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Anaphylactoid reaction following epidural block: local anaesthetic or latex?

In response to Dr Wildsmith’s letter (Anaesthesia 1993; 48: 916-7) which refuted the ‘delayed intravenous reaction’ to local anaesthetics, reported by Thomas and Caunt (Anaesthesia 1993; 48: 50-2) in a case of anaphylactoid reaction following epidural block, I would like to offer a better and more feasible diagnosis; that this was a case of latex anaphylaxis. Latex anaphylaxis has recently been highlighted in two separate editorials [1,2], as a result of increasing numbers of reports of severe allergic reactions to latex. The reaction, which may be life-threatening, has an important feature of delayed onset (20-150 min or much later) because i t requires time for the responsible allergens to be absorbed into the circulation from latex rubber materials. Anaphylaxis due to anaesthetic agents typically occurs at the time of administration. In this case, anaphylaxis occurred at 25 min after epidural injection, or indeed later if exposure to latex was to blame. The handling of epidural needle and catheter with commonly used latex gloves would have introduced latex allergenic proteins to tissues under the skin, sufficient to trigger an anaphylactic reaction. The above temporal pattern can cause confusion and therefore latex allergy should be suspected. When the subsequent skin testing for this patient was equivocal, other agents should have been considered. Without being tested for latex allergy, this patient could not have been properly and fully managed.