Article

Determination of independent risk factors and comparative analysis of diagnostic methods for immediate type latex allergy in spina bifida patients.

Department of Paediatrics, University Hospital Gasthuisberg, Leuven, Belgium.
Clinical & Experimental Allergy (impact factor: 5.03). 09/1997; 27(9):1067-76. pp.1067-76
Source: PubMed

ABSTRACT 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.

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Keywords

allergenic latex gloves
 
atopic disease
 
commercial latex
 
diagnostic methods
 
diagnostic significance
 
independent major risk factor(s)
 
latex application test
 
latex glove fragment
 
major independent
 
natural latex
 
natural rubber latex
 
positive application test
 
radioimmuno assay
 
Skin-prick tests
 
specific diagnostic tool
 
spina bifida patients
 
surgical interventions
 
Unstandardized skin-prick tests
 
valid alternative
 
valuable diagnostic procedure