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Latex provocation tests in patients with spina bifida: who is at risk of becoming symptomatic?
B Niggemann1, D Buck, T Michael
1Department of Pediatrics, Virchow-Clinic of Humboldt University, Berlin, Germany.
Background:
Although there is accepted information on the prevalence rates of sensitization to latex in patients with spina bifida, little is known about the clinical relevance of this sensitization.
Methods:
We performed provocation tests with latex gloves in 159 patients with spina bifida (median age, 10 years).
Results:
Eighty-eight patients (55.3%) were sensitized to latex in terms of a positive skin prick test response, specific IgE to latex in serum, or both. Fifty-five patients (34.6% of all patients or 62.5% of latex-sensitized patients) showed clinical symptoms on provocation. Specific IgE to latex was significantly higher in patients with a positive provocation test response (P <.0001). The total number of operations and degree of sensitization showed a significant correlation. More than 8 operations significantly increased the risk of sensitization (P <.0001), and more than 9 operations increased the risk of allergy to latex (P <.0001). One hundred seventeen (75%) patients had a ventricular shunt system. Specific IgE in these patients was significantly higher than in patients without (P <.0001), and the odds ratio for the existence of a shunt system in terms of a positive provocation was 3.9. Patients with a shunt system were significantly more often sensitized and had positive provocation results (P <.0001). Seventy-two patients (45.3%) were classified as atopic; they were significantly more often sensitized and clinically symptomatic (P <.0001), and the odds ratio for having a positive provocation response was 3.2 for atopic subjects. History of symptoms on contact with material containing latex had a sensitivity of 53.7% and specificity of 94.2%.
Conclusions:
Our results indicate that an atopic disposition, number of operations, and presence of a shunt system increase the risk of becoming not only sensitized but also allergic to latex. Our results strongly support the necessity that patients with spina bifida as a high-risk group for latex allergy should remain latex-free from the first day of life.
