In this month’s (March 2011) Anesthesiology
, two articles focus on latex allergy, namely Draisci et al.’s report on the prevalence of latex allergy in obstetrical patients
and Sampathi and Lerman’s case scenario discussion of latex allergy in children
. The subject matter of these two articles doesn’t surprise me since the areas of obstetric anesthesia and pediatric anesthesia comprise most of our cases of latex anaphylaxis.
But here is the real question: is latex allergy that big of a deal for anesthesiologists?
A bit of a history is in order. Back in the mid-1990s, latex allergy was still a “hot” topic. In pediatric anesthesia, we knew that the risk factors were congenital abnormalities (spina bifida or bladder extrophy) and atopy. In fact, all of the case reports in children involved those who had one of these congenital abnormalities. Interestingly, the first reports of latex allergy in adults were exclusively in women during childbirth. To read a great first person account of anaphylaxis, I refer you to Barbara Zucker-Pinchoff’s write-up of experiencing an anaphylactic reaction during childbirth.(1
At that time, many of us were focused on latex allergy and finding substitute equipment to use in those patients with a predisposition for developing latex allergy (we call this “latex precautions”) and those with a true allergy.
In 1998, FDA regulation went into effect that all devices containing latex had to be labeled. Because of this new regulation and heightened awareness of latex allergy, manufacturers made the calculation that if they could remove latex, they would have a better chance of selling their products. The result is that now, there are very few latex-containing products in anesthesia care equipment with the exception of gloves and tourniquets. Even then, non-sterile gloves are almost always latex-free.
Today, if we encounter a patient with potential latex sensitivity or one who is allergic to latex, we just change our tourniquet and make sure we use sterile latex-free gloves. Because of this, in my opinion, latex allergy is not a big deal for anesthesiologists!
The challenge for patients with latex allergy is no longer in the medical setting but rather in the rest of the world. In a news report in 2008, Barbara Zucker-Pinchoff was confronted with latex balloons at the theater, not in the operating room!(3
1. Zucker-Pinchoff B, Ramanathan S. Anaphylactic reaction to epidural fentanyl. ANESTHESIOLOGY 1989;71:599-601
2. Zucker-Pinchoff B, Chandler MJ. Latex anaphylaxis masquerading as fentanyl anaphylaxis: retraction of a case report. ANESTHESIOLOGY 1993;79:1152-3
3. ABC news story
Posted by Amr Abouleish MD, MBA