title: Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits.
abstract: BACKGROUND
  Latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant.
  
  
  OBJECTIVE
  Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred.
  
  
  METHODS
  A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an American-style fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. Latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. Immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed.
  
  
  RESULTS
  In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific Hevea species allergen similar to that of the foam layer sample.
  
  
  CONCLUSIONS
  Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets.
authors.affiliation: Department of Child and Maternal Medicine, The Melloni Hospital, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fiocchi
authors.forename: P
authors.initials: P
authors.lastname: Restani
authors.forename: C
authors.initials: C
authors.lastname: Ballabio
authors.forename: G R
authors.initials: GR
authors.lastname: Bouygue
authors.forename: A
authors.initials: A
authors.lastname: Serra
authors.forename: M
authors.initials: M
authors.lastname: Travaini
authors.forename: L
authors.initials: L
authors.lastname: Terracciano
mesh_terms: D000707:Anaphylaxis / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D020315:Latex Hypersensitivity / Q000209:etiology*; D008297:Male; D010988:Play and Playthings