De Swert L F, Van Laer K M, Verpoorten C M, Van Hoeyveld E M, Cadot P, Stevens E A
Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium.
Clin Exp Allergy. 1997 Sep;27(9):1067-76. doi: 10.1111/j.1365-2222.1997.tb01259.x.
Development of allergy to natural rubber latex in spina bifida patients is determined by several risk factors, such as age, number of interventions and atopic disease that are, however, interdependent. Furthermore, several diagnostic procedures have been analysed, but a comprehensive analysis of their diagnostic significance is lacking.
To determine the independent major risk factor(s) for development of natural rubber latex allergy and the most valuable diagnostic procedure.
In aselectively collected spina bifida patients, we correlated existing natural rubber latex allergy with age, sex, atopy and the number of hospitalizations and of surgical interventions in appropriately matched subgroups. Allergy to natural rubber latex was established by application of a latex glove fragment on the skin. Skin-prick tests with glove eluate, a natural latex extract and a commercial latex extract were carried out as were specific IgE measurements by radioimmuno assay (RAST-CAP). The results of the latex application test are compared with the other diagnostic methods.
Out of 74 fully evaluated patients, 17 had a positive application test. The number of surgical interventions correlates strongly with the presence of natural rubber latex allergy (P<0.0002), independent of age, sex and presence of atopy. Skin-prick tests with unstandardized allergens made from known high allergenic latex gloves represent the most sensitive diagnostic method, with the highest negative predictive value and a specificity of 0.95. RAST-CAP was the next best method with a specificity of 0.93, a sensitivity of 0.89 and a negative predictive value of 0.97.
The number of surgical interventions is the major independent determining factor for allergy to natural rubber latex in spina bifida patients. Unstandardized skin-prick tests are the most sensitive and specific diagnostic tool, but RAST-CAP is almost equally performant and therefore a valid alternative.
脊柱裂患者对天然橡胶乳胶过敏的发生取决于多种风险因素，如年龄、干预次数和特应性疾病等，然而这些因素相互关联。此外，已经对多种诊断方法进行了分析，但缺乏对其诊断意义的综合分析。
确定天然橡胶乳胶过敏发生的主要独立风险因素以及最有价值的诊断方法。
在一组选择性收集的脊柱裂患者中，我们将现有的天然橡胶乳胶过敏情况与年龄、性别、特应性以及在适当匹配的亚组中的住院次数和手术干预次数进行了关联分析。通过将乳胶手套碎片应用于皮肤来确定对天然橡胶乳胶的过敏情况。用手套洗脱液、天然乳胶提取物和商业乳胶提取物进行皮肤点刺试验，并通过放射免疫分析（RAST - CAP）进行特异性IgE测量。将乳胶应用试验的结果与其他诊断方法进行比较。
在74例经过全面评估的患者中，17例乳胶应用试验呈阳性。手术干预次数与天然橡胶乳胶过敏的存在密切相关（P<0.0002），与年龄、性别和特应性无关。用已知高致敏性乳胶手套制成的未标准化变应原进行皮肤点刺试验是最敏感的诊断方法，具有最高的阴性预测值和0.95的特异性。RAST - CAP是次佳方法，特异性为0.93，敏感性为0.89，阴性预测值为0.97。
手术干预次数是脊柱裂患者对天然橡胶乳胶过敏的主要独立决定因素。未标准化的皮肤点刺试验是最敏感和特异的诊断工具，但RAST - CAP的表现几乎同样出色，因此是一种有效的替代方法。
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