a patient with Lobstein's syndrome]

We report on a 21-year-old woman with a severe form of Lobstein's syndrome, who underwent a Cesarean section. The following issues are discussed: the risk of sustaining fractures during positioning, fractures by automatic blood pressure measurement, an almost always existing latex allergy, a susceptibility for malignant hyperthermia, potential cardiac defect, difficult endotracheal intubation, lowering of the conus medullaris to an area usually used for spinal puncture, severe spinal deformities resulting in difficult puncture, hemorrhagic diathesis, and unpredictability of the expansion of local anesthetics in the vertebral canal. In this case the procedure could be carried out in spinal anesthesia without encountering major problems.

Latex sensitisation and allergy in children with myelomeningocele

INTRODUCTION

Children with spina bifida (SB) have a high degree of exposure to latex products as a consequence of repeated surgical procedures, implantation of latex-containing materials and catheterisation. The consequence is a higher incidence of latex allergic reactions.

OBJECTIVE

The aim of this study is to evaluate the prevalence of latex sensitisation and allergy in a population of children with myelomeningocele (MMC) and to assess the role of associated risk factors.

RESULTS

Forty-eight percent of the patients (29 out of 60) showed a latex sensitisation with specific IgE >0.7 kU/l while 15% (9 out of 60) were allergic to latex (specific IgE >0.7 kU/l and clinical manifestations). The principal factor correlated with allergy to latex was specific serum IgE to latex (radioallergosorbent test [RAST]) values (p<0.01). Other factors were total serum IgE (paper radioimmunosorbent test [PRIST]) values, number of surgical procedures and familiarity with allergy.

CONCLUSION

These results underline the importance of prophylactic measures to avoid the exposure, not only in the sanitary environment, through the institution of latex-safe routes, but also in daily life, to prevent potentially serious allergic reactions.

Hetastarch allergy and positive latex radioallergosorbent test in a patient suffering cardiovascular decompensation during multiple perioperative periods

The cause of sudden cardiovascular collapse in the perioperative period can be elusive. Allergy may be overlooked as a cause. When allergy is considered, latex is often suspected. Because hetastarch is frequently used in situations involving hypovolemia and hypotension, and because allergic reactions to it are rare, it may be overlooked as a possible allergen. We report a case of a patient suffering cardiovascular decompensation during four nonconsecutive perioperative periods before it was determined that she was allergic to hetastarch. She also had a very highly positive latex radioallergosorbent test, suggesting a latex allergy.

Myelomeningocele, avocados, and rubber tree plants

Infants with myelomeningocele and the nurses who care for them have something in common. Both are at higher risk than the general population for developing latex allergies. This article provides a review of the literature regarding latex production, latex allergic responses in children and adults, types of latex allergic reactions, and prevention of latex allergies.

Increased incidence of latex allergy in children with allergic diseases in Japan

The incidence of latex allergy is increasing in Japanese adults. However, the changing incidence of latex allergy in children with or without allergic diseases has not been reported in detail. After obtaining written informed consent from parents, Japanese children under 14 years of age were studied. In total, 776 non-atopic children, 802 children with allergic rhinitis (AR), 706 children with bronchial asthma (BA) and 844 children with atopic eczema/dermatitis syndrome (AEDS) were asked about symptoms of latex allergy, and tested by serum latex-specific IgE, skin prick test to latex allergen and latex-glove-wearing test between 2001 and 2003. All the patients were outpatients at Ujitakeda Hospital, while the non-atopic children were children of the staff of Ujitakeda Hospital or Unitika Ltd. This was a retrospective study. The incidence of latex allergy in 2001/2002/2003 was 1.4/3.1/4.7% in non-atopic children, 3.1/5.1/9.1% in AR patients, 3.6/6.5/10.3% in BA patients and 6.1/11.3/15.9% in AEDS patients, respectively. Moreover, although no cases of anaphylactic shock were noted in allergic patients in 2001, two and eight cases were noted in 2002 and 2003, respectively. These results indicate that the incidence of latex allergy is increasing in paediatric patients with allergic diseases. A latex-reduced environment may be desirable in future.

Grand rounds: latex-induced occupational asthma in a surgical pathologist

CONTEXT

Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice.

CASE PRESENTATION

A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time.

DISCUSSION

The patient's presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work.

RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE

The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.

Réaction anaphylactique liée au latex probablement transmis par le greffon au cours d'une transplantation rénale

We report a case of a young man with an allergy to latex who developed anaphylactic shock during anaesthesia for renal transplantation. All anaesthetic agents used before the episode were tested as potential allergens and only latex was shown to be positive. It appears that latex contamination in the graft was the cause since no materials containing latex were used during the operation. We feel it essential that donor organs should be removed in a totally latex-free environment. Such conditions will remove the risk of anaphylactic shock at the point of reperfusion of the transplant.

Managing Latex-Free Mitral Valve Replacement

The management of cardiac surgery patients with latex allergy can be challenging. We describe successful mitral valve replacement in a latex-allergic patient using an integrated multidisciplinary approach. We also provide a list of some available latex-free products or latex-free alternatives.

[Intraoperative anaphylaxis in a patient with undiagnosed latex sensitivity]

Latex allergy is a cause of anaphylactic reactions during general anesthesia. It is currently the second most common cause of anaphylaxis during anesthesia and should be considered in all cases in which signs develop during surgery. Clinical manifestations are highly variable and depend on the type and amount of exposure to the allergen as well as on individual sensitivity. Cardiovascular collapse is the most common presentation in anesthetized patients, and the second most common manifestations are skin rash and bronchospasm. Latex gloves are implicated in most allergic reactions triggered by latex. Individuals allergic to latex are also sensitive to certain fruits (latex-fruit syndrome) because the presence of specific proteins common in both causes a phenomenon known as cross reactivity. A 34-year-old man with acute abdomen underwent emergency exploratory laparoscopy, which was converted to laparotomy based on findings in the surgical field. Coinciding with surgical manipulation, the patient developed severe hypotension, tachycardia, bronchospasm, and arterial desaturation, which responded favorably to intravenous fluids and medication. After all other possible causes of the events were ruled out, intraoperative anaphylactic reaction was suspected and later confirmed by tests, including allergy tests. When the patient was stable and the surgical environment was latex-free, the procedure was carried out with no complications and the postoperative course was uneventful.

Latex and chickpea (Cicer arietinum) allergy: first description of a new association

In this paper we describe the existence of cross-reactivity between allergens from latex and chickpea, a food from the Leguminosae family, which is common in the Mediterranean diet. We present the case report of a spina bifida boy with a clinical relevant food allergy to chickpea (oral syndrome + dysphonia), developing after the appearance of latex allergy symptoms (lip angioedema + intraoperative anaphylaxis). Specific IgE to latex and chickpea was demonstrated by skin prick tests, measurement of patient's serum specific IgE and IgE-immunoblotting. Cross-reactivity was studied by means of EAST-inhibition and western blotting-inhibition. A strong inhibition was observed in several IgE-binding bands when latex extract was used in solid phase and patient serum was preincubated with chickpea extract (chickpea extract as inhibitor phase). As far as we know, this is the first report of cross-reactivity between latex and chickpea, a food which should therefore be added to the extensive list of latex cross-reactive foods.

Latex allergy and skin

PURPOSE OF REVIEW

In this review we address the prevalence and outcome of latex allergy in health care workers (HCWs). Recent findings in natural rubber latex (NRL) allergens and trials of specific immunotherapy (SIT) are also of interest.

RECENT FINDINGS

A study involving skin prick test (SPT) screening in HCWs in Russia and adjacent countries found a prevalence of latex allergy of 1.9%. Questionnaire studies performed in Wales and in the USA identified prevalence rates of about 0.6%. An intervention undertaken at the Mayo Clinic, in which only gloves with low or undetectable allergen levels were allowed, reduced markedly the incidence of NRL allergy. Two studies, one from Finland and another from Ohio, showed that outcomes in latex-allergic HCWs are generally good. A study involving SPT screening showed that 6% of construction workers had latex allergy. A questionnaire study among allergists practicing in the USA showed that 62% performed latex SPT and 6% reported anaphylaxis, which mostly occurred while using a homemade SPT solution. Hev b 2, Hev b 5, Hev b 6.01 and Hev b 13 produced positive SPT reactions in over 60% of latex-allergic individuals. Topical application of NRL in a murine model of protein contact dermatitis caused a striking increase in prohevein-specific (Hev b 6.01) immunoglobulin E levels, together with a T-helper-2 type dermatitis. A placebo-controlled SIT trial with NRL extract alleviated cutaneous symptoms but caused some systemic reactions in latex-allergic patients.

SUMMARY

Low prevalence rates suggest that the peak of the latex allergy epidemic has already passed in HCWs. Hospital-wide interventions requiring use of low-allergen gloves reduce sensitization and changing gloves to nonlatex ones, or even using low-allergen latex gloves, in the affected individuals appears to confer adequate secondary prevention. In the USA there is an urgent need for standardized latex SPT reagent. Hev b 5 and Hev b 6.01 are major in vivo NRL allergens. Findings in mice suggest that NRL proteins eluting from latex gloves may also cause hand eczema in humans. SIT with NRL extract must still be considered an experimental treatment.