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British Journal of Anaesthesia 2006 96(6):738-741; doi:10.1093/bja/ael104
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Perioperative anaphylaxis from locally applied rifamycin SV and latex

D. G. Ebo1, G. Verheecke2, C. H. Bridts1, C. H. Mertens1 and W. J. Stevens1,*

1 Department of Immunology, Allergology and Rheumatology, University Antwerp (UA) Belgium
2 Department of Anaesthesiology AZ Klina Brasschaat, Belgium

*Corresponding author: Immunologie, Allergologie, Reumatologie, Universiteit Antwerpen, Campus Drie Eiken (T4.01), Universiteitsplein 1, 2610 Antwerpen (Wilrijk), Belgium. E-mail: immuno{at}ua.ac.be

A patient developed severe anaphylaxis during irrigation of a wound with rifamycin SV. The temporal relationship between application of rifamycin SV, the positive skin test and basophil activation test for rifamycin SV strongly supported diagnosis of anaphylaxis from the locally applied antibiotic. However, after operation the patient had two anaphylactic reactions with pruritus, urticaria and angio-oedema after routine care by a nurse, and these were probably caused by natural rubber latex. This case report has several messages. First, it is not widely appreciated that topically applied drugs and related compounds can elicit life-threatening anaphylaxis. Second, it illustrates patients can present with more than one allergy. Finally, it provides an opportunity to summarize the applications of flow cytometry-assisted quantification of in vitro activated basophils in diagnosing the cause of anaphylaxis during anaesthesia.


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