Are Drugs Interchangeable? Sir—curt Furberg and Colleagues

The patient had a sibling who was mismatched for one HLA-haplotype and was able to provide bone-marrow stem cells instead of the matched unrelated donor. Natural rubber latex, the sap of the Brazilian rubber tree, is used to produce rubber, a material now used widely in the household and in medical practice. Immediate hypersensitivity reactions to latex were first reported in 1979, but the incidence of allergy to latex has probably increased in the last decade as a result of widespread use of rubber gloves by health-care workers to prevent microbial spread. Epidemiological studies show that 2–15% of health-care workers are allergic to latex. Anaphylactic reactions in individuals who have an allergy to latex are common during the perioperative period, reflecting the breach of tissue barriers and parenteral administration of drugs and fluids through latexcontaining syringes and tubing. Consequently, there has been an attempt to increase the awareness of anaesthetists in the UK, and specific guidelines have been prepared to ensure that the risk of anaphylaxis is reduced as much as possible. Nevertheless adherence to these guidelines cannot guarantee the safety of any procedure and the anaesthetist involved in this case believed that the risk of general anaesthesia for a healthy volunteer donor could not be justified, a view with which we concur. This case highlights the need to enquire specifically about latex allergy during the medical assessment of prospective haemopoietic stem-cell donors. Specific testing may be indicated, particularly in health-care workers. A history of allergy to latex should probably be regarded as an absolute contraindication to stem-cell donation by a volunteer donor.