Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits

Background: Latex causes anaphylaxis in specific contexts among children. W e present 2 cases that show that severe reactions may occur in everyday cir cumstances with latex as a contaminant. Objective: Because 2 cases of severe reactions to latex suggested similar c ircumstances of exposure, we investigated the immediate environment in whic h episodes occurred. Methods. A 5-year-old girt presented to our casualty department with anaphy laxis 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 belongi ng 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 fi nger testing. Immunoblotting of elutions from a ball, the natural rubber la tex foam pit lining and its polyvinyl chloride sheet were performed. Results: In the girl's immunoblot high levels of IgE specific to Hey b 4, H ev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to R ev b 7. The polyvinyl chloride ball sample showed a high concentration of s pecific Hevea species allergen similar to that of the foam layer sample. Conclusion. Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and th erefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent p otentially severe reactions in young customers of fast-food outlets.