Surgery in a patient allergic to ethylene oxide

Excerpt

To the editor—Ethylene oxide (EO), an alkylating compound of high chemical reactivity, is widely used as a sterilisation gas for various medical devices (MD) that are heat-sensitive. This type of sterilisation can cause rare but severe allergic reactions in sensitive patients. Allergic manifestations such as hives/rash, asthma or anaphylactic shock have been noted among patients in repeated contact with EO-sterilised MD. Widespread hypersensitivity to EO has also been documented in numerous dialysis patients [1, 2]. Allergic reactions to EO-treated products have also been described in several children with spina bifida [3]. The high prevalence of sensitisation to EO, and the frequency, unpredictability, and potential danger of anaphylactic reactions to EO have led to the conclusion that EO sterilisation of dialyzers should be discontinued, since alternative modalities of sterilisation are currently available. However, in spite of the progressive desorption of EO after prolonged storage times, residual EO is still detectable in the milligram range. Even though intraoperative rinsing with physiological saline reduced the residual level of EO [4, 5], this approach has not been validated and so safety cannot be guaranteed for the sensitive/allergic patient. …