Latex allergy manifested in urological surgery and care of adult spinal cord injured patients.

This report exemplifies the cases of two male and one female spinal cord injury (SCI) patients with latex allergy, two of whom had life threatening episodes of intraoperative cardiovascular collapse. The three patients were extensively exposed to latex products as a result of urinary management programs, and two developed marked hypotension immediately upon abdominal exploration during reconstructive urological surgery. The third case represents the development in a male of latex allergy to over 12 types of latex condoms manifest as penile dermatitis. In each of these cases, allergy and immunology consultation confirmed the latex allergy. The diagnosis of latex allergy was established using both Radioallergosorbert (RAST) testing and a skin test to the latex antigen. The two patients who experienced intraoperative cardiovascular collapse required resuscitation with intravenous fluids, epinephrine, and antihistamines. Because each episode of hypotension occurred during bowel manipulation with latex gloves, they were suspected of inducing anaphylaxis. In the third patient, latex allergy was suspected after the immediate resolution of allergic symptoms upon replacing latex condom catheters with those made of silicone. This is the first report of a life-threatening reaction to latex allergy in the SCI population. Measures instituted to prevent further latex-associated morbidity included the use of medical alert bracelets, self-administration epinephrine injection kits, and nonlatex appliances, including gloves, condoms, and urethral catheters. It is recommended that precautions against the development of anaphylaxis be undertaken in SCI patients with chronic exposure to latex-containing products.