LATEX HYPERSENSITIVITY IN CHILDREN - CLINICAL PRESENTATION AND DETECTION OF LATEX-SPECIFIC IMMUNOGLOBULIN-E

Objective. To better understand the clinical characteristics, diagnosi s, and possible prevention of immediate hypersensitivity reactions to latex in a hospitalized, pediatric patient population. Methods. We per formed a retrospective case analysis of the first 35 patients with lat ex allergy evaluated by our service over a 2-year period at our instit ution, Characteristics of patients and clinical reactions were analyze d and the presence of latex-specific immunoglobulin E was assessed usi ng in vitro methods. In a limited group of patients, the success of st rict environmental control and premeditation with steroids and antihis tamines was evaluated for the prevention of latex allergic reactions. Results. The majority of our patients had life-threatening reactions. In previous reports, most pediatric patients underwent reactions in th e perioperative period and belonged to two well-recognized ''high-risk '' patient groups (spina bifida and genitourinary malformations). In o ur series, 21 patients (60%) had reactions outside of the operating ro om setting, and 14 patients (40%) had primary diagnoses outside of the previously recognized ''high-risk'' groups. Many patients had a histo ry of multiple surgical procedures, and a history of a surgical proced ure in the first year of life was very common. A pre-existing clinical history of latex allergy was present in only 18 of the 35 patients, a nd a severe or life-threatening allergic reaction was the presenting f eature of latex allergy in 11 of the 35 patients. Using in vitro assay s, we were able to detect latex-specific immunoglobulin E in the sera of all but two of our patients. Latex gloves and latex-containing intr avenous sets were common triggers for reactions. When exposure to late x occurs systemically, as through an intravenous line, premedication w ith steroids and antihistamines may fail to protect against anaphylaxi s. Conclusions. Our experience indicates that the incidence of latex h ypersensitivity in children is increasing, that the circumstances (pat ient profile, hospital location, route of exposure) in which life-thre atening reactions may occur are more broad than previously reported, a nd that a better understanding of both environmental sources of latex antigens and host responses to latex exposure are needed for improved prevention of serious reactions.