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The search of latex sensitization in spina bifida: diagnostic approach

Authors


Nieto S. de Alergia Pediátrica, Hospital Infantil La Fe, Av. Campanar, 21, 46009-Valencia, Spain.

Abstract

Background

Sensitization to latex has become a major problem in children with spina bifida. Life-threatening reactions may occur in these patients, therefore the search of latex sensitization must be an active task in all of these children.

Objective

To design an approach for the diagnosis of latex sensitization in children with spina bifida.

Methods

We studied 100 consecutive unselected patients. Skin prick tests with a commercial latex extract were performed, latex-specific serum immunoglobulin (Ig) E was determined by CAP test, and risk factors were studied. Originally, patients with an area of latex skin test > 50% of the area of histamine and/or CAP class ≥ 3 were considered sensitized to latex. Diagnostic tests were also performed in a control group of 51 atopic and nonatopic children.

Results

After performing a receiver-operating characteristics curve for both tests we recommend skin tests > 25% of the area of histamine (sensitivity − SEN = 79%, specificity − SPE = 100%, positive predictive value − PPV = 100%, negative predictive value − NPV = 90%), or CAP class ≥ 2 (SEN = 88%, SPE = 100%, PPV = 100%, NPV = 94%) as diagnostic cut-off points. The anamnesis had a SEN of 44% for diagnosis, and a SPE of 100%. Latex sensitization was associated with more than 5 operations (OR = 8, 95% CI = 3–21.3), a personal history of atopy (OR = 11.5, 95% CI = 2.3–57.1), and serum total IgE ≥ 2 z-units (OR = 4, 95% CI = 1.6–10).

Conclusion

For the routine evaluation of children with spina bifida, we propose a diagnostic algorithm with skin prick tests as a first step and CAP second.

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