Latex provocation tests in patients with spina bifida: who is at risk of becoming symptomatic?

Abstract

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. We performed provocation tests with latex gloves in 159 patients with spina bifida (median age, 10 years). 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%. 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.