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Reducing incidence of latex anaphylaxis during cesarean delivery
Abstract Number: T-11
Abstract Type: Original Research
Introduction: The incidence of latex anaphylaxis is higher during surgical procedures among women, in particular cesarean delivery. In our tertiary institution with 5600 deliveries and 21% cesarean delivery rate, 11 cases of latex anaphylaxis during cesarean delivery were recorded during the year 2008. A latex-free policy was subsequently adopted for all cesarean deliveries, but discontinued 8 months later for financial reasons.
Study objective: To decrease the incidence of latex anaphylaxis among parturients undergoing cesarean delivery by using a directed questionnaire to assess incidence and risk factors for latex sensitivity.
Methods: Questions validated in previously published studies by skin prick tests and/or serum latex IgE antibodies with high sensitivity and specificity to detect latex sensitivity were collated in a questionnaire which was administered prospectively to all women undergoing elective cesarean delivery. Elective cases were chosen for logistical reasons. Women identified as latex sensitive from the questionnaire underwent latex free cesarean delivery (gloves and urinary catheter). Data were collected for the incidence of latex anaphylaxis during cesarean deliveries for three consecutive periods: no questionnaire/latex period, no questionnaire/latex-free period, questionnaire/latex period. Epidemiological and medical details were collected from the questionnaires. Patients who developed anaphylaxis during the study period were referred for allergy testing, specifically latex IgE or latex skin prick test. Sample size of 416 women was required for a significance level of 5% and power of 80%. Financial analysis using a decision tree assessed the economic impact of the questionnaire compared with latex-free management on the incidence of latex anaphylaxis in cesarean delivery.
Results: Four hundred and fifty three parturients completed the questionnaire over 14 months. The incidence of latex suspicion from the questionnaire was 14.6%. The incidence of latex anaphylaxis was 2%(11/460 cases) during the no questionnaire/latex period and reduced to 0% (among 302 cases), p =0.003 during the no questionnaire/latex-free period and to 0.6% (3/526 cases) in the questionnaire/latex period, p =0.015. Sensitivity analysis showed latex-free surgery as the least costly policy when the incidence of anaphylaxis is ≥2% or the cost for latex anaphylaxis therapy including ICU is ≥500 US dollars. All latex anaphylaxis cases were referred (with many verbal/written reminders) to allergy clinic for testing but only 7/16 (44%) attended, all were positive to skin prick test for latex.
Conclusions: Using the questionnaire significantly reduced the incidence of latex anaphylaxis during elective cesarean delivery, but did not eliminate the occurrence completely. Using latex-free surgery in the operation room during cesarean delivery was the most efficient policy both medically and economically.