title: Evaluation of a prospectively administered written questionnaire to reduce the incidence of suspected latex anaphylaxis during elective cesarean delivery.
abstract: BACKGROUND
  Life-threatening anaphylaxis has been reported in women exposed to latex during surgery. We compared a written screening questionnaire to identify suspected latex sensitivity with a verbal inquiry used previously in a historical control group of women undergoing cesarean delivery to determine if the incidence of suspected latex anaphylaxis could be reduced.
  
  
  METHODS
  To identify suspected latex sensitivity among women undergoing elective cesarean delivery in a single-site tertiary unit, a nine-item written screening questionnaire was compared to historical use of a standard verbal inquiry "Are you allergic to medications or latex?". Women who had suspected latex sensitivity risk factors, or who had known latex allergy, underwent latex-free surgery. Women with suspected anaphylaxis during cesarean delivery were recommended to undergo allergen testing. The primary study outcome was suspected anaphylaxis incidence during the two periods: historical control January to December 2008, questionnaire March 2010 to April 2011.
  
  
  RESULTS
  The questionnaire identified suspected latex sensitivity in 66 of 453 women (14.6%) who completed the questionnaire. The standard verbal inquiry group had identified 12 of 460 women (2.6%) with self-reported latex sensitivity. The incidence of suspected anaphylaxis during cesarean delivery was significantly lower during the questionnaire period when compared to historical controls (3/516, 0.6% vs. 11/460, 2.4%, P=0.015). For both groups, 13 of 14 women (92.9%) with suspected latex anaphylaxis were contactable; five of 13 (38.5%) had undergone allergen testing and all were positive for latex.
  
  
  CONCLUSIONS
  Use of the written screening questionnaire was associated with fewer cases of suspected anaphylaxis during cesarean delivery compared with the historical control. Most women with suspected anaphylaxis did not perform allergy testing; however, all who did were positive for latex.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Péer
authors.affiliation: Department of Quality Assurance, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: M L
authors.initials: ML
authors.lastname: Brezis
authors.affiliation: Department of Allergy and Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Shalit
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: B
authors.initials: B
authors.lastname: Carvalho
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: P D
authors.initials: PD
authors.lastname: Levin
authors.affiliation: Department of Midwifery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Seri
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: carolynfweiniger@gmail.com.
authors.forename: C F
authors.initials: CF
authors.lastname: Weiniger
mesh_terms: D000293:Adolescent; D000328:Adult; D000707:Anaphylaxis / Q000517:prevention & control*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D020315:Latex Hypersensitivity / Q000517:prevention & control*; D008297:Male; D011446:Prospective Studies; D011786:Quality Control; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cesarean delivery; Latex allergy; Questionnaire