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Anaphylactoid and systemic reactions following saline enema administration. Six case reports
Insights
Children with spina bifida experienced severe allergic reactions, including hives and anaphylaxis, after saline enemas. Reactions were linked to new enema kit components, particularly the rectal end-piece, suggesting a material-related issue.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Medical Device Safety
Background:
- Spina bifida management often involves bowel care, including enemas.
- Allergic reactions to medical devices can pose significant risks.
Observation:
- Six children with spina bifida reported 13 episodes of hives, angioedema, and anaphylactoid reactions post-saline enema.
- Reactions consistently occurred with the initial use of new enema kits.
- One child experienced a systemic reaction solely from the rectal end-piece, without fluid infusion.
Findings:
- The rectal end-piece of the enema kit was identified as the most probable cause of the observed anaphylactoid reactions.
- In-hospital challenge confirmed the end-piece's role in triggering acute reactions in a sensitive patient.
- The specific causative agent and reaction mechanisms remain undetermined.
Implications:
- This highlights a potential safety concern with specific enema kit components in pediatric patients.
- Further investigation is crucial to identify the allergen/irritant in the rectal end-piece.
- Clinicians should be aware of potential device-related hypersensitivity in spina bifida patients undergoing enema therapy.
Abstract:
This report describes six children with spina bifida who have experienced a total of 13 episodes of generalized hives, angioedema and in two cases, anaphylactoid reactions immediately following saline enema infusions. The enemas were administered using a kit comprised of a plastic bag, tubing, and rectal end-piece. The reactions always occurred with the first use of new kits. A third child developed a systemic reaction with only the rectal end-piece in situ and without infusion of fluid. An in-hospital challenge using a new end-piece in one patient, who was clinically the most sensitive, produced an acute anaphylactoid reaction implicating the end-piece as the most likely source of the problem. The definitive mechanism(s) of the reactions and the agent(s) responsible for them presently remain unknown.