Severe anaphylactic shock due to ethylene oxide in a patient with myelomeningocele: successful exposure prevention and pretreatment with omalizumab.

Ethylene oxide (EO) is a highly reactive gas widely used for sterilization of medical devices, for example, plastic materials and ventriculoperitoneal shunts. Allergic reactions to EO are rare and have been observed mainly in patients during hemodialysis and myelomeningocele patients. We describe severe anaphylaxis to EO in a patient with myelomeningocele during general anesthesia. A detailed description is provided about the prevention measures aimed at reducing exposure to EO including a novel approach by resterilization with plasma. Also, pretreatment with omalizumab was implemented for the first time in such a case. With these measures, further surgeries in our patient were uneventful.