Latex allergy: the incidence among Turkish children with atopic disease and with neural tube defects
N. Akçakaya*, K. Kulak**, A. Hassanzadeh**, Y. Camcio%glu* and H. Çoku%gra sx***
Division of Infectious Disease. Clinical Immunology and Allergy. Department of Pediatrics. Cerrahpasxa Medical Faculty. Istanbul University. Turkey. *Professor of Pediatrics. Istanbul University. Cerrahpasxa Faculty of Medicine. **General Pediatricians. Istanbul University. Cerrahpasxa Faculty of Medicine. ***Associated Professor of Pediatrics. Istanbul University. Cerrahpasxa Faculty of Medicine.
Correspondence:
Prof. Dr. Necla Akçakaya
Sakayik Sok.Susehri AP.
No. 18 Kat: 2 D: 5
Tesvikiye-Sisli
Istanbul-Turkey
SUMMARY
Background: latex allergy occurs mainly in people exposed to latex products because of their occupation or because of repeated surgery. Atopy is a strong predisposing factor. Identification of latex sensitive individuals can be life saving.
Methods: to investigate the incidence of latex hypersensitivity, 212 children with atopic disease, 85 with neural tube defects and 200 normal children aged 2 to 14 years were interviewed and prick skin tests were performed.
Results: latex allergy was found in 10.8% of atopic children, 30.5% of children with neural tube defects, and 1% of normal children. Latex allergy incidence in operated children with neural tube defects was found 3.5 times more frequently in compare with non-operated patients.
Conclusions: atopic children and children with neural tube defects should carefully be followed up for latex allergy specially if recurring itching, urticaria, eczema, rhinitis and eye symptoms are present.
Key words: Atopic disease. Child latex allergy. Neural tube defect.
RESUMEN
Antecedentes: se produce alergia a látex sobre todo en personas expuestas a los productos de látex por su trabajo o por intervenciones quirúrgicas repetidas. La atopia es un factor predisponente importante. La identificación de individuos sensibles al látex puede salvar vidas.
Métodos: para investigar la incidencia de la hipersensibilidad al látex, 212 niños con atopia, 85 niños con defectos del tubo neural y 200 niños sanos, de edades comprendidas entre los 2 y 14 años, fueron entrevistados y sometidos a pruebas cutáneas.
Resultados: se encontró alergia al látex en 10,8% de los niños atópicos, en 30,5% de los niños con defectos del tubo neural y en 1% de los niños sanos. La incidencia de alergia al látex en los niños con defectos del tubo neural intervenidos quirúrgicamente fue 3,5 veces más frecuente que en los pacientes no intervenidos.
Conclusiones: los niños atópicos y los niños con defectos del tubo neural deben ser controlados para detectar la alergia al látex, sobre todo si presentan síntomas de picor, urticaria, eccema, rinitis y molestias oculares.
Palabras clave: Enfermedad atópica. Niños. Alergia a látex. Defecto del tubo neural.
INTRODUCTION
Since its initial description in 1979, latex allergy has been a medical problem of increasing significance. Latex protein hypersensitivity has been reported to cause anaphylactic reactions, asthma, eczema, urticaria and death, especially in high-risk groups such as rubber industry workers, children with spina bifida, health care workers and persons requiring multiple operative procedures (1-3). As with most other allergens, latex-specific IgE antibodies have been detected using both skin testing and immunoassays. Skin testing has been assumed to be more sensitive than immunoassays even though there are few reports of direct comparison (4). The aim of this study was to determine the incidence of latex allergy in children, by performing the skin test in various groups (atopic children, children with neural tube defects, and normal children) and by assessing the history and clinical features.
MATERIALS AND METHOD
Patient selection
To determine the incidence and clinical features of latex allergy in patients with neural tube defects, and its association with other allergic conditions (asthma, rhinitis, atopic dermatitis and food hypersensitivity) a prospective study was designed in the out patient clinic or our allergy section. Three groups of subjects were evaluated. Group 1 consisted of 212 children aged 2 to 14 years (103 boys and 109 girls) randomly chosen from patients previously diagnosed as having allergic asthma (151), allergic rhinitis (27), atopic dermatitis (24) and food hypersensitivity (10). Group 2 consisted of 85 children aged 2 to 14 years (40 boys and 45 girls) with neural tube defects followed together with the department of neurosurgery from 1995 to 1996. Group 3, which was our control group, consisted of 200 healthy children aged 2 to 14 years (100 boys and 100 girls) with normal physical examination and without personal or family history of atopic disease (table I).
| Table ICharacteristics of study groups | |||
| Group 1 Allergic children | Group 2 Natural tube defects | Group 3 Healthy children | |
| Number | 212* | 85 | 200 |
| Age (year) | 2-14 | 2-14 | 2-14 |
| Sex (female/male) | 109/103 | 45/40 | 100/100 |
| *Allergic asthma (151), allergic rhinitis (27), atopic dermatitis (24), food allergy (10). | |||
Skin testing
Skin prick tests were performed on the volar aspect of the forearm using disposable 27-gauge needles, and the results were evaluated 15 minutes later. Wheal reaction larger than the negative controls were judged as 0-3 mm (), 3-6 mm (+), 7-9 mm (++) and 10-12 mm (+++) (5). Commercially available latex skin test reagent was used (Stallergens Laboratories, Paris). Normal saline and histamine reagent 1:1.000 (Stallergens Laboratories, Paris) were used as negative and positive controls respectively. All skin tests were performed by same doctor and nurse in an asymptomatic period and after a drug-free interval of at least 10 years.
Interview
The interview comprised questions related to the clinical aspects of latex allergy. These were: itching or swelling of lips after inflating a balloon or after mouth examination by dentist; local swelling and itching after rectal examination; local swelling and itching after contact with latex products; history of surgical operations (if present, the number and the time of the operations, and whether catheters was used); food allergy; inhalation allergy; reaction to barium graphy; swelling and itching of the hands after using latex gloves; atopy symptoms such as eczema, allergic rhinitis, conjunctivitis, rhinorrhea; reaction after contact with latex containing materials; and anaphylaxis demonstrated as bronchospasm, hypotension or shock. The same doctor and nurse performed all interviews.
Latex allergy was defined as the development of rhinitis, conjunctivitis, sneezing, hives, eczema, angioedema, dyspnea, flushing, wheezing, dizziness or anaphylaxis in association with the contact or use of latex products. Food allergy is diagnosed by history of an allergic reaction after eating of any food and a positive skin test result with the same food.
Statistical analysis
Chi-square, Fischer''s exact and multiple regression tests were used in evaluating the correlations between the variables and the differences between the groups. Calculations were done in the department of biostatistics by a computerized SPSS/PC program.
RESULTS
As seen in table II, latex allergy was found in 10.8% of atopic children, in 30.5% of children with neural tube defects and in 1% of the control group. When these three groups were compared, statistically significant difference was observed (*2 = 56.8, p < 0.001). In the group with neural tube defects, latex positivity was significantly higher than in the atopic group (*2 = 17.16, p < 0.001).
Table II Patient characteristics, test results and distribution of prior vreactions after contact with latex in each group | ||||
| Groups | History | Latex (+) | Latex (-) | % positivity |
| Atopic (n = 212) | Positive: 130 | 22 | 108 | 10.8 |
| Negative: 82 | 1 | 81 | ||
| With neural tube defects (n = 85) | Positive: 51 | 24 | 27 | 30.5 |
| Negative: 34 | 2 | 32 | ||
| Control (n = 200) | Positive: 46 | 2 | 44 | 1.0 |
| Negative: 154 | 0 | 154 | ||
Distribution of prior reactions after contact with latex in each group is shown in table II. As seen in table II, a significant correlation between the clinical history after contact with latex and the skin test was observed in each group. Latex skin test positivity was found in 1 atopic child and 2 children with neural tube defects who had no clinical reaction history after contact with latex.
Clinical manifestations and frequently of allergic reactions after contact with latex in all study groups is presented in table III. As can be seen in table III, after contact with latex, itching, erythema, urticaria, eczema, rhinitis, cough and eye symptoms occurred at a higher rate in atopic children and children with neural tube defects, compared with control group. There was no significant difference between asthma or anaphylaxis and latex contact in any of the three groups.
Table III Clinical manifestations and frequency of allergic reactions after history of contact with latex in all study groups | ||||
| Clinical manifestation | Atopic (n= 212) | Neural tube defects (n = 85) | Control (n = 200) | |
| Itching | 63 (29%) | 27 (31%) | 17 (8%) | |
| Erythema | 50 (23%) | 30 (35%) | 18 (9%) | |
| Urticaria | 21 (9%) | 15 (17%) | 4 (2%) | |
| Eczema | 25 (11%) | 15 (17%) | 5 (2.5%) | |
| Cough | 8 (3%) | 3 (3%) | 2 (1%) | |
| Rhinitis | 22 (10%) | 13 (15%) | 5 (2.5%) | |
| Eye symptoms | 24 (11%) | 14 (16%) | 5 (2.5%) | |
| Asthma | 5 (2%) | 1 (1%) | 0 | |
| Anaphylaxis | 2 (1%) | 2 (2%) | 0 | |
There was a positive correlation between surgical operation and latex allergy positivity in patients with neural tube defect (*2 = 11.93, p < 0.001). Latex allergy was present 3.5 times more frequently in operated patients. There was a direct relation between the number of operations and the frequency of latex allergy in patients with neural tube defects (r = 0.32, p < 0.01) (table IV).
Table IVNumber of operations and frequency of latex allergy in patients with neural tube defect | ||
| No. of operations | Latex (-) | Latex (+) |
| Non-operated (n: 39) | 34 | 5 |
| One (n: 14) | 8 | 6 |
| Two (n: 22) | 13 | 9 |
| Three (n: 6) | 3 | 3 |
| Four (n: 3) | 1 | 2 |
| Five (n: 1) | 0 | 1 |
| Total operated on (n: 46) | 25 | 21 |
DISCUSSION
Hypersensitivity reactions to latex products have been increasingly reported in the last 10 years. More than 1.000 anaphylactic reactions to latex medical devices had been reported in the US Food and Drug Administration Report between 1988-1992, including 15 deaths (6). Today as a result of the change in latex production methods, both the protein content and allergenicity of latex has increased. It has been shown that, an allergic latex protein content increase when the steam sterilisation time and the storing time is shorter.
In our study, latex allergy was found in 10.8% of atopic children, in 30.5% of children with neural tube defects, and in 1% of the control group. Results from the literature indicate that the prevalence of latex allergy in atopic children ranges from 2.2-10.2% (7-10). In Turkey, latex positivity was found as 9.8% in one study (11) and in another study Saraçlar et al found that four of 40 atopic child had positive skin prick tests to latex without any history of latex associated reactions (12).
Latex allergy was positive in 23 of 212 atopic patients. The results of skin tests was an (+) in 5 patients and as (++) in 18 patients. Latex reaction of (+++) wasn''t observed in any patient. There was no difference in latex positivity between atopic patients. In 4 of 10 patients with food allergy, allergy to fruits (kiwi and pineapple) has been observed and only 1 of the 4 has shown positive skin test with latex. The other patients with food allergy were sensitive to milk, egg and fish. Including the patients with food allergy, the risk of latex allergy was found the same in all groups. In a total of 26 patients with neural tube defects, latex allergy positivity was observed as (+) in 4, and as (++) in 17 and as (+++) in 5 patients. Latex allergy ratio was 30.5% by patients with neural tube defect. These children are at a higher risk of latex allergy as they are exposed to latex products much more frequently and at an earlier age. According to various studies, the incidence of latex allergy varies between 28-67% in children with neural tube defects (13, 14).
Latex allergy incidence in operated children with neural tube defects is 3.5 times more compared to non-operated patients. This may be related to more frequent contact with latex in operated patients. The most important complaint after contact was erythema in patients with (+) skin test. Urticaria, itching, eye symptoms and rhinitis followed this. Latex skin test positivity was present in 75% of patients with a history of anaphylaxis and in 67% of those with urticaria.
In the history of atopic patients, the most frequent symptoms were itching (29.7%) followed by eye symptoms, rhinitis and urticaria (table III). In the control group, latex allergy ratio was 1%. There was no correlation between latex allergy and sex in any of the 3 groups. Atopic children and children with neural tube defects should carefully be followed up for latex allergy especially if recurring itching, urticaria, eczema, rhinitis and eye symptoms are present. Patients who have positive skin test but no symptoms are also important. It is possible that the particles in the air or contact with latex products, as baby bottles, toys and balloons during childhood cause hypersensitivity. Although using products that do not contain latex is an important method in protection against latex allergy, there is a more important point; what can be done to the patients who already have latex hypersensitivity? When these patients need surgical operation, the biggest duty belongs to the allergy and anesthesia specialists.
In our study latex skin positivity was 1% in control group. Latex skin test being cheap and simply performed and evaluated may be adopted as the test of choice, which should be performed in atopic children and children who having a probability of contact with latex.
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