Leonard J C, Morin C, Albecq J F
Institut Cazin-Perrochaud, France.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(4):321-6.
Latex allergy is becoming a subject of extreme concern, especially in patients who have undergone multiple operations and/or have after effects of myelodysplasia. Presenting their data, the authors wish to make it aware to orthopaedic surgeons focusing on different risk groups, and at the same time advising on medical examinations, of the various measures to take.
Twenty patients were tested (17 with spina bifida and 3 with cerebral palsy) for latex and ethylene oxide allergy, and with certain fruits known for their cross-reactivity. Atopic history has also been researched. The immunologic examination had been carried out by means of skin-tests with evidence of specific IgE antibodies being found.
Out of the twenty patients tested, eight had clinical signs of a latex allergy while the twelve others were classified as being at risk. The results show that 11 out of 20 are allergic to latex, 4 of them have an allergy to ethylene oxide, and 7 have food allergies: banana (2), kiwi (1), chestnut (1), hazelnut (3).
We confirm: 1) the increased risk of a latex allergy among patients with spina bifida: 47 per cent in our study; 2) the association of an ethylene oxide allergy, practically the only product used in the sterilisation of medical equipment; 3) a more and more frequent association to food allergies, in particular to fruits: 7 out of 11 patients in our study compared to 50 per cent in other published studies. The classical subject of atopy is not found here.
Against the increase of latex allergy, it is necessary to propose a strategy: firstly to determine the groups at risk: patients who have undergone multiple operations, atopic persons, isolated cases of food allergies, spina bifida cases. Then, to test them and if necessary, taking draconian measures concerning their medical environment; to identify them; to provide them with auto-injectable epinephrine; to give premedication, though with no success guarantee in case of anticipated surgical procedure. Finally, we recommend to manufacturers that all equipment and products should be free of latex.
乳胶过敏正成为一个备受关注的问题，尤其是在接受过多次手术和/或患有骨髓发育异常后遗症的患者中。作者展示他们的数据，希望让关注不同风险群体的骨科医生了解这一情况，同时就医学检查以及应采取的各种措施提供建议。
对20名患者（17名脊柱裂患者和3名脑瘫患者）进行了乳胶和环氧乙烷过敏测试，以及对某些已知具有交叉反应性的水果进行测试。还研究了特应性病史。通过皮肤试验进行免疫检查，并发现了特异性IgE抗体。
在接受测试的20名患者中，8名有乳胶过敏的临床症状，另外12名被归类为有风险。结果显示，20人中有11人对乳胶过敏，其中4人对环氧乙烷过敏，7人有食物过敏：香蕉（2人）、猕猴桃（1人）、栗子（1人）、榛子（3人）。
我们证实：1）脊柱裂患者中乳胶过敏风险增加：在我们的研究中为47%；2）环氧乙烷过敏的关联，环氧乙烷实际上是医疗设备灭菌中唯一使用的产品；3）与食物过敏的关联越来越频繁，特别是与水果：在我们的研究中，11名患者中有7名，而在其他已发表的研究中为50%。这里未发现典型的特应性情况。
针对乳胶过敏的增加，有必要提出一项策略：首先确定风险群体：接受过多次手术的患者、特应性个体、孤立的食物过敏病例、脊柱裂病例。然后，对他们进行检测，如有必要，对其医疗环境采取严格措施；识别他们；为他们提供自动注射肾上腺素；进行术前用药，不过对于预期的手术程序不能保证成功。最后，我们建议制造商所有设备和产品都应不含乳胶。
