Reduction of Latex Sensitisation in Spina Bifida Patients by a Primary Prophylaxis Programme (Five Years Experience)

Abstract

Spina bifida patients represent a group with the highest risk for latex sensitisation and allergy with life-threatening symptoms mostly during surgery. At the end of 1995 we initiated a primary latex prophylaxis around and during surgery and anaesthesia of all spina bifida patients.

The aim of our study was to investigate the prevalence of latex sensitisation in the spina bifida patients born during the five years after establishing latex prophylaxis in the Cologne Children's Hospital in December 1995. We investigated 34 serum samples of 27 spina bifida patients (mean age 2.4 years) for specific IgE antibodies against latex allergens (CAP system) and compared these patients born after 1995 with 38 spina bifida patients up to 5 years of age (mean 3.1 years) born before.

In the prophylaxis group two of 27 patients (7 %), one of them with two operations outside the Children's Hospital, had low specific IgE against latex (≤ 0.9 kU/l, 3 and 5 operations). The other patients in this group were not sensitised despite up to 8 operations (min. 1, mean 3.1). In contrast, before introducing the prophylaxis, 16 of 38 patients (42 %) were latex IgE-positive after multiple operations (min. 2, max. 11, mean 4.7) with values of specific IgE up to > 100 kU/l (mean 22.6 kU/l, min 0.4 kU/l). Sera of 22 patients remained negative for latex IgE (min. 1, max. 19, mean 4.3 operations).

By primary latex prophylaxis during surgery, anaesthesia and in paediatric wards the prevalence of latex sensitisation can be significantly reduced even in the high risk group of spina bifida patients. Problems can arise by the need for surgery in hospitals not experienced in the treatment of spina bifida patients, where latex prophylaxis is neglected.

Latex sensitisation - Latex allergy - Primary prophylaxis - Spina bifida

References

• 1 Baur X, Allmers H, Raulf-Heimsoth M. Naturlatex-Allergie. Empfehlungen der interdisziplinären Arbeitsgruppe.  Allergologie. 1996;  19 248-251
• 2 Baur X, Chen Z. et al . Protein and allergen content of various natural latex articles.  Allergy. 1997;  52 661-664
• 3 Baur X, Rennert J. et al . Latex allergen elimination in natural latex sap and latex gloves by treatment with alkaline potassium hydroxide solution.  Allergy. 1997;  52 306-311
• 4 Beuers U, Baur X, Schraudolf M, Richter W O. Anaphylactic shock after game of squash in atopic woman with latex allergy. (Letter).  Lancet. 1990;  335 1095
• 5 Chen Z, Cremer R, Bauer X. Latex allergy correlates with operation.  Allergy. 1997;  52 873
• 6 Cinquetti M, Peroni D. et al . Latex allergy in a child with banana anaphylaxis.  Acta Paediatr. 1995;  84 709-710
• 7 Cremer R, Kleine-Diepenbruck U, Hoppe A, Blaker F. Latex allergy in spina bifida patients - prevention by primary prophylaxis.  Allergy. 1998;  53 709-711
• 8 Cremer R, Hoppe A, Korsch E, Kleine-Diepenbruck U, Blaker F. Natural rubber latex allergy: prevalence and risk factors in patients with spina bifida compared with atopic children and controls.  Eur J Pediatr. 1998;  157 13-16
• 9 Hourihane J O'B, Allard J M, Wade A M, McEwan A I, Strobel S. Impact of repeated surgical procedures on the incidence and prevalence of latex allergy: A prospective study of 1263 children.  J Pediatr. 2002;  140 479-482
• 10 Nieto A, Mazon A, Pamies R, Lanuza A, Munoz A, Estornell F, Garcia-Ibarra F. Efficacy of latex avoidance for primary prevention of latex sensitization in children with spina bifida.  J Pediatr. 2002;  140 370-372
• 11 Niggemann B, Kulig M, Bergmann R, Wahn U. Development of latex allergy in children up to 5 years of age - a retrospective analysis of risk factors.  Pediatr Allergy Immunol. 1998;  9 36-39
• 12 Niggemann B, Buck D, Michael T, Haberl H, Wahn U. Latex allergy in spina bifida: At the turning point?.  J Allergy Clin Immunol. 2001;  16 1201
• 13 Reider N, Kretz B, Menardi G, Ulmer H, Fritsch P. Outcome of a latex avoidance program in a high-risk population for latex allergy - a five-year follow-up study.  Clin Exp Allergy. 2002;  32 708-713
• 14 Schürer N Y, Fillies B. et al .Die Latextransparenzliste. Köln; Dahlhausen & Co. GmbH 1995
• 15 Sussman G L, Beezhold D H, Perrella F W, Jones J. IgE-dependent reactions to urologic catheter extracts by skin testing in latex-allergic patients.  Annals Allergy Asthma Immunol. 1995;  75 133-137
• 16 Task Force on Allergic Reactions to Latex . Committee report.  J Allergy Clin Immunol. 1993;  92 16-18
• 17 Ventura A, Bertolani P. et al . Do pacifiers cause latex allergy?.  Allergy. 1999;  54 100