Diagnosis and Assessment
ÎA standardized commercial skin test reagent for NRL is not available in the United States. In this regard, allergists have prepared NRL extracts from gloves to use for clinical testing. It should be noted, however, that such extracts prepared from gloves demonstrate tremendous variability in content of NRL allergen. Nevertheless, skin prick test with NRL extract to identify IgE-mediated sensitivity should be considered if patients are members of high risk groups or have a clinical likelihood of NRL allergy and have negative
tests. (C)
ÎPatients with spina bifida (regardless of a history of NRL allergy) and patients with a positive history of NRL allergy ideally should have all medical-surgical-dental procedures performed in a NRL-safe environment. (D)
ÎA NRL-safe environment is an environment in which no NRL gloves are used in the room or surgical suite and there is limited NRL accessories (catheters, adhesives, tourniquets, and anesthesia equipment or devices) which come in contact with the patient. (D)
ÎIn health care settings, general use of NRL gloves with negligible allergen content, powder-free NRL gloves, and nonlatex gloves and medical articles should be considered in an effort to minimize patient exposure to latex. Such an approach can diminish NRL sensitization of health care workers and patients and reduce the risk of reactions to NRL in previously sensitized individuals. (D)
ÎPatients with a diagnosis of NRL allergy by history and/or skin or blood testing should wear a medical identification bracelet, carry a medical identification card, or both. If patients have a history of anaphylaxis to NRL, it is important for them to carry auto-injectible epinephrine. (D)
Anaphylaxis During General Anesthesia, the Intra-Operative Period, and the Postoperative Period
ÎThe incidence of anaphylaxis during anesthesia has been reported to range from 1 in 4000 to 1 in 25,000. Anaphylaxis during anesthesia can present as cardiovascular collapse, airway obstruction, and/or skin manifestations. (C)
ÎIt can be difficult to differentiate between immune and nonimmune mast cell-mediated reactions and pharmacologic effects from the variety of medications administered during general anesthesia. In addition, cutaneous manifestations of anaphylaxis are less likely to be apparent when anaphylaxis occurs in this setting. (B)
ÎThe evaluation of IgE-mediated reactions to medications used during anesthesia can include skin testing to a variety of anesthetic agents. (B)
ÎThe management of anaphylactic reactions that occur during general anesthesia is similar to the management of anaphylaxis in other situations. (B)
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