High Risk of Sensitization to Latex in Children with Spina Bifida

Abstract

The risk of per-operative anaphylactic shock in response to latex is established in children with spina bifida. This study focuses on 30 children with spina bifida and aims at evaluating the value of predictive tests (skin tests and RAST). No patient had shown a preoperative accident. Hypersensitivity to latex, sometimes suspected by questioning of the patient, was detected 12 times out of 30 (40%). 10 children of the 12 were atopic (83%). The incidence of atopy is significantly higher than that of the general pediatric population (14 out of 30; 46%). This study demonstrates the frequency of the latent hypersensitivity to latex and the subsequent potential risk of per-operative anaphylactic shock. This sensitization can be partly explained by multiple contacts with latex; urinary catheterization several times a day, daily use of latex gloves for routine care, repetitive surgery (more than 8 operations per child). However, atopy increases the risk of sensitization to latex. The authors underline the importance of taking preventive measures for these children such as the use of PVC, silicone or polyurethane catheters and of synthetic rubber. Hypoallergenic gloves are under investigation. A questionnaire and systematic preventive cutaneous assessment before each operation are strongly advised.

Natural rubber latex allergy: prevalence and risk factors in patients with spina bifida compared with atopic children and controls

“…This high percentage of latex sensitized children with spina bi®da is in accordance with the literature [2,4,7,16]. Antibody formation is promoted by the ®rst operation soon after birth and is stimulated by repeated operations.…”

“…Several studies showed a higher prevalence of atopic children among the latex sensitized patients with spina bi®da [4,7,15,16], in studies with greater numbers of patients ranging from 35% [7] to 49% [15]. We found 22% of children with atopic disease in our study without any signi®cant dierence between latex sensitized and not sensitized children.…”

Risk factors for latex allergy in patients with spina bifida

“…We found a rate of sensitization to latex of 49% in the spina bifida group. In the literature, prevalence rates range from 34% [8], 40% [9] and 49% [10] up to 64.5% [11]. The validity of our data may be high, because we investigated the largest number of spina bifida patients published so far.…”

“…We found that 34% of latex-sensitized patients with spina bitida were atopic in terms of presence of specific IgE in serum to common environmental allergens. In the literature, figures from 27% [2] up to 83% [9] have been reported. However, the numbers of patients were small in these studies.…”

Latex Allergy in Children

“…By far the most relevant risk group are children with spina bifida: prevalence rates for sensitization in these children range from 25 [14], 34 [15], 38 [16], 40 [17], 49 [18], and 55.3 [19]to even 64.5% [20]. In summary, approximately every second child with spina bifida is sensitized to latex.…”