PEDIATRICS Vol. 112 No. 2 August 2003, pp. 463-464
IMPACT OF REPEATED SURGICAL PROCEDURES ON THE INCIDENCE AND PREVALENCE OF LATEX ALLERGY: A PROSPECTIVE STUDY OF 1263 CHILDREN
Michael S. Kaplan, MD
Los Angeles, CA
Houribane, JO, Allard JM, Wade AM, McEwan AI, Strobel S. J Pediatr. 2002;140:479–482
 |
Purpose of the Study.
|
|---|
Latex sensitization can occur in up to 70% of children who require
repeated surgeries for spina bifida or bladder extrophy. Primary
prophylaxis is the best approach to reduce the risk of sensitization,
while secondary prophylaxis of sensitized children reduces the
risk for latex allergic reactions. The purpose of this study
was to determine prospectively the prevalence of latex sensitivity
and latex allergic reactions in children admitted to a surgical
referral center for elective surgery.
|
Study Population.
|
|---|
Patients were eligible if they were due to have elective surgery
under general anesthesia. After screening, a final group of
1263 children were enrolled before their first operation during
the study period. The median age at the time of enrollment was
6 years. Fifty-nine percent were males.
|
Methods.
|
|---|
Before each surgery latex-specific immunoglobulin E (IgE) was
measured in vitro (Pharmacia UNICAP, Uppsala, Sweden) and skin
prick testing was performed (Soluprick, ALK-Abello United Kingdom).
One hundred fifty-six repeat operations were performed on this
cohort. Patients were designated latex-allergic (LA) if they
had a history of typical symptoms after latex exposure and they
demonstrated either a positive skin prick test or in vitro test
for latex. Patients without a latex allergy history but with
a positive test for latex were designated as latex-sensitive
(LS). A multiple regression model was used to assess the prevalence
of latex sensitivity as a function of age, number of prior surgeries,
and age at the first operation.
|
Results.
|
|---|
Six cases of latex allergy (LA) were identified (0.47%). Fifty
additional patients were LS. Latex seroconversion occurred in
3 of 144 (2.1%) patients who required repeat operations. Each
of these 3 patients had >3 surgeries before their enrollment
in the study. Statistically significant differences occurred
between the 6 LA patients and the 50 LS patients. LA patients
were older (13.8 vs 9.5 years), had more operations (25 vs 5)
and had higher latex-specific IgE levels (5.62 vs 0.86 kU
A/L).
Data from the LA and LS patients were pooled and compared with
data from the 1207 non-LA/LS patients. Significant difference
was observed. LA/LS patients were older, had more surgeries,
a higher rate of atopy, higher total IgE, had more past or current
asthma and or rhinitis, and a higher incidence of allergy to
kiwi fruit, banana, and peanut.
|
Conclusions.
|
|---|
Previous surgery increased the odds ratio 13-fold. A 16% increase
in risk for latex sensitization occurred for each year increase
in age. Latex seroconversion occurred in 2% of repeat operations.
In this study physician review combined with tests with high
specificity and negative predictive value ruled out false-positive
questionnaire responses.
|
Reviewer’s Comments.
|
|---|
Although the actual incidence of LA reaction was low in this
study as well as other reports, the incidence of sensitization
can be high for children with spina bifida or urogenital malformations.
Potential life-threatening intraoperative anaphylaxis is avoidable
by latex prophylaxis. This study differs from previous reports
that the risk of LA reactions correlates with the absolute number
of repeated surgeries. In this study even 1 prior surgery increased
the risk and there was no correlation with increasing number
of repeat surgeries. Initial and sustained avoidance of latex
devices may be prudent for children with spina bifida or urogenital
defects.
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
TOP
Purpose of the Study.
Study Population.
