[MCOH-EH] Life threatening allergic reaction in in-patient nurse

[Galaid Edward I]

Cross posting to OEM List and MCOH.

64 year old LPN, employed here for 36 years, had acute onset hand erythema, swelling, itching, followed by general weakness, slight shortness of breath, thought she was going to faint, and then blacked out.    Immediately prior to onset, she had been performing perineal care on a patient with non-sterile nitrile exam gloves, and then did a straight cath.  The sterile gloves were vinyl.   The catheter was latex, but she did not have any direct contact without gloves being worn.

She was quickly transported to the ED by wheelchair.  Her initial BP was 66/42, HR 85, O2 sat 87% room air.  She was arousable.  Serial BPs over the next half hour were 62/41, 79/42,  97/68 after fluid  bolus.  Subsequently received epinephrine, diphenhydramine, methylprednisolone, and BP came up to 116/78, pulse 101.   Troponins and D-Dimer were negative; abd CT done because of nonspecific abdominal pain; AAA ruled out.   Intestinal wall edema was attributed to the anaphylaxis.  Her LVEF was 72%.  All of her labs were normal throughout hospitalization.  Her exam was remarkably unremarkable.  She was observed overnight in the ICU, then to the floor where I saw her .    She was subsequently discharged home.  Checked in on her yesterday, and she wants to know when she can go back to work.

Past medical history of hypertension and hypothyroidism, on amlodipine and levothyroxine.   No changes in her meds, no food allergies, no hobbies, no nuthin'.

When I talked to her, she said that "there was something different" about the gloves on the straight cath tray, but didn't think much about it.  We talked with several nurses on the floor, and apparently they had noticed something as well.  When we talked with the manufacturer's rep, he told us that four months ago, there had been a minor change in the packaging and labeling of the sterile vinyl gloves, but that was it.  We're trying to find out if there was anything else changed in the manufacturing process or their supplier.

Not much in the literature on allergies to PVC gloves, but in 2014 there was a report of tricresyl phosphate, a plasticizer in PVC gloves, causing an allergic contact derm.  Only could get the abstract.

Any similar experiences or insight to share certainly will be appreciated.

Ed Galaid

Edward I. Galaid, MD, MPH
ABIM, ABPM
Medical Director, Occupational Health Partners
Roper St . Francis       Charleston, SC
Member, ACOEM Task Group on Medical Guidance for Law Enforcement Officers
Member, NFPA 1582 Writing Group - NFPA Technical Committee on Fire Fighter Safety and Health
843-906-0519


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