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Severe Anaphylactic Shock Due to Ethylene Oxide in a Patient with Myelomeningocele: Successful Exposure Prevention and Pretreatment with Omalizumab

Listyo, Adrian MD*; Hofmeier, Kathrin Scherer MD*; Bandschapp, Oliver MD; Erb, Thomas MD; Hasler, Carol-Claudius MD§; Bircher, Andreas J. MD*

doi: 10.1097/ACC.0b013e3182a08ff1
Case Reports: Case Report

Ethylene oxide (EO) is a highly reactive gas widely used for sterilization of medical devices, for example, plastic materials and ventriculoperitoneal shunts. Allergic reactions to EO are rare and have been observed mainly in patients during hemodialysis and myelomeningocele patients. We describe severe anaphylaxis to EO in a patient with myelomeningocele during general anesthesia. A detailed description is provided about the prevention measures aimed at reducing exposure to EO including a novel approach by resterilization with plasma. Also, pretreatment with omalizumab was implemented for the first time in such a case. With these measures, further surgeries in our patient were uneventful.

From the *Allergy Unit, Dermatology Clinic and Departments of Anesthesia and Intensive Care/Pediatric Anesthesia and Pediatric Anesthesia, University Hospital; and §Orthopaedic Department, University Children’s Hospital, Basel, Switzerland.

Accepted for publication May 2, 2013.

Funding: Financial support was received from the research funds of the Allergy Unit, Dermatology Clinic, University Hospital, Basel, Switzerland.

The authors declare no conflicts of interest.

Address correspondence to Andreas J. Bircher, MD, Allergy Unit, Dermatology Clinic, University Hospital, Petersgraben 4, 4031 Basel, Switzerland. Address e-mail to

© 2014 International Anesthesia Research Society
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