title: Intraoperative anaphylaxis to bacitracin during pacemaker change and laser lead extraction.
abstract: BACKGROUND
  Bacitracin is widely used in operating rooms to soak implants, irrigate compound fractures, and apply to surgical incisions. However, bacitracin is a known sensitizer and causes not only allergic contact dermatitis but also anaphylaxis.
  
  
  OBJECTIVE
  To describe a 72-year-old woman with anaphylaxis after irrigation and packing of an infected pacemaker pocket with a bacitracin solution.
  
  
  METHODS
  Skin prick testing to bacitracin and latex; serum tryptase, serum histamine, serum IgE to latex, and serial cardiac enzyme measurements; blood cultures, transthoracic echocardiograms, and venograms were performed to characterize the reaction.
  
  
  RESULTS
  Six hours after the anaphylactic event, the patient had an elevated serum tryptase level of 49 ng/mL (reference range, 2-10 ng/mL), which normalized the next morning. She had immediate-type skin prick test reactions to full-strength bacitracin ointment (500 U/g) and bacitracin solution (150 U/mL). Serum IgE level to latex was undetectable, and results of skin testing to latex were negative.
  
  
  CONCLUSIONS
  To our knowledge, this is the first case report of anaphylaxis to bacitracin during pacemaker surgery. This case illustrates that intraoperative anaphylaxis to bacitracin can be life-threatening.
authors.affiliation: Department of Allergy/Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236, USA. John.Freiler@lackland.af.mil
authors.forename: John F
authors.initials: JF
authors.lastname: Freiler
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Steel
authors.forename: Larry L
authors.initials: LL
authors.lastname: Hagan
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Rathkopf
authors.forename: Javier
authors.initials: J
authors.lastname: Roman-Gonzalez
mesh_terms: D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D001414:Bacitracin / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010138:Pacemaker, Artificial; D012882:Skin Tests; D007507:Therapeutic Irrigation
chemical_list: D000891:Anti-Infective Agents, Local; D001414:Bacitracin