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Latex anaphylaxis during tissue expander insertion in a healthy child
1Department of Anaesthesia and the Research Institute, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Intraoperative latex anaphylaxis occurred in a healthy child with no prior latex exposure history. This case highlights the potential for severe allergic reactions in children undergoing surgery.
Area of Science:
- Anesthesiology
- Allergy and Immunology
- Pediatric Surgery
Background:
- Latex anaphylaxis is typically associated with specific risk factors such as myelodysplasia, genitourinary anomalies, healthcare worker sensitization, or frequent latex exposure.
- While documented in various patient groups, intraoperative latex anaphylaxis in otherwise healthy children remains infrequently reported.
Observation:
- A 9-year-old girl experienced severe intraoperative latex anaphylaxis during a surgical procedure.
- Symptoms included increased airway pressure, wheezing, decreased oxygen saturation, profound hypotension, and urticaria.
- The patient required immediate treatment with intravenous epinephrine and hydrocortisone, followed by an epinephrine infusion and extended intensive care unit admission.
Findings:
- The patient's only documented latex exposure was prior plastic surgery.
- Latex allergy was confirmed postoperatively via prick testing, establishing a causal link.
- This case demonstrates that even limited prior exposure can sensitize a child to latex.
Implications:
- Healthcare providers should consider latex allergy in the differential diagnosis of intraoperative anaphylaxis in pediatric patients, even without apparent risk factors.
- Preoperative screening for latex sensitivity may be warranted in children undergoing procedures with potential latex exposure.
- This case underscores the importance of vigilance for latex allergy in pediatric surgical settings.
Purpose:
To report intraoperative latex anaphylaxis that occurred in an otherwise healthy child. Although latex anaphylaxis is seen in patients with myelodysplasia, genitourinary anomalies, sensitised healthcare workers, and patients with frequent exposure to latex, it has not been described in otherwise healthy children.
Clinical Features:
A nine-year-old girl developed intraoperative latex anaphylaxis manifested by increased airway pressure, expiratory wheezing, a decrease in oxygen saturation, severe hypotension and urticaria. The patient was treated with 5 micrograms.kg-1 epinephrine i.v. and 5 mg.kg-1 hydrocortisone i.v. She required an epinephrine infusion of 0.4 microgram.kg-1.min-1 and prolonged ICU admission. Her only previous latex exposure was during plastic surgical procedures. Latex allergy was confirmed weeks later using the prick method allergy testing.
Conclusion:
Latex anaphylaxis can occur in otherwise healthy children whose only latex exposure occurred during a previous operation, including plastic surgery.