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. The patient's parents did not consent to a skin-prick test; therefore, a basophil activation test (BAT) was performed to identify the offending anaphylactic agent. All probable allergens, including the anesthetic drugs and surgical materials used, were tested. The BAT results were strongly positive for the rubber dam sheet ( Figure ), indicating that latex was the most probable cause of anaphylaxis. Approximately 9 months later, the dental treatment was successfully performed under general anesthesia using latex-free materials. Figure

Mediators Released During Anaphylaxis Table 2 Clinical Criteria for Diagnosing Anaphylaxis COMMON CAUSATIVE AGENTS Among the myriad of drugs and substances used in the provision of an anesthetic, neuromuscular blockers are the number one cause of reported cases of anaphylaxis with an incidence of 69.2%. 2 Latex (12.1%) is the second leading cause with antibiotics (8%), hypnotics (3.7%), colloids (2.7%), opioids (1.4%), and

bound because of complete paraplegia. Scoliosis and thoracic deformity were observed. The patient had a history of latex allergy with 3 previous episodes of systemic inflammatory response to latex. Sleep-disordered breathing was reportedly observed at night. First Intravenous Sedation Procedure Intravenous sedation using a continuous infusion of propofol was planned. We anticipated problems with the patient's airway, so preparations for tracheal intubation were made. All the devices used were latex free. On arrival in the operating room

appear in the literature. 35 – 37 Simply stated, a patient's claim of a cutaneous reaction or airway compromise leaves little recourse but to avoid prescribing the offending drug. Latex Natural rubber latex is a milky white sap obtained from rubber trees (Hevea brasiliensis) and is used in over 40,000 medical products. 38 , 39 The allergenicity of this substance was first published in 1979, and its incidence began to rise during the latter 1980s and 1990s in concert with improved emphasis on infection control in response to the

anaphylaxis 5 – 15 ; hence, care should be taken when using them ( Table 1 ). Special attention should be observed when using antibiotics such as penicillin, pain medications such as nonsteroidal anti-inflammatory drugs, antiseptics such as chlorhexidine, and latex products in dental practice. Penicillin and amoxicillin are frequently used in dentistry. These antibiotics are classified as β-lactam antibiotics, and cross-reactivity with cephalosporins has been reported, albeit with a low probability of 2%. 29 In addition, Zagursky and Pichichero 30 reported that there is

There is potential risk of an allergic reaction with latex and all drugs including muscle relaxants, antibiotics, local anesthetics, induction drugs, and opioids administered during anesthesia. 1 , 2 Although midazolam is considered a relatively safe drug, it has been reported that midazolam may cause a life-threatening anaphylactoid reaction and hypersensitivity, such as hypotension, edema, and bronchoconstriction, during anesthesia. 3 – 9 We obtained the patient's consent for publication of protected health information of this case

shock occurring during general anesthesia is one of the most serious complications. 1 Many cases have been reported to occur on induction when multiple agents are rapidly administered. Simons et al 2 have reported that skin or mucous membrane changes are the most important signs. Muscle relaxants, latex, or antibiotics have often been shown to be the causative drug, and the muscle relaxant rocuronium bromide has been reported to be the most likely cause. 2 , 3 It has been reported that the possibility of anaphylactic shock in response to rocuronium should be

CASE REPORT A 27-year-old woman (height 156 cm, weight 47 kg, body mass index 19.3 kg/m 2 ) was scheduled for maxillary Le Fort I osteotomy and mandibular bilateral sagittal split osteotomies to correct maxillofacial deformities. She had a history of atopic dermatitis, allergic rhinitis, and retinal detachment; reported allergies to latex, walnuts, and ampicillin; and was taking bilastine daily. The patient denied any history of epistaxis, and preoperative nasal endoscopy showed no abnormal nasal cavity morphology or cysts. No abnormal

bradycardia may be seen rarely. In dental patients, exposure to offending agents for anaphylaxis is relatively uncommon outside of known triggers such as antibiotics (eg, penicillin), latex, and neuromuscular blockers. Local anesthetic allergies are so rare they would seem unlikely to fit the definition of a high-risk allergen as presented in the WAOA Guidance 2020 document. Looking at these differences, it appears that the WAOA anaphylaxis recommendations would be inappropriately applied to hypotension in the absence of skin symptoms following administration of local