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An Update for the Otolaryngologist

Matthew L. Kashima, MD, MPH; David E. Tunkel, MD; Charles W. Cummings, MD

Arch Otolaryngol Head Neck Surg. 2001;127:442-446.

Objective  To describe the clinical manifestations of latex allergy in otolaryngology patients.

Design  Descriptive case series.

Setting  Tertiary academic otolaryngology practice.

Patients  Otolaryngology patients with documented allergic reactions to latex during surgery and confirmatory laboratory test results for latex allergy.

Main Outcome Measures  Clinical description of latex reactions; identification of risk factors for latex allergy.

Results  We describe 3 patients, 2 children and 1 young adult, with severe latex allergy manifested by intraoperative cardiorespiratory changes and confirmed by positive latex-specific IgE test results. A 9-year-old boy with a tracheotomy and a history of multiple procedures for laryngeal stenosis developed a rash and unexplained bronchospasm during an open laryngeal procedure. Surgery was aborted, and subsequent surgery was performed uneventfully 4 weeks later using a latex-safe environment. A 13-year-old boy with recurrent respiratory papillomatosis and a ventriculoperitoneal shunt had sudden unexplained arterial oxygen desaturation and a rash during laser endoscopy. He was then treated successfully using latex-safe protocols. A 23-year-old man with a parotid malignancy developed unexplained hypotension and ventilatory difficulties in the operating room during preparation for surgery. He responded to medical treatment for anaphylaxis.

Conclusion  The otolaryngologist should share in the increased awareness of latex allergy. Our patients who have had multiple surgical procedures or who are exposed to latex on a long-term basis may be at increased risk. Latex allergy should be considered when unexplained cardiorespiratory compromise occurs during surgery.

From the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.

Corresponding author and reprints: David E. Tunkel, MD, Johns Hopkins Outpatient Center, Room 6231, 601 N Caroline St, Baltimore, MD 21287-0910 (e-mail: dtunkel{at}jhmi.edu).