AnaphylaxisDuetoAirborneExposuretoLatexina.pptVIP

Anaphylaxis Due to Airborne Exposure to Latex in a Primigravida 麻醉部 林子富 17 March, 2004 History Taking A 32-yr-old gravida 1 para 0 patient at 38 weeks’ gestational age premature rupture of membrane Abnormal fetal presentation With a history of asthma Allergic reactions to seafoods Had no previous surgery Presenting Symptoms Approximately 35 min after spinal injection Cough Tightness in the throat Rhino-conjunctivitis Sneezing Ocular itch Tearing Conjunctival congestion Breathing difficulty Restlessness Decreased SpO2 to 72 % No chest tightness No wheezing No apparent change on blood pressure Mild increase in heart rate No skin reactions: itching, rash, flushing, hives, urticaria… No other medications used other than piton-s, ergotamine and intrathecal marcaine. Initial Diagnosis Based on symptoms and signs suggestive of an anaphylactic reaction after unintentional exposure to airborne latex particles… Immediate Measures Taken.. Keep maintaining airway with 100 % oxygen. Wash hands thoroughly Bricanyl and epinephrine via nebulization Vena 30 mg IV Methylprednisolone 40 mg IV Epinephrine 10 μg IV Quick resolution of symptoms Natural Rubber Latex NRL cis-1,4-polyisoprene is a milky fluid obtained from Hevea brasiliensis tree. Incidence of latex anaphylaxis increased since the 1980s because of Universal Precautions. Hev b proteins are major allergens in latex. Hev v 5 sensitization is common among health care workers. Cornstarch acts as a carrier for latex allergens by binding to latex proteins. Natural Rubber Latex Mandate by FDA since Sep. 30 1998 “Caution: The packing of this product contains natural rubber latex which may cause allergic reactions” Labeling statements relating to “hypoallergenic” are prohibited. Products containing latex Urinary catheter Tourniquet Rubber plunger of syringe IV tubing Tape ECG pad Reactions Associated with Latex Latex sensitization Presence of IgE antibodies to latex Without clinical symptoms Latex allergy Any immune-related reac