Patient information 

A 31 year old woman who

• shows a delayed hypersensitivity reaction to nickel

• has had several operations - including appendicectomy, herniorrhaphy & four caesarian sections

• (in retrospect) experienced a less severe episode of facial swelling and wheezing after blowing up some balloons

Main complaint 

During treatment to remove an abscess the surgeon wore latex gloves, within 10 minutes the patient experienced facial swelling, tight throat and wheezing. Her GP arrived to find her moribund, she was rushed to hospital and survived a respiratory arrest.

Referral 

The patient was immediately referred to the local A&E department.

Diagnosis

The GP diagnosed anaphylaxis and injected adrenaline, chlophenirame, and hydrocortisone.

Various tests were performed under controlled conditions to ascertain the cause:

Patch tests

• various rubber chemicals gave a negative result

• nickel and cobalt gave a positive result

Prick tests

• positive hypersensitive reaction to piece of latex rubber after 10 minutes, showing a 5mm weal and 15mm flare

• negative reaction to control polythene glove

Other tests

• blood tests taken after 36 hours showed normal C3 and C4 concentrations, and a C1 esterase inhibitor concentration of 0.12 g/l - which excluded idiopathic angio-oedema

Results and Treatment 

The results show a severe immediate hypersensitivity reaction to latex rubber was the cause of her anaphylactic reaction. The patient had probably been sensitised by repeated contact with latex rubber surgical gloves during multiple operations and treatment. 

The patient recovered within 24 hours and was discharged from hospital. Pre-loaded syringes containing adrenaline (0.5ml 1/1,000) were provided for intramuscular infection and 240mg of terfenadine to take orally at the onset of any attack.

Source:  

Severe anaphylactic reaction to latex rubber surgical gloves.  Mansell P, Reckless JPD and Lovell CR.  British Dental Journal 1995; 178(3): 86-87.