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Management of latex allergy

Created: 18/5/2006
Updated: 14/10/2008
 

Clinical symptoms


Awake patients may experience a metallic taste in the mouth. The most common symptoms are hypotension, rash/erythema and bronchospasm. Tachycardia occurs due to histamine and secondary release of adrenaline and noradrenaline. Systemic vascular resistance is decreased by up to 80% due to the direct efffects of histamine. Other symptoms include arrhythmias, pulmonary hypertension, pharyngeal oedema, pulmonary oedema, and nausea and vomiting.

Treatment

The management of anaphylaxis due to latex is the same as for all other causes of anaphylaxis. See below for an illustration of the immunological mechanisms of anaphylaxis.
 
Immunological mechanisms of anaphylaxis

Immunological mechanisms of anaphylaxis:

1] Antigen is internalised by the antigen-presenting cell (APC).
2] The internalised antigen is processed within the APC.
3] The APC presents the processed peptide to CD4+ T lymphocytes via the major histocompatibility complex II.
4] After the peptide is presented, the T cell differentiates into TH2 T lymphocytes and produces cytokines. These then cause B cell immunoglobulin isotypes to switch to IgE.
6] Circulating IgE binds to IgE receptors on mast cells.
7] Antigen similar to the original antigen cross-links the mast cell with surface-bound IgE and results in cellular degranulation.


 Click here to view the guidelines produced by The Association of Anaesthetists.

NB. Mini-jets of resuscitation drugs are latex-free.

The patient must be closely monitored on the intensive care unit/high-dependency unit for at least 24 hours as further symptoms may occur.

Investigations


Investigations should be sent as for any other episode of anaphylaxis. Send serum for a mast cell tryptase test 1 hour and 6-24 hours after the onset (to determine the baseline tryptase level). Also send urine for a methylhistamine assay. Explain the situation to the patient and arrange for a medic alert bracelet to be worn.

 Click here to view detailed information regarding the Tryptase test.

 Click here to view Tryptase Case Study

Click here for details about the medic alert system.

ArticleDate:20060518
SiteSection: Article
 
   
    
                                            
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