Sompornrattanaphan Mongkhon, Kreetapirom Piyawut, Srinoulprasert Yuttana, Kanistanon Duangjit, Klinniyom Anchalika, Wongsa Chamard, Thongngarm Torpong
1Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Pediatrics, Chaophya Hospital, Bangkok, Thailand.
Allergy Asthma Clin Immunol. 2019 Mar 29;15:19. doi: 10.1186/s13223-019-0335-4. eCollection 2019.
Natural rubber latex and chlorhexidine have previously been identified as causative substances in perioperative anaphylaxis. A pelvic examinations is generally considered noninvasive, however, this procedure is rarely associated with severe allergic reactions. We reported a rare case of dual latex and chlorhexidine allergies which caused anaphylaxis after pelvic examination in a woman with a history of latex-related fruits allergy.
A 54-year-old woman had severe anaphylaxis after a pelvic examination due to dual latex and chlorhexidine (CHX) allergies. The gynecologist used CHX for the vaginal preparation and wore latex-containing gloves with lubricating gel during the examination. In vivo and in vitro tests revealed CHX sensitization by a positive skin prick test to chlorhexidine at a very low concentration (0.002 mg/mL), and a positive basophil activation test to CHX. Latex allergy was confirmed by a positive specific IgE to latex and a positive glove-use test at 20 min. An analysis of specific IgE to latex component revealed positive results for Hev b 1, 5, 6.02, and 11. As she also had a past history of fruit allergy, prick-to-prick testing with latex-related fruits was performed. The results were positive for avocado, banana, jackfruit, kiwi, and longan.
Concomitant mucosal exposure of both natural rubber latex and CHX in highly sensitized patients during pelvic examinations can lead to severe anaphylaxis. Pre-procedural screening for an allergy to latex or CHX, or to any other allergen, should be performed in patients where there is suspicion of a specific allergy due to a previous allergic reaction. Increased awareness of these two allergens in all healthcare settings may improve patient safety.
天然橡胶乳胶和洗必泰先前已被确定为围手术期过敏反应的致病物质。盆腔检查通常被认为是无创的，然而，该操作很少与严重过敏反应相关。我们报告了一例罕见的乳胶和洗必泰双重过敏病例，该病例在一名有乳胶相关水果过敏史的女性进行盆腔检查后引发了过敏反应。
一名54岁女性在盆腔检查后因乳胶和洗必泰双重过敏发生严重过敏反应。妇科医生在检查期间使用洗必泰进行阴道准备，并戴着含有乳胶的手套及润滑凝胶。体内和体外测试显示，通过对极低浓度（0.002 mg/mL）洗必泰的皮肤点刺试验阳性以及对洗必泰的嗜碱性粒细胞活化试验阳性，证实了洗必泰致敏。乳胶过敏通过对乳胶的特异性IgE阳性和20分钟时的手套使用试验阳性得以确认。对乳胶成分的特异性IgE分析显示，Hev b 1、5、6.02和11呈阳性结果。由于她既往有水果过敏史，因此对与乳胶相关的水果进行了点刺试验。鳄梨、香蕉、菠萝蜜、猕猴桃和龙眼的试验结果呈阳性。
在盆腔检查期间，高度敏感患者同时黏膜接触天然橡胶乳胶和洗必泰可导致严重过敏反应。对于因既往过敏反应而怀疑有特定过敏的患者，应在术前进行乳胶或洗必泰或任何其他过敏原的过敏筛查。在所有医疗环境中提高对这两种过敏原的认识可能会提高患者安全性。
