Goldberg Hanan, Aharony Shachar, Levy Yael, Sivan Bezalel, Baniel Jack, Ben Meir David
Urology Unit, Schneider Children's Medical Center of Israel, and Sackler School of Medicine, Tel Aviv University, Israel.
Urology Unit, Schneider Children's Medical Center of Israel, and Sackler School of Medicine, Tel Aviv University, Israel.
J Pediatr Urol. 2016 Feb;12(1):52.e1-5. doi: 10.1016/j.jpurol.2015.07.011. Epub 2015 Sep 5.
Studies in the past have shown that children with spinal dysraphism have highly prevalent latex allergy. These children have a spectrum of congenital spinal anomalies, caused by defects in neural tube closure, with an incidence of 1 in 1000 births. Proposed risk factors for latex allergy include multiple surgeries since birth, including an insertion of a ventriculoperitoneal shunt, elevated IgE titers, repeat multiple catheterizations, and atopy. In the 1990 s, studies published in the United States and Europe showed a latex allergy prevalence of over 70% in these patients. On the other hand, studies published years later in other countries showed a declining prevalence of no more than 17%.
Our goal was to prospectively assess the prevalence of latex allergy in children with spinal dysraphism in our non-latex free environment center compared with a control group.
The study group included 58 children with spinal dysraphism attending our center between 2010 and 2013. Findings were compared to 65 children referred for evaluation of allergic diseases. The parents completed questionnaires assessing personal and familial history of allergic diseases. All children were tested for blood latex IgE-specific antibodies (IMMULITE 2000).
The mean age was 120.9 (67.6) months in the study group and 129.5 (68.5) months in the control group (p = 0.27). The corresponding median number of surgical procedures was 2 (range 0-10) and 0 (range 0-4), and mean duration of clean intermittent catheterization was 52 (72.2) months in the study group. Positive IgE antibodies and clinical allergic reactions were low with very similar prevalence in both groups (Figure).
Our results show considerable lower latex allergy and sensitization than studies published in the United States and Europe in the past, despite the fact that our center utilizes minimal avoidance measures for latex allergy. Study limitations include the relatively small number of patients in our single-center study. Moreover, our control group could not include normal volunteering healthy children due to institutional review board refusal.
Children with spinal dysraphism in our center have a low prevalence of latex allergy. Possible explanations include low latex protein content gloves and catheters used worldwide, including our center, lower number of surgeries, or a disease associated propensity for latex sensitization with a geographically variable genetic association. More studies are needed to validate our conclusion that using minimal avoidance measures, without maintaining a strict latex free environment, seems sufficient to prevent clinical latex allergy, at least in the Mediterranean region.
过去的研究表明，患有脊柱裂的儿童乳胶过敏非常普遍。这些儿童患有一系列先天性脊柱异常，由神经管闭合缺陷引起，发病率为千分之一。乳胶过敏的潜在风险因素包括自出生以来的多次手术，包括脑室腹腔分流术的插入、IgE滴度升高、多次重复导尿以及特应性。在20世纪90年代，美国和欧洲发表的研究表明，这些患者中乳胶过敏的患病率超过70%。另一方面，多年后其他国家发表的研究表明患病率下降至不超过17%。
我们的目标是前瞻性评估在我们非无乳胶环境中心与对照组相比，脊柱裂儿童乳胶过敏的患病率。
研究组包括2010年至2013年间在我们中心就诊的58名脊柱裂儿童。将研究结果与65名因过敏性疾病转诊进行评估的儿童进行比较。家长完成了评估过敏性疾病个人和家族史的问卷。所有儿童均检测了血液中乳胶特异性IgE抗体（IMMULITE 2000）。
研究组的平均年龄为120.9（67.6）个月，对照组为129.5（68.5）个月（p = 0.27）。相应的手术次数中位数分别为2次（范围0 - 10次）和0次（范围0 - 4次），研究组清洁间歇性导尿的平均持续时间为52（72.2）个月。两组中IgE抗体阳性和临床过敏反应发生率较低且非常相似（图）。
我们的结果显示，与过去美国和欧洲发表的研究相比，乳胶过敏和致敏率要低得多，尽管我们中心对乳胶过敏采取的避免措施极少。研究局限性包括我们单中心研究中的患者数量相对较少。此外，由于机构审查委员会的拒绝，我们的对照组不能包括正常自愿参与的健康儿童。
我们中心的脊柱裂儿童乳胶过敏患病率较低。可能的解释包括全球范围内使用的手套和导管中乳胶蛋白含量较低，包括我们中心，手术次数较少，或者与疾病相关的乳胶致敏倾向存在地理可变的基因关联。需要更多研究来验证我们的结论，即至少在地中海地区，使用极少的避免措施，而不维持严格的无乳胶环境，似乎足以预防临床乳胶过敏。
