Nieto A, Mazón A, Estornell F, Reig C, García-Ibarra F
Section of Paediatric Allergy, Children's Hospital La Fe, Valencia, Spain.
Clin Exp Allergy. 2000 Feb;30(2):264-9. doi: 10.1046/j.1365-2222.2000.00705.x.
Sensitization to latex has become a major problem in children with spina bifida. Life-threatening reactions may occur in these patients, therefore the search of latex sensitization must be an active task in all of these children.
To design an approach for the diagnosis of latex sensitization in children with spina bifida.
We studied 100 consecutive unselected patients. Skin prick tests with a commercial latex extract were performed, latex-specific serum immunoglobulin (Ig) E was determined by CAP test, and risk factors were studied. Originally, patients with an area of latex skin test > 50% of the area of histamine and/or CAP class > or = 3 were considered sensitized to latex. Diagnostic tests were also performed in a control group of 51 atopic and nonatopic children.
After performing a receiver-operating characteristics curve for both tests we recommend skin tests > 25% of the area of histamine (sensitivity - SEN = 79%, specificity - SPE = 100%, positive predictive value - PPV = 100%, negative predictive value - NPV = 90%), or CAP class > or = 2 (SEN = 88%, SPE = 100%, PPV = 100%, NPV = 94%) as diagnostic cut-off points. The anamnesis had a SEN of 44% for diagnosis, and a SPE of 100%. Latex sensitization was associated with more than 5 operations (OR = 8, 95% CI = 3-21.3), a personal history of atopy (OR = 11.5, 95% CI = 2.3-57.1), and serum total IgE > or = 2 z-units (OR = 4, 95% CI = 1. 6-10).
For the routine evaluation of children with spina bifida, we propose a diagnostic algorithm with skin prick tests as a first step and CAP second.
对乳胶过敏已成为脊柱裂患儿的一个主要问题。这些患者可能会发生危及生命的反应，因此，对所有这些患儿进行乳胶过敏筛查必须是一项积极的工作。
设计一种诊断脊柱裂患儿乳胶过敏的方法。
我们对100例未经挑选的连续患者进行了研究。用市售乳胶提取物进行皮肤点刺试验，通过CAP试验测定乳胶特异性血清免疫球蛋白（Ig）E，并研究危险因素。最初，乳胶皮肤试验面积>组胺试验面积的50%和/或CAP分级>或=3的患者被认为对乳胶过敏。还对51例特应性和非特应性儿童的对照组进行了诊断试验。
在对两种试验进行受试者工作特征曲线分析后，我们建议皮肤试验>组胺试验面积的25%（敏感性-SEN=79%，特异性-SPE=100%，阳性预测值-PPV=100%，阴性预测值-NPV=90%），或CAP分级>或=2（SEN=88%，SPE=100%，PPV=100%，NPV=94%）作为诊断切点。问诊诊断的敏感性为44%，特异性为100%。乳胶过敏与5次以上手术相关（比值比-OR=8，95%置信区间-CI=3-21.3）、个人特应性病史（OR=11.5，95%CI=2.3-57.1）和血清总IgE>或=2个z单位（OR=4，95%CI=1.6-10）。
对于脊柱裂患儿的常规评估，我们提出一种诊断算法，第一步进行皮肤点刺试验，第二步进行CAP试验。
