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.
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.
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.
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 kUA/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.
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.
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.