Kelly K J, Pearson M L, Kurup V P, Havens P L, Byrd R S, Setlock M A, Butler J C, Slater J E, Grammer L C, Resnick A
Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee.
J Allergy Clin Immunol. 1994 Jul;94(1):53-61. doi: 10.1016/0091-6749(94)90071-x.
Anaphylactic reactions (ARs) in high-risk pediatric patients undergoing general anesthesia, especially those with spina bifida, have been attributed to anesthetics, muscle relaxants, antimicrobials, ethylene oxide, and latex.
To identify risk factors for AR during general anesthesia and to investigate the role of latex allergy, we studied epidemiologic and immunologic characteristics of patients with ARs during general anesthesia during a 13-month cluster of such reactions at Children's Hospital of Wisconsin (case patients). Patients with AR were compared with patients with spina bifida undergoing uneventful general anesthesia during the same period (control patients). For each case patient and control patient, we conducted a chart review; a parental interview; skin prick testing with latex, anesthetics, aeroallergens, and banana extract; ELISA and RAST for latex-specific IgE; a total serum IgE; and an ELISA for IgE antibody to ethylene oxide.
Anaphylactic reactions occurred exclusively in patients with spina bifida (n = 10) or patients with a congenital urinary tract anomaly (n = 1). Case-patients were more likely than control patients to have a history of asthma (p = 0.002), rubber contact allergy (p = 0.001), food allergy (p = 0.001), rash caused by adhesive tape (p = 0.05), daily rectal disimpaction (p < 0.001), nine or more prior surgical procedures (p < 0.002), latex-specific IgE (p = 0.027), or elevated total serum IgE levels (p = 0.002). Multivariate analysis identified non-white race, rubber contact allergy, history of food allergy, and nine or more surgical procedures as significant independent risk factors. Logistic model equation identified the predicted probability of AR with a sensitivity, specificity, and positive predictive value of 82%, 97%, and 82%, respectively.
These findings demonstrate that atopy, especially symptomatic latex allergy, is associated with AR during anesthesia in patients with spina bifida. Until a standardized latex test is available, a medical history of immediate rubber contact allergy, non-white race, food allergy, or nine or more prior surgical procedures can identify patients with spina bifida at highest risk for ARs. A complete history, including rubber contact and food allergy, should be compiled on all patients with spina bifida before surgery.
接受全身麻醉的高危儿科患者，尤其是患有脊柱裂的患者，其过敏反应（ARs）被认为与麻醉剂、肌肉松弛剂、抗菌药物、环氧乙烷和乳胶有关。
为了确定全身麻醉期间AR的危险因素并研究乳胶过敏的作用，我们研究了威斯康星儿童医院在13个月内此类反应集中发生期间全身麻醉时发生AR的患者的流行病学和免疫学特征（病例患者）。将发生AR的患者与同期接受顺利全身麻醉的脊柱裂患者（对照患者）进行比较。对于每例病例患者和对照患者，我们进行了病历审查、家长访谈、用乳胶、麻醉剂、空气过敏原和香蕉提取物进行皮肤点刺试验、乳胶特异性IgE的ELISA和RAST检测、总血清IgE检测以及环氧乙烷IgE抗体的ELISA检测。
过敏反应仅发生在脊柱裂患者（n = 10）或先天性尿路异常患者（n = 1）中。病例患者比对照患者更有可能有哮喘病史（p = 0.002）、橡胶接触过敏史（p = 0.001）、食物过敏史（p = 0.001）、胶带引起的皮疹（p = 0.05）、每日直肠排便（p < 0.001）、九次或更多次既往手术（p < 0.002）、乳胶特异性IgE（p = 0.027）或总血清IgE水平升高（p = 0.002）。多变量分析确定非白种人、橡胶接触过敏、食物过敏史和九次或更多次手术是显著的独立危险因素。逻辑模型方程确定AR的预测概率，其敏感性、特异性和阳性预测值分别为82%、97%和82%。
这些发现表明，特应性，尤其是有症状的乳胶过敏，与脊柱裂患者麻醉期间的AR相关。在有标准化的乳胶检测方法之前，即刻橡胶接触过敏病史、非白种人、食物过敏或九次或更多次既往手术史可识别出脊柱裂患者中发生AR风险最高的患者。所有脊柱裂患者在手术前都应收集包括橡胶接触和食物过敏在内的完整病史。
