Concomitant chronic spontaneous urticaria treatment might hinder the diagnosis of occupational latex-induced anaphylaxis: A case report
Ploylarp Lertvipapath,1 Aree Jameekornrak Taweechue,2 Chamard Wongsa,2 Torpong Thongngarm,2 Waratchaya Uawattanasakul,3 Mongkhon Sompornrattanaphan2
1 Adverse Drug Reaction Unit, Division of Academic Affairs, Department of Pharmacy, Siriraj Hospital, Mahidol University, Bangkok, Thailand
2 Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
3 Out-Patient Pharmacy Division, Department of Pharmacy, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Abstract
Background: Cutaneous manifestations of chronic spontaneous urticaria (CSU) are identical to type 1 hypersensitivity reactions. The daily occurrence of rash from occupational allergy could be misinterpreted as CSU exacerbation.
Objective: We aim to report a nurse with concomitant CSU suffering from latex-induced anaphylaxis.
Method: Skin tests, specific IgE using ImmunoCAP, and gloves challenge were performed.
Result: A 27-year-old nurse with CSU suffered from several episodes of severe urticarial flare. H1-antihistamine up-dosing and oral corticosteroid burst were given. Unfortunately, she developed 3 episodes of anaphylaxis during her routine nursing care work on a medical ward, leading to allergist consultation. She had positive latex-specific IgE (6.86 kUA/L) and positive gloves challenge test.
Conclusion: Concomitant CSU treatment might hinder the recognition of latex allergy by masking or delaying skin manifestations. IgE-mediated allergy should be suspected if there was a change in severity or frequency of previously controlled CSU or the presence of systemic symptoms.
Key words: Anaphylaxis, drug hypersensitivity, hypersensitivity, latex hypersensitivity, nursing, natural rubber latex, skin tests, urticaria