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The search of latex sensitization in spina bifida: diagnostic approach
A Nieto1, A Mazón, F Estornell
1Section of Paediatric Allergy, Children's Hospital La Fe, Valencia, Spain.
Insights
Latex sensitization is a significant risk for children with spina bifida. This study proposes a diagnostic approach using skin prick tests and CAP tests to identify sensitization effectively.
Area of Science:
- Pediatric Allergy and Immunology
- Clinical Diagnostics
Background:
- Latex sensitization poses a serious health risk to children with spina bifida, necessitating proactive screening.
- Life-threatening allergic reactions can occur, highlighting the urgency of early detection.
Purpose of the Study:
- To develop and validate a diagnostic strategy for identifying latex sensitization in pediatric spina bifida patients.
- To establish reliable diagnostic cut-off points for screening methods.
Main Methods:
- Evaluated 100 children with spina bifida using skin prick tests (SPT) and latex-specific serum immunoglobulin E (IgE) via CAP test.
- Determined optimal diagnostic thresholds for SPT and CAP tests based on receiver-operating characteristic (ROC) curve analysis.
- Assessed risk factors associated with latex sensitization, including surgical history and atopy.
Main Results:
- Recommended SPT with a latex skin test area > 25% of histamine area (sensitivity 79%, specificity 100%) or CAP class ≥ 2 (sensitivity 88%, specificity 100%) for diagnosis.
- Identified key risk factors: >5 operations (OR=8), personal history of atopy (OR=11.5), and serum total IgE ≥ 2 z-units (OR=4).
- Anamnesis showed 44% sensitivity and 100% specificity for diagnosis.
Conclusions:
- Proposed a two-step diagnostic algorithm for routine evaluation of latex sensitization in children with spina bifida.
- Prioritizes skin prick tests as the initial diagnostic step, followed by CAP testing for confirmation.
Background:
Sensitization to latex has become a major problem in children with spina bifida. Life-threatening reactions may occur in these patients, therefore the search of latex sensitization must be an active task in all of these children.
Objective:
To design an approach for the diagnosis of latex sensitization in children with spina bifida.
Methods:
We studied 100 consecutive unselected patients. Skin prick tests with a commercial latex extract were performed, latex-specific serum immunoglobulin (Ig) E was determined by CAP test, and risk factors were studied. Originally, patients with an area of latex skin test > 50% of the area of histamine and/or CAP class > or = 3 were considered sensitized to latex. Diagnostic tests were also performed in a control group of 51 atopic and nonatopic children.
Results:
After performing a receiver-operating characteristics curve for both tests we recommend skin tests > 25% of the area of histamine (sensitivity - SEN = 79%, specificity - SPE = 100%, positive predictive value - PPV = 100%, negative predictive value - NPV = 90%), or CAP class > or = 2 (SEN = 88%, SPE = 100%, PPV = 100%, NPV = 94%) as diagnostic cut-off points. The anamnesis had a SEN of 44% for diagnosis, and a SPE of 100%. Latex sensitization was associated with more than 5 operations (OR = 8, 95% CI = 3-21.3), a personal history of atopy (OR = 11.5, 95% CI = 2.3-57.1), and serum total IgE > or = 2 z-units (OR = 4, 95% CI = 1. 6-10).
Conclusion:
For the routine evaluation of children with spina bifida, we propose a diagnostic algorithm with skin prick tests as a first step and CAP second.