Nieto A, Mazon A, Pamies R, et al. J Pediatr. 2002;140:370–372
Purpose of the Study.
Sensitivity to latex or natural rubber is very common in children with spina bifida (SB). The American Academy of Allergy, Asthma, and Immunology (AAAAI) has recommended a latex-free environment for all procedures performed on SB patients as a means of preventing latex allergy. The purpose of this study was to assess the efficacy of latex avoidance for primary prevention of latex sensitization.
Two groups of patients with spina bifida were selected for study. The 15 group I patients received no preventative measures. They represent the natural history of latex sensitization. The 22 group II patients were born later when latex-free measures had been implemented at the study site and parental education for latex avoidance was routine. Children were followed for a 6-year period. When >1 evaluation was done, the latest was used.
Data were recorded regarding gender, age, personal and family atopic history, number of operations, number of cystourethrograms, presence of ventriculoperitoneal (VP) shunt, and clinical reaction to latex. Allergy testing was done in vitro and by skin prick testing to commercial latex extract, banana and chestnut. These foods are among those that can cross-react to latex. A total serum immunoglobulin E (IgE) was also measured. Comparisons for the above parameters were made between the 2 groups of SB patients.
There were no significant differences in the above parameters between the 2 groups except for the prevalence of latex sensitization and clinical latex reactions. Latex sensitization occurred in 27% of group I patients (no prophylaxis) versus 4.5% of group II patients (prophylaxis). None of the patients had a positive allergy test or clinical sensitivity to banana or chestnut. A total of 5 patients had a clinical latex reaction. Only 1 patient was from group II and all 5 patients had VP shunts. All of these patients had evidence of latex sensitivity by either a positive prick test or positive in vitro test.
Latex avoidance reduced the prevalence of latex sensitivity by 6-fold.
The number of patients in this study was small, as were the number of operations and cystourethrograms. Latex exposure in group I patients is less than reported elsewhere. In other studies of children with SB or congenital urogenital malformations multiple surgeries or frequent exposure to latex devices are risk factors for sensitization. In this study the mean number of operations was 3.3 ± 1.5 for group I and 2.8 ± 2.3 for group II. Only 37 of 137 SB patients followed by this group were reported. No information was given as to the prevalence of clinical latex allergy reactions for entire cohort. The reduced sensitization in the latex avoidance group supports the recommendations of the AAAAI for early and sustained latex avoidance for such patients.