Niggemann B, Buck D, Michael T, Wahn U
Department of Pediatrics, Virchow-Clinic of Humboldt University, Berlin, Germany.
J Allergy Clin Immunol. 1998 Oct;102(4 Pt 1):665-70. doi: 10.1016/s0091-6749(98)70285-4.
Although there is accepted information on the prevalence rates of sensitization to latex in patients with spina bifida, little is known about the clinical relevance of this sensitization.
We performed provocation tests with latex gloves in 159 patients with spina bifida (median age, 10 years).
Eighty-eight patients (55.3%) were sensitized to latex in terms of a positive skin prick test response, specific IgE to latex in serum, or both. Fifty-five patients (34.6% of all patients or 62.5% of latex-sensitized patients) showed clinical symptoms on provocation. Specific IgE to latex was significantly higher in patients with a positive provocation test response (P <.0001). The total number of operations and degree of sensitization showed a significant correlation. More than 8 operations significantly increased the risk of sensitization (P <.0001), and more than 9 operations increased the risk of allergy to latex (P <.0001). One hundred seventeen (75%) patients had a ventricular shunt system. Specific IgE in these patients was significantly higher than in patients without (P <.0001), and the odds ratio for the existence of a shunt system in terms of a positive provocation was 3.9. Patients with a shunt system were significantly more often sensitized and had positive provocation results (P <.0001). Seventy-two patients (45.3%) were classified as atopic; they were significantly more often sensitized and clinically symptomatic (P <.0001), and the odds ratio for having a positive provocation response was 3.2 for atopic subjects. History of symptoms on contact with material containing latex had a sensitivity of 53.7% and specificity of 94.2%.
Our results indicate that an atopic disposition, number of operations, and presence of a shunt system increase the risk of becoming not only sensitized but also allergic to latex. Our results strongly support the necessity that patients with spina bifida as a high-risk group for latex allergy should remain latex-free from the first day of life.
尽管关于脊柱裂患者中乳胶致敏率已有公认信息，但对于这种致敏的临床相关性却知之甚少。
我们对159例脊柱裂患者（中位年龄10岁）进行了乳胶手套激发试验。
88例患者（55.3%）皮肤点刺试验反应阳性、血清中存在针对乳胶的特异性IgE或两者均有，提示对乳胶致敏。55例患者（占所有患者的34.6%或乳胶致敏患者的62.5%）在激发试验时出现临床症状。激发试验反应阳性的患者中，针对乳胶的特异性IgE显著更高（P<.0001）。手术总数与致敏程度呈显著相关性。超过8次手术显著增加致敏风险（P<.0001），超过9次手术增加乳胶过敏风险（P<.0001）。117例（75%）患者有脑室分流系统。这些患者的特异性IgE显著高于无分流系统的患者（P<.0001），就激发试验阳性而言，存在分流系统的比值比为3.9。有分流系统的患者致敏和激发试验结果阳性的情况显著更常见（P<.0001）。72例患者（45.3%）被归类为特应性体质；他们致敏和出现临床症状的情况显著更常见（P<.0001），特应性受试者激发试验反应阳性的比值比为3.2。接触含乳胶材料时出现症状的病史，敏感性为53.7%，特异性为94.2%。
我们的结果表明，特应性体质、手术次数和分流系统的存在不仅增加致敏风险，也增加乳胶过敏风险。我们的结果有力支持了脊柱裂患者作为乳胶过敏高危人群应从出生第一天起就避免接触乳胶的必要性。
