Safety of Latex EBUS Balloons in patients with Self-Reported Latex Allergy: A Retrospective Study

Safety of Latex EBUS Balloons in patients with Self-Reported Latex Allergy: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety of Latex EBUS Balloons in patients with Self-Reported Latex Allergy: A Retrospective Study Sung H Choi, Mohammed Alsaud, Alvin Yang, Bertin D. Salguero, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8090329/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Convex probe endobronchial ultrasound (EBUS) procedures utilize a latex balloon at the bronchoscope tip to ensure proper ultrasound coupling with the airway wall. Patients with latex allergy are typically advised to avoid all latex exposure due to the risk of severe reactions. This study evaluates the safety of performing EBUS with latex balloons in patients with self-reported latex allergy. Methods We conducted a single-center, retrospective review of all patients who underwent EBUS for lymph node sampling between January 2019 and July 2024, including those with a latex allergy. Key data collected included patient demographics, details of the latex allergy history (e.g., prior reaction severity), any pre-procedure prophylactic measures, and intra- or post-procedure adverse events. The primary outcome was the occurrence of any allergic or adverse reaction during or after the EBUS procedure. Results A total of 38 patients with self-reported latex allergy underwent 48 EBUS procedures. A latex balloon was used in 40 procedures (83%), while in 8 cases (17%), the balloon was not used due to provider concerns. No allergic reactions, anaphylaxis, or adverse events were observed in any patient, including in those with a history of anaphylaxis. Only one patient received premedication with dexamethasone. Conclusions In a controlled setting, EBUS may be safely performed with latex balloons in patients who report latex allergy. Given the potential severity of latex reactions, careful patient assessment and preparedness for emergency management remain essential. Further studies with larger cohorts and confirmatory allergy testing are warranted to validate the safety of this practice. Introduction Latex allergy is a significant concern in medical practice, affecting approximately 1–2% of the general population [ 1 ]. It is an IgE-mediated hypersensitivity reaction to natural rubber latex proteins that can manifest with symptoms ranging from contact urticaria to life-threatening anaphylaxis [ 2 – 3 ]. Notably, latex has been identified as one of the leading causes of severe intraoperative allergic reactions, second only to certain anesthetic drugs [ 4 ]. Consequently, strict avoidance of latex-containing equipment in sensitized individuals is a standard precaution to prevent accidental exposure [ 5 ]. Many hospitals have adopted latex-free protocols for patients with known allergies, given that even small amounts of latex can trigger serious reactions in highly sensitive patients [ 6 ]. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly performed minimally invasive procedure for diagnosing and staging lung cancer and other mediastinal pathologies. A specialized latex balloon is attached to the tip of the EBUS bronchoscope and inflated with saline to provide acoustic coupling between the ultrasound probe and the airway wall, thereby improving ultrasound image quality [ 7 ]. In patients with a known latex allergy, however, balloon use is generally not advised [ 8 ]. The conventional approach for a bronchoscopist faced with a latex-allergic patient is either to perform the EBUS without inflating the balloon or to use an alternative means of coupling such as use of a water-based lubricant [ 9 ]. A recent pilot randomized trial confirmed that using the balloon significantly improves ultrasound image quality compared to no balloon at the 4R LN station, although diagnostic yield may remain similar in the short term [ 10 ]. Thus, the absence of the balloon could make the procedure more technically challenging or prolonged, especially for less experienced operators or in difficult anatomical locations. Recommendations in the allergy and immunology literature uniformly advise against deliberate latex exposure in known allergic individuals. [ 11 , 12 ]. Nonetheless, there is a paucity of data quantifying the actual risk of an allergic reaction in the specific context of EBUS-TBNA. Given the potential drawbacks of not using the EBUS balloon, another possible approach is to cautiously proceed with the latex balloon even in patients reporting latex allergy—essentially testing the assumption that a latex allergic patient will invariably have a reaction. Many “latex-allergic” patients carry that label based on historical reactions or positive testing, but the spectrum of latex allergy is broad. Some patients have only experienced mild contact dermatitis (a type IV hypersensitivity), rather than a true IgE-mediated type I reaction [ 13 ]. Others may have been labeled allergic without definitive testing, leading to possible over-cautious avoidance. Moreover, even among patients with confirmed latex IgE allergy, the degree of sensitivity can vary. It is conceivable that a tightly controlled exposure, such as a latex balloon confined to the airway, might not always provoke a systemic reaction, especially if prophylactic antihistamines or steroids are used (though such prophylaxis is not reliably protective for severe allergy). To date, direct research on using latex-containing devices in latex-allergic patients is extremely limited. In a study of 57 patients with reported latex allergy who underwent linear endoscopic ultrasound (EUS), remarkably no adverse allergic events were reported, even though a latex balloon was used in the majority of cases [ 14 ]. This finding raises the question of whether similar safety can be observed in EBUS procedures. Unlike gastrointestinal endosonography, where non-latex balloons or other alternatives might be available (albeit at higher cost), for EBUS there is no readily available latex-free EBUS balloon on the market. At our institution, we have, in select cases, proceeded with EBUS-TBNA using the latex balloon in patients with self-reported latex allergy, under careful monitoring and preparedness, due to lack of alternatives and a pressing clinical need. This presented an opportunity to retrospectively assess the outcomes of those cases. Methods Study Design and Setting We performed a retrospective cohort study at a large tertiary care academic medical center. After obtaining institutional review board approval from the relevant ethics committee (with waiver of informed consent due to the study’s retrospective nature), we queried our bronchoscopy database for all EBUS-TBNA procedures performed between January 2019 and July 2024. From these, we identified cases in which the patient had a documented latex allergy in their medical record. We then reviewed the electronic health records and procedural reports for each identified case. Inclusion and Exclusion Criteria We included all adult patients (age ≥ 18) with a self-reported or physician-documented latex allergy who underwent a convex probe EBUS procedure for any indication during the study period. If a patient underwent multiple EBUS procedures, each procedure was considered separately for adverse event analysis, but patient characteristics were recorded only once. Data Collection : Using a standardized data abstraction form, we collected the following information for each case: patient demographics (age, sex), underlying diagnosis or reason for EBUS, details of latex allergy history (how the allergy was documented and any noted reaction severity – e.g., contact dermatitis vs. anaphylaxis in the past), whether any pre-procedure prophylaxis was given (such as H1-blockers, H2-blockers, corticosteroids, etc.), and details of the EBUS procedure (number of lymph node stations sampled, duration, type of anesthesia). The primary outcome of interest was any adverse event consistent with an allergic reaction during the procedure or within the post-procedure recovery period. This included any rash/urticaria, bronchospasm, angioedema, hypotension or cardiovascular collapse, or any notation by the medical team of “allergic reaction” or anaphylaxis. We also noted any other complications unrelated to allergy (such as bleeding, infection, or sedation-related events) for completeness. All EBUS procedures at our center are performed with the patient under general anesthesia with an anesthesiologist present, and standard monitoring (continuous pulse oximetry, electrocardiogram (ECG), blood pressure) is used, which would detect hemodynamic changes suggestive of anaphylaxis. Thus, we were confident that a significant allergic event would have been documented if it occurred. Statistical Analysis Given the descriptive nature of this study, we primarily used summary statistics. Categorical data (e.g., presence of prior anaphylaxis history, use of prophylaxis) are presented as counts and percentages. Continuous data (age, etc.) are presented as means or medians as appropriate. We did not perform comparative hypothesis testing due to the lack of a non-exposed control group and the zero incidence of allergic reactions in the study cohort (see ‘Results’ Table 1 below), which precluded calculation of risk differences. All analyses were done using Microsoft Excel and SPSS Version 27. Table 1 Reported Severity and Type of Latex Allergy Number of Patients Type of Reaction Balloon Used? Premedication? 17 Rash, Itching (low)* Yes No 11 Rash (moderate-severe)* Yes No 9 N/A Yes No 1 Angioedema Yes Yes (Dexamethasone 8mg IV) *Self-reported Results Patient Characteristics A total of 38 patients with self-reported latex allergy were included in the study (reported severity of reactions in Table 1 ). The majority of patients were female (32/38, 84%). The mean age at the time of the procedure was 67 years. None of the patients had been formally assessed by an allergist or investigated for latex allergy. EBUS-TBNA Procedures A total of 48 EBUS-TBNA procedures were performed on the 38 patients. A latex balloon was used in 40 procedures. The balloon was not used in 8 procedures; in all of them, the decision was made due to concerns by the medical staff. Six patients underwent multiple bronchoscopies. In one of these procedures, the patient was premedicated with dexamethasone 8 mg IV, administered 30 minutes prior to the procedure, due to a history of anaphylaxis. In the remaining 39 procedures where a balloon was used, none of the patients were premedicated. Allergic Reactions No allergic reactions were noted during or immediately after the procedure in any of the patients. Discussion In this retrospective study, we found that no immediate allergic reactions occurred when using an EBUS latex balloon in patients with self-reported latex allergy. To our knowledge, this is the first study focusing on bronchoscopic ultrasound in this context. The zero-incidence of allergic events in our cohort parallels the findings of an EUS study of 87 procedures on 57 latex-allergic patients where latex ultrasound balloons were used [ 14 ]. (No pre-medication was used). Together, these studies – albeit retrospective – suggest that the risk of serious latex reactions from internal latex balloons (in airway or GI tract) may be lower than traditionally feared. Several considerations may explain why our patients did not experience reactions despite their latex allergy history. First, it is possible that many of these patients were not as highly sensitive as presumed. “Latex allergy” as noted in charts can encompass a range of immunologic profiles [ 1 ]. Some patients have only had mild or localized reactions in the past, which might indicate a lower burden of IgE or primarily a contact (Type IV) sensitivity rather than a systemic Type I allergy. In our series, a portion of patients had only contact dermatitis history; such patients might tolerate brief internal exposure without issue. Second, even among patients with genuine Type I latex allergy, the dose and route of exposure during EBUS may be a factor that influences safety [ 15 ]. The latex balloon is a relatively small surface area – this controlled exposure is quite different from powdered latex gloves being snapped or latex encountering broken skin or directly with the bloodstream. It’s conceivable that the amount of latex antigen that leaches out from an intact balloon into the airway mucosa is minimal. Moreover, any small amount of antigen might induce only localized irritation (if any) rather than a full systemic response. The absence of any detectable reaction in our high-risk patients, including those with prior anaphylaxis, is especially intriguing – it suggests a possibility that the threshold for triggering anaphylaxis was not reached in these cases, though we cannot know if trace immunologic responses occurred; we did not measure tryptase or perform any immunologic assays post-procedure. Another possible limitation of our series is the possible element of selection bias. It is possible that the most severely latex-allergic patients were never referred for EBUS with a latex balloon at all out of caution. Thus, our cohort might represent a somewhat “lower-risk” subset of latex-allergic individuals, even though some did have past reported anaphylaxis. Additionally, because this was not a prospective trial, we did not systematically expose patients to latex in a controlled fashion; rather, we observed what happened in necessary clinical cases. The sample size, while one of the largest to date on this topic, is still modest. A true incidence of a severe reaction could be higher but our study may simply be underpowered to detect it. In addition, our follow-up was limited to checking for any delayed reactions within a week; we did not systematically follow patients long-term, but it is unlikely for a latex allergic reaction to present beyond the immediate hours after exposure. Our findings must be interpreted in light of the standard recommendations that currently exist [ 12 – 16 ]. Our study is not advocating that these recommendations be disregarded; rather, it provides real-world data for situations wherein the ideal cannot be achieved. If faced with a critical need to get diagnostic samples via EBUS in a latex-allergic patient, our experience suggests that it may be possible to proceed with extreme caution. Furthermore, the specific clinical scenario and technology used can influence the necessity of the balloon. For example, in our experience with the newer Olympus BF-UC190F, a third-generation EBUS-TBNA bronchoscope, the catheter’s sheath often needs to be extended further out as it tends to sometimes get pushed back during scope flexion. This makes the use of a balloon crucial for consistent contact between the ultrasound probe and the bronchial wall. This need for consistent contact is also critical when certain lymph node stations (such as stations 4L and 10L) or lesions, especially in patients with prominent airway cartilaginous rings, are targeted, as these can be much harder to visualize without the balloon, particularly in less experienced hands or when trying to biopsy very small targets. Key precautions should include performing the case in a fully monitored setting (preferably with an anesthesiologist), having emergency medications (epinephrine, albuterol, etc.) and equipment ready at bedside, minimizing any other latex in the environment, and possibly, pre-medicating the patient. Under those controlled conditions, as our series indicates, the likelihood of a severe reaction might be very low. Another consideration is the availability of non-latex equipment. In other fields, latex-free versions of devices have become available. As of this writing, most EBUS systems on the market come with latex balloons. Development of a silicone or other synthetic polymer EBUS balloon would eliminate this issue entirely. Cost, however, is a factor – non-latex medical products tend to be more expensive, and unless the demand is high, companies may not have the incentive to produce a specialized non-latex EBUS balloon [ 14 ]. Conclusion This study provides evidence that, under carefully controlled conditions, the use of latex EBUS balloons may not result in any immediate allergic complications. In select scenarios, bronchoscopists may consider proceeding with the latex balloon with appropriate precautions. However, this should be done with thorough patient counseling and readiness to manage an adverse event. Our findings should not be interpreted as an outright negation of latex allergy concerns, but rather as an expansion of the knowledge needed to balance risks and benefits. Future prospective research or multi-center registries could further elucidate the safety profile and help establish definitive guidelines for managing latex allergy in bronchoscopic procedures. Abbreviations EBUS Endobronchial ultrasound EBUS-TBNA Endobronchial ultrasound-guided transbronchial needle aspiration GI Gastrointestinal IV Intravenous ECG Electrocardiogram EUS Endoscopic ultrasound LN Lymph node Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board of the Mount Sinai School of Medicine (Study ID: STUDY-24-01006, Approval Period: October 11, 2024 to October 10, 2027), operating under FWA#00005656 and FWA#00005651, with a waiver of informed consent. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its later amendments. Consent for publication Not applicable. This manuscript does not include any individual person’s identifiable images or personal data. Availability of data and materials The datasets generated and analyzed during the current study are availble from the corresponding author on reasonable request. Competing interest The authors declare that they have no competing interests. Funding No funds, grants or other financial support were received during the preparation/execution of this study. Authors’ contributions S.C, M.A and U.C designed and wrote the main manuscript text. A.Y performed data collection and statistical analysis. B.S and A.A performed statistical analysis and contributed to discussion and conclusion. All authors revied the manuscript. Acknowledgement Not applicable. References Nguyen K, Kohli A. Latex Allergy. StatPearls Publishing; 2023 Jul. p. 10. Binkley HM, Schroyer T, Catalfano J. Latex allergies: a review of recognition, evaluation, management, prevention, education, and alternative product use. J Athl Train. 2003;38(2):133–40. Taylor JS, Erkek E. Latex allergy: diagnosis and management. Dermatol Ther. 2004;17(4):289–301. Cabañes N, Igea JM, de la Hoz B, et al. Latex allergy: Position Paper. J Investig Allergol Clin Immunol. 2012;22(5):313–30. British Thoracic Society Bronchoscopy Guidelines Committee, a Subcommittee of Standards of Care Committee of British Thoracic Society. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001;56(Suppl 1):i1–21. 10.1136/thorax.56.suppl_1.i1 . Palosuo T, Antoniadou I, Gottrup F, Phillips P. Latex medical gloves: time for a reappraisal. Int Arch Allergy Immunol. 2011;156(3):234–46. 10.1159/000323892 . Gilbert CR, Dust C, Argento AC, et al. Acquisition and Handling of Endobronchial Ultrasound Transbronchial Needle Samples: An American College of Chest Physicians Clinical Practice Guideline. Chest. 2025;167(3):899–909. 10.1016/j.chest.2024.08.056 . Avasarala SK, Aravena C, Almeida FA. Convex probe endobronchial ultrasound: historical, contemporary, and cutting-edge applications. J Thorac Dis. 2020;12(3):1085–99. 10.21037/jtd.2019.10.76 . Harris K, Dhillon SS. Enhancing Endobronchial Ultrasound Images Using a Water-based Lubricant Technique. Ann Am Thorac Soc. 2015;12(11):1734–6. Huseini T, DeMaio A, Yarmus L, et al. The Impact of Balloon Use during Endobronchial Ultrasound: A Randomized Pilot Study. Respiration. 2025;104(4):272–80. 10.1159/000542448 . Preheim EA, Chen D, Gandhi N, et al. Latex Allergy Alerts in the Age of CPOE: Assessing the Risk From Injectable Medications. Hosp Pharm. 2022;57(4):413–5. Sussman GL, Gold MS. Guidelines for the Management of Latex Allergies and Safe Latex Use in Health Care Facilities. American College of Allergy, Asthma & Immunology (ACAAI); 1996. Burkhart C, Schloemer J, Zirwas M. Differentiation of latex allergy from irritant contact dermatitis. Cutis. 2015;96(6):369–401. Salame M, Tariq R, Siddiqui A, et al. Safety of EUS Latex Balloon Use in Patients with a Latex Allergy. Gastrointest Endosc. 2024;99(6):1032–4. Charous BL, Tarlo SM, Charous MA, Kelly K. Natural rubber latex allergy in the occupational setting. Methods. 2002;27(1):15–21. 10.1016/S1046-2023(02)00047-6 . Neupane N. Endobronchial Ultrasound: Practice Essentials, Technique, Post-Procedure. Medscape; 2023 Jun 15. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8090329","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":563266073,"identity":"4b5f10bf-4200-4f41-8246-ebc8ae46f6cd","order_by":0,"name":"Sung H Choi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYBAC+QYGBmYGhgMMbMzMBx//qQAKMTM34NVicACmhZ0t2YDnDEgLIwEtDFAtDPw8ZhK8bSAxQlokcg+/Lqi5I8fHzGNsIDmvNpq/HajlR8U23H6ZkZdmPePYM2M2ZrbCB4bbjufOOMzYwNhz5jZua27kmBnzNhxObGNm3myQuO1YbgNQCzNjG1FaGMwkDs45ljufCC3GjyFaWMwkGxtqcjcQ0mJw5o0ZM8+xwyC/JBszHDuQuxGo5SA+v8i35xh/5qk5LCfff/jgY4aautx55w8ffPCjAo/DGBjYJJA4h8HkAXzqgYD5AxKnjoDiUTAKRsEoGIkAAIrGW7sIPETxAAAAAElFTkSuQmCC","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":true,"prefix":"","firstName":"Sung","middleName":"H","lastName":"Choi","suffix":""},{"id":563266074,"identity":"8db43bec-4f8b-4af9-a44e-e508235ef4e4","order_by":1,"name":"Mohammed Alsaud","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai Morningside/West Hospitals","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Alsaud","suffix":""},{"id":563266076,"identity":"99397f30-f94f-4749-b6c7-e51ac6d92cfa","order_by":2,"name":"Alvin Yang","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai Morningside/West Hospitals","correspondingAuthor":false,"prefix":"","firstName":"Alvin","middleName":"","lastName":"Yang","suffix":""},{"id":563266078,"identity":"c2479017-f9a7-486c-86f8-1c91e3e3a0ec","order_by":3,"name":"Bertin D. 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It is an IgE-mediated hypersensitivity reaction to natural rubber latex proteins that can manifest with symptoms ranging from contact urticaria to life-threatening anaphylaxis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Notably, latex has been identified as one of the leading causes of severe intraoperative allergic reactions, second only to certain anesthetic drugs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Consequently, strict avoidance of latex-containing equipment in sensitized individuals is a standard precaution to prevent accidental exposure [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Many hospitals have adopted latex-free protocols for patients with known allergies, given that even small amounts of latex can trigger serious reactions in highly sensitive patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly performed minimally invasive procedure for diagnosing and staging lung cancer and other mediastinal pathologies. A specialized latex balloon is attached to the tip of the EBUS bronchoscope and inflated with saline to provide acoustic coupling between the ultrasound probe and the airway wall, thereby improving ultrasound image quality [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In patients with a known latex allergy, however, balloon use is generally not advised [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The conventional approach for a bronchoscopist faced with a latex-allergic patient is either to perform the EBUS without inflating the balloon or to use an alternative means of coupling such as use of a water-based lubricant [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A recent pilot randomized trial confirmed that using the balloon significantly improves ultrasound image quality compared to no balloon at the 4R LN station, although diagnostic yield may remain similar in the short term [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Thus, the absence of the balloon could make the procedure more technically challenging or prolonged, especially for less experienced operators or in difficult anatomical locations.\u003c/p\u003e \u003cp\u003eRecommendations in the allergy and immunology literature uniformly advise against deliberate latex exposure in known allergic individuals. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nonetheless, there is a paucity of data quantifying the actual risk of an allergic reaction in the specific context of EBUS-TBNA. Given the potential drawbacks of not using the EBUS balloon, another possible approach is to cautiously proceed with the latex balloon even in patients reporting latex allergy\u0026mdash;essentially testing the assumption that a latex allergic patient will invariably have a reaction. Many \u0026ldquo;latex-allergic\u0026rdquo; patients carry that label based on historical reactions or positive testing, but the spectrum of latex allergy is broad. Some patients have only experienced mild contact dermatitis (a type IV hypersensitivity), rather than a true IgE-mediated type I reaction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Others may have been labeled allergic without definitive testing, leading to possible over-cautious avoidance. Moreover, even among patients with confirmed latex IgE allergy, the degree of sensitivity can vary. It is conceivable that a tightly controlled exposure, such as a latex balloon confined to the airway, might not always provoke a systemic reaction, especially if prophylactic antihistamines or steroids are used (though such prophylaxis is not reliably protective for severe allergy).\u003c/p\u003e \u003cp\u003eTo date, direct research on using latex-containing devices in latex-allergic patients is extremely limited. In a study of 57 patients with reported latex allergy who underwent linear endoscopic ultrasound (EUS), remarkably no adverse allergic events were reported, even though a latex balloon was used in the majority of cases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This finding raises the question of whether similar safety can be observed in EBUS procedures. Unlike gastrointestinal endosonography, where non-latex balloons or other alternatives might be available (albeit at higher cost), for EBUS there is no readily available latex-free EBUS balloon on the market. At our institution, we have, in select cases, proceeded with EBUS-TBNA using the latex balloon in patients with self-reported latex allergy, under careful monitoring and preparedness, due to lack of alternatives and a pressing clinical need. This presented an opportunity to retrospectively assess the outcomes of those cases.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e \u003cp\u003e We performed a retrospective cohort study at a large tertiary care academic medical center. After obtaining institutional review board approval from the relevant ethics committee (with waiver of informed consent due to the study\u0026rsquo;s retrospective nature), we queried our bronchoscopy database for all EBUS-TBNA procedures performed between January 2019 and July 2024. From these, we identified cases in which the patient had a documented latex allergy in their medical record. We then reviewed the electronic health records and procedural reports for each identified case.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e \u003cp\u003eWe included all adult patients (age\u0026thinsp;\u0026ge;\u0026thinsp;18) with a self-reported or physician-documented latex allergy who underwent a convex probe EBUS procedure for any indication during the study period. If a patient underwent multiple EBUS procedures, each procedure was considered separately for adverse event analysis, but patient characteristics were recorded only once.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eData Collection\u003c/b\u003e: Using a standardized data abstraction form, we collected the following information for each case: patient demographics (age, sex), underlying diagnosis or reason for EBUS, details of latex allergy history (how the allergy was documented and any noted reaction severity \u0026ndash; e.g., contact dermatitis vs. anaphylaxis in the past), whether any pre-procedure prophylaxis was given (such as H1-blockers, H2-blockers, corticosteroids, etc.), and details of the EBUS procedure (number of lymph node stations sampled, duration, type of anesthesia). The primary outcome of interest was any adverse event consistent with an allergic reaction during the procedure or within the post-procedure recovery period. This included any rash/urticaria, bronchospasm, angioedema, hypotension or cardiovascular collapse, or any notation by the medical team of \u0026ldquo;allergic reaction\u0026rdquo; or anaphylaxis. We also noted any other complications unrelated to allergy (such as bleeding, infection, or sedation-related events) for completeness. All EBUS procedures at our center are performed with the patient under general anesthesia with an anesthesiologist present, and standard monitoring (continuous pulse oximetry, electrocardiogram (ECG), blood pressure) is used, which would detect hemodynamic changes suggestive of anaphylaxis. Thus, we were confident that a significant allergic event would have been documented if it occurred.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003cp\u003eGiven the descriptive nature of this study, we primarily used summary statistics. Categorical data (e.g., presence of prior anaphylaxis history, use of prophylaxis) are presented as counts and percentages. Continuous data (age, etc.) are presented as means or medians as appropriate. We did not perform comparative hypothesis testing due to the lack of a non-exposed control group and the zero incidence of allergic reactions in the study cohort (see \u0026lsquo;Results\u0026rsquo; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below), which precluded calculation of risk differences. All analyses were done using Microsoft Excel and SPSS Version 27.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReported Severity and Type of Latex Allergy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType of Reaction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBalloon Used?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePremedication?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRash, Itching (low)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRash (moderate-severe)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAngioedema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes (Dexamethasone 8mg IV)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Self-reported\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003ePatient Characteristics\u003c/b\u003e A total of 38 patients with self-reported latex allergy were included in the study (reported severity of reactions in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of patients were female (32/38, 84%). The mean age at the time of the procedure was 67 years. None of the patients had been formally assessed by an allergist or investigated for latex allergy.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEBUS-TBNA Procedures\u003c/b\u003e A total of 48 EBUS-TBNA procedures were performed on the 38 patients. A latex balloon was used in 40 procedures. The balloon was not used in 8 procedures; in all of them, the decision was made due to concerns by the medical staff. Six patients underwent multiple bronchoscopies. In one of these procedures, the patient was premedicated with dexamethasone 8 mg IV, administered 30 minutes prior to the procedure, due to a history of anaphylaxis. In the remaining 39 procedures where a balloon was used, none of the patients were premedicated.\u003c/p\u003e \u003cp\u003e \u003cb\u003eAllergic Reactions\u003c/b\u003e No allergic reactions were noted during or immediately after the procedure in any of the patients.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective study, we found that no immediate allergic reactions occurred when using an EBUS latex balloon in patients with self-reported latex allergy. To our knowledge, this is the first study focusing on bronchoscopic ultrasound in this context. The zero-incidence of allergic events in our cohort parallels the findings of an EUS study of 87 procedures on 57 latex-allergic patients where latex ultrasound balloons were used [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. (No pre-medication was used). Together, these studies \u0026ndash; albeit retrospective \u0026ndash; suggest that the risk of serious latex reactions from internal latex balloons (in airway or GI tract) may be lower than traditionally feared.\u003c/p\u003e \u003cp\u003eSeveral considerations may explain why our patients did not experience reactions despite their latex allergy history. First, it is possible that many of these patients were not as highly sensitive as presumed. \u0026ldquo;Latex allergy\u0026rdquo; as noted in charts can encompass a range of immunologic profiles [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Some patients have only had mild or localized reactions in the past, which might indicate a lower burden of IgE or primarily a contact (Type IV) sensitivity rather than a systemic Type I allergy. In our series, a portion of patients had only contact dermatitis history; such patients might tolerate brief internal exposure without issue. Second, even among patients with genuine Type I latex allergy, the dose and route of exposure during EBUS may be a factor that influences safety [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The latex balloon is a relatively small surface area \u0026ndash; this controlled exposure is quite different from powdered latex gloves being snapped or latex encountering broken skin or directly with the bloodstream. It\u0026rsquo;s conceivable that the amount of latex antigen that leaches out from an intact balloon into the airway mucosa is minimal. Moreover, any small amount of antigen might induce only localized irritation (if any) rather than a full systemic response. The absence of any detectable reaction in our high-risk patients, including those with prior anaphylaxis, is especially intriguing \u0026ndash; it suggests a possibility that the threshold for triggering anaphylaxis was not reached in these cases, though we cannot know if trace immunologic responses occurred; we did not measure tryptase or perform any immunologic assays post-procedure. Another possible limitation of our series is the possible element of selection bias. It is possible that the most severely latex-allergic patients were never referred for EBUS with a latex balloon at all out of caution. Thus, our cohort might represent a somewhat \u0026ldquo;lower-risk\u0026rdquo; subset of latex-allergic individuals, even though some did have past reported anaphylaxis. Additionally, because this was not a prospective trial, we did not systematically expose patients to latex in a controlled fashion; rather, we observed what happened in necessary clinical cases. The sample size, while one of the largest to date on this topic, is still modest. A true incidence of a severe reaction could be higher but our study may simply be underpowered to detect it. In addition, our follow-up was limited to checking for any delayed reactions within a week; we did not systematically follow patients long-term, but it is unlikely for a latex allergic reaction to present beyond the immediate hours after exposure.\u003c/p\u003e \u003cp\u003eOur findings must be interpreted in light of the standard recommendations that currently exist [\u003cspan additionalcitationids=\"CR13 CR14 CR15\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Our study is not advocating that these recommendations be disregarded; rather, it provides real-world data for situations wherein the ideal cannot be achieved. If faced with a critical need to get diagnostic samples via EBUS in a latex-allergic patient, our experience suggests that it may be possible to proceed with extreme caution. Furthermore, the specific clinical scenario and technology used can influence the necessity of the balloon. For example, in our experience with the newer Olympus BF-UC190F, a third-generation EBUS-TBNA bronchoscope, the catheter\u0026rsquo;s sheath often needs to be extended further out as it tends to sometimes get pushed back during scope flexion. This makes the use of a balloon crucial for consistent contact between the ultrasound probe and the bronchial wall. This need for consistent contact is also critical when certain lymph node stations (such as stations 4L and 10L) or lesions, especially in patients with prominent airway cartilaginous rings, are targeted, as these can be much harder to visualize without the balloon, particularly in less experienced hands or when trying to biopsy very small targets. Key precautions should include performing the case in a fully monitored setting (preferably with an anesthesiologist), having emergency medications (epinephrine, albuterol, etc.) and equipment ready at bedside, minimizing any other latex in the environment, and possibly, pre-medicating the patient. Under those controlled conditions, as our series indicates, the likelihood of a severe reaction might be very low.\u003c/p\u003e \u003cp\u003eAnother consideration is the availability of non-latex equipment. In other fields, latex-free versions of devices have become available. As of this writing, most EBUS systems on the market come with latex balloons. Development of a silicone or other synthetic polymer EBUS balloon would eliminate this issue entirely. Cost, however, is a factor \u0026ndash; non-latex medical products tend to be more expensive, and unless the demand is high, companies may not have the incentive to produce a specialized non-latex EBUS balloon [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides evidence that, under carefully controlled conditions, the use of latex EBUS balloons may not result in any immediate allergic complications. In select scenarios, bronchoscopists may consider proceeding with the latex balloon with appropriate precautions. However, this should be done with thorough patient counseling and readiness to manage an adverse event. Our findings should not be interpreted as an outright negation of latex allergy concerns, but rather as an expansion of the knowledge needed to balance risks and benefits. Future prospective research or multi-center registries could further elucidate the safety profile and help establish definitive guidelines for managing latex allergy in bronchoscopic procedures.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEBUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndobronchial ultrasound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEBUS-TBNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndobronchial ultrasound-guided transbronchial needle aspiration\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGastrointestinal\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntravenous\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eECG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eElectrocardiogram\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEndoscopic ultrasound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of the Mount Sinai School of Medicine (Study ID: STUDY-24-01006, Approval Period: October 11, 2024 to October 10, 2027), operating under FWA#00005656 and FWA#00005651, with a waiver of informed consent.\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This manuscript does not include any individual person’s identifiable images or personal data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are availble from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds, grants or other financial support were received during the preparation/execution of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.C, M.A and U.C designed and wrote the main manuscript text. A.Y performed data collection and statistical analysis. B.S and A.A performed statistical analysis and contributed to discussion and conclusion. All authors revied the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNguyen K, Kohli A. Latex Allergy. StatPearls Publishing; 2023 Jul. p. 10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBinkley HM, Schroyer T, Catalfano J. Latex allergies: a review of recognition, evaluation, management, prevention, education, and alternative product use. J Athl Train. 2003;38(2):133\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor JS, Erkek E. Latex allergy: diagnosis and management. Dermatol Ther. 2004;17(4):289\u0026ndash;301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaba\u0026ntilde;es N, Igea JM, de la Hoz B, et al. 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Cutis. 2015;96(6):369\u0026ndash;401.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalame M, Tariq R, Siddiqui A, et al. Safety of EUS Latex Balloon Use in Patients with a Latex Allergy. Gastrointest Endosc. 2024;99(6):1032\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCharous BL, Tarlo SM, Charous MA, Kelly K. Natural rubber latex allergy in the occupational setting. Methods. 2002;27(1):15\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S1046-2023(02)00047-6\u003c/span\u003e\u003cspan address=\"10.1016/S1046-2023(02)00047-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeupane N. Endobronchial Ultrasound: Practice Essentials, Technique, Post-Procedure. Medscape; 2023 Jun 15.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8090329/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8090329/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eConvex probe endobronchial ultrasound (EBUS) procedures utilize a latex balloon at the bronchoscope tip to ensure proper ultrasound coupling with the airway wall. Patients with latex allergy are typically advised to avoid all latex exposure due to the risk of severe reactions. This study evaluates the safety of performing EBUS with latex balloons in patients with self-reported latex allergy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We conducted a single-center, retrospective review of all patients who underwent EBUS for lymph node sampling between January 2019 and July 2024, including those with a latex allergy. Key data collected included patient demographics, details of the latex allergy history (e.g., prior reaction severity), any pre-procedure prophylactic measures, and intra- or post-procedure adverse events. The primary outcome was the occurrence of any allergic or adverse reaction during or after the EBUS procedure.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 38 patients with self-reported latex allergy underwent 48 EBUS procedures. A latex balloon was used in 40 procedures (83%), while in 8 cases (17%), the balloon was not used due to provider concerns. No allergic reactions, anaphylaxis, or adverse events were observed in any patient, including in those with a history of anaphylaxis. Only one patient received premedication with dexamethasone.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn a controlled setting, EBUS may be safely performed with latex balloons in patients who report latex allergy. Given the potential severity of latex reactions, careful patient assessment and preparedness for emergency management remain essential. Further studies with larger cohorts and confirmatory allergy testing are warranted to validate the safety of this practice.\u003c/p\u003e","manuscriptTitle":"Safety of Latex EBUS Balloons in patients with Self-Reported Latex Allergy: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 17:56:32","doi":"10.21203/rs.3.rs-8090329/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"46891371-e1f4-4083-be04-d5b8bf812c56","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-29T09:44:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 17:56:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8090329","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8090329","identity":"rs-8090329","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}