Latex-induced Anaphylactic Reaction in a Child with Spina Bifida Muhammad Waseem, MD, Sandhya Ganti, MD, and Antonia Hipp, DO Abstract: Allergy to natural rubber latex presents a unique challenge in the emergency department. Latex allergy in children is most commonly identified in patients who have undergone multiple operations for neural tube defects or genitourinary anomalies. We report a life-threatening anaphylactic reaction to latex in a patient with spina bifida despite with latex-free precautions. Key Words: latex allergy, anaphylaxis, spina bifida CASE A 14-year-old girl with spina bifida and neurogenic bladder presented to the emergency department with right-sided flank pain and dysuria. She described the pain as dull and radiating to the inguinal area. She had no fever, vomiting, or history of trauma but she reported self-catheterization with a latex-free catheter. She described the pain as dull and radiating to the inguinal area. She had undergone multiple urological procedures under general anesthesia without incident. Previously she had been diagnosed with a latex allergy and was managed with ‘‘apparent’’ latex-free equipment in the emergency department and the latex-free environment was main- tained throughout her stay in the ED according to hospital guidelines. On examination, she was alert, oriented, but uncomfortable because of abdominal pain. Her vital signs were as follows: temperature, 97.88F; heart rate, 68 beats per minute; respiratory rate, 22 breaths per minute; and blood pressure, 115/78 mm Hg. Her chest was clear without any wheeze. She had diffuse abdominal tenderness, which was marked in the suprapubic area and in the right lower quadrant. The rest of her examination was unremarkable. An intravenous line was maintained and fluids were initiated as the patient was kept NPO (nothing by mouth). Approximately 15 minutes after the initiation of intravenous fluids, she developed generalized flushing with stridor and wheezing. Her blood pressure dropped to 74/47 mm Hg and heart rate was noted to be 160 beats per minute. Within a few minutes, she became unresponsive and required respiratory support with endotracheal intubation. A computed tomography scan of abdomen revealed bladder perforation with extravasation of fluid in her abdomen (Fig. 1). After initial stabilization, she was taken to the operating room for surgical repair of her bladder. She had an uneventful recovery and was discharged home in stable condition after 6 days. DISCUSSION Latex allergy continues to be an important medical problem. It is being recognized with increased frequency. 1,2 One important factor related to the increasing recognition of latex allergy was the discovery that it existed. 3 Pediatric patients with spina bifida, bladder exstrophy, and anorectal malformations are at high risk for latex allergy. 4–7 Children with myelomeningocele may be uniquely sensitive because of early and repetitive exposure or altered neuroimmune interactions. 8 Individuals with increased previous exposure to latex (eg, anyone who requires chronic bladder care with repeated insertion of latex catheters or chronic indwelling catheters) are at risk for anaphylaxis to latex. 9 Other significant risk factors are repeat surgical procedures and atopy. 4 – 7,10,11 Latex (natural rubber) is a highly processed polymer derived from the sap of the commercial rubber tree (Hevea brasiliensis). 12,13 Allergy to latex was first reported in 1979. 14 The incidence of latex sensitivity in the general population ranges from 0.8% to 6.5%, 15 whereas the inci- dence of latex sensitivity in patients who require chronic bladder care (eg, individuals with bladder exstrophy and spina bifida) has been reported to be as high as 72%. 11 In another study, 16 the prevalence of latex sensitization and latex allergy among children with spina bifida was 32.4% and 18.8%, respectively. Latex is responsible for type I and type IV allergic reactions, mainly in populations with frequent contact with this allergen, such as children with meningomyelocele. Patients with spina bifida who have frequent operations seem to be particularly vulnerable to immuloglobulin E – latex hypersensitivity reactions, including contact urticaria, rhinitis, FIGURE 1. CT Scan of abdomen and pelvis with contrast showing extravasation of fluid consistent with bladder perfo- ration. Illustrative Case Pediatric Emergency Care  Volume 22, Number 6, June 2006 441 Department of Emergency Medicine, Lincoln Medical & Mental Health Center, Bronx, NY. Address correspondence and reprint requests to Muhammad Waseem, MD, Department of Emergency Medicine, Lincoln Medical & Mental Health Center, 234 E 149th St, Bronx, NY 10451. E-mail: waseemm2001@ hotmail.com. Copyright n 2006 by Lippincott Williams & Wilkins ISSN: 0749-5161/06/2205-0441 Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.