Latex allergy in spina bifida patients--prevention by primary prophylaxis.

BACKGROUND: The effect of latex prophylaxis has not been investigated in spina bifida children, a high-risk group for latex allergy. As repeated operations have been identified as a major cause of latex sensitization, we wanted to find out whether primary latex prophylaxis during surgery could prevent latex allergy in children with spina bifida. METHODS: In December 1995, we established latex-free surgery and anesthesia for all patients with spina bifida regardless of their sensitization to latex. Twelve children born after that date (mean age 1.2 years, mean number of operations 3.3, range 1-7) were tested for specific IgE against latex until December 1997 (ImmunoCap, Pharmacia, Uppsala, Sweden) and compared with eight children born before December 1995 (mean age 1.3 years, mean number of operations 3.6, range 1-8), in whom a test for latex IgE had been done before the age of 2 years. RESULTS: Before we established primary prophylaxis, three of seven children with spina bifida (38%) were sensitized to latex until the age of 2 years. After the establishment of a latex-free operating theater for spina bifida patients, none of the 12 patients were sensitized to latex despite up to seven operations in each child. CONCLUSIONS: Primary latex prophylaxis during surgery can prevent latex sensitization in young spina bifida patients.

Longitudinal study on latex sensitization in children with spina bifida.

The course of latex sensitization is rarely documented, and only a few reports about the influence of prophylaxis in the occupational environment have been published concerning health care workers. Therefore we did a follow-up study in the high risk group of patients with spina bifida and evaluated the efficacy of latex prophylaxis. For this purpose we measured IgE antibodies (FEIA) against latex and inhalative allergens in the sera of 67 patients with spina bifida and reevaluated them 0.6 to 4.1 years later, having instructed the patients about prophylactic measures and established a latex-free environment for surgery of all spina bifida patients in our hospital. 37% of the patients did not develop latex antibodies during the follow-up period, 27% showed decreasing levels of antibodies (12% to non-detectable levels), 19% had an increase in latex sensitization (6% newly sensitized), and 9% showed no change in levels of latex antibodies. From our data it may be concluded that surgery without strict latex prophylaxis is the main cause of new sensitization and worsening of preexisting latex antibody levels. Mild sensitization can be reduced by prophylactic measurements to non-detectable antibody levels. With consistent prophylaxis, even symptomatic patients can be operated without risk of allergic complications or increasing antibodies.

Natural rubber latex allergy: prevalence and risk factors in patients with spina bifida compared with atopic children and controls.

UNLABELLED: Type 1 allergy against natural rubber latex is an increasing problem in health care workers and children with spina bifida or urogenital malformations. The aim of our study was to evaluate the prevalence of latex IgE antibodies and cross-reacting fruit antibodies in patients with spina bifida compared with atopic and non-atopic controls. Risk factors for sensitization should be determined. Sera of 148 patients with spina bifida and 98 controls (44 with atopy) were screened for IgE antibodies against latex, banana and kiwi by fluorescence enzyme immunoassay (CAP system). Atopies, allergic symptoms after latex contacts and the number of operations were compiled by a questionnaire. Patients with spina bifida developed latex IgE antibodies (> or =0.7 kU/l) more frequently (40.5%) than atopic children (11.4%) or healthy controls (1.9%). All 18 symptomatic patients belonged to the spina bifida group and had high values of latex antibodies. The risk for developing latex antibodies increases with the number of operations. There was no difference in the history of atopic diseases and in a screening test of IgE antibodies against inhalative allergens between latex sensitized and not sensitized children with spina bifida. Antibodies against banana were more frequent in the latex sensitized children with spina bifida. (18.3% vs 3.4%, P = 0.002). CONCLUSION: The high prevalence of latex antibodies in children with spina bifida justifies a primary prophylaxis by avoiding latex contacts, especially during anaesthesia and surgery, a correlation between the number of operations and the development of latex antibodies exists.

Severe hepatotoxicity during valproate therapy: an update and report of eight new fatalities.

Since our last report on valproate (VPA)-related hepatotoxicity in 1988, 8 other children have died of VPA-associated liver failure in Germany and Switzerland. We compared the clinical course of these children with that of 6 children with a reversible outcome of severe hepatotoxicity related to VPA. Thirty-five percent of patients with fatal liver failure were normally developed, 23.5% were receiving VPA monotherapy, and 35.3% were aged < or = 2 years. The initial clinical symptoms of VPA-related hepatotoxicity were nausea, vomiting, apathy or coma, and increasing seizures in more than 50% of patients, in combination with febrile infections at onset of symptoms. As compared with the series of German patients reported in 1988, one third of the fatalities occurred after the first 6 months of therapy as compared with 6% in the 1988 series. Clinical symptoms and laboratory findings were the same in patients with reversible and with fatal outcome. Early or immediate withdrawal of VPA after the first signs of VPA-associated hepatotoxicity may be responsible for the increased number of children who recovered after VPA-related severe liver failure. The pathogenesis of liver failure during VPA treatment remains unknown; metabolic defects and cofactors such as polypharmacy or infections have become increasingly likely to contribute by depleting intracellular CoA. Worldwide, 132 patients have died of VPA-associated liver failure and/or pancreatitis. Because a group at risk for fatalities with VPA cannot be defined precisely, patients treated with VPA and their families must be made well aware of the clinical symptoms of hepatotoxicity such as apathy, vomiting, or increased seizure frequency, especially in the presence of febrile infections. Laboratory tests and clinical controls during the first 6 months of therapy should not be neglected.

[Secondary myocardial hypertrophy in a very small premature infant treated with dexamethasone]. / Sekundäre Myokardhypertrophie bei sehr kleinen Frühgeborenen unter Dexamethasontherapie.

BACKGROUND: There is an increasing number of reports about the use of dexamethasone in the treatment of preterm infants at high risk for bronchopulmonary dysplasia. The possibility of myocardial hypertrophy developing during this treatment has not been examined. METHODS: As an example the course of one patient is described. We examined seven preterm infants (mean birth weight 791 g, mean gestational age 26 weeks) with eight treatments of dexamethasone retrospectively. The therapy was associated with a significant increase of the mean thickness of the interventricular septum and of the left ventricular posterior wall. After the termination of dexamethasone therapy the abnormal echocardiographic findings disappeared. CONCLUSION: We suggest careful monitoring of preterm infants treated with dexamethasone by performing serial echocardiographic investigations.

[Evaluation of a rapid test for direct detection of group A streptococcal antigen in throat swabs. Study of 4 commercial test systems]. / Bewertung von Schnelltests zum Direktnachweis des Gruppe-A-Streptokokkenantigens in Rachenabstrichen. Untersuchung zu vier kommerziellen Testsystemen.

Four commercially prepared test reagent kits for the rapid screening of throat swabs for group A streptococci were examined in comparison to bacteriological cultures of 963 double throat swabs. The sensitivities of the test systems were 86.7% (Abbott Test Pack Strep A), 81.8% (Hybritech Tandem Icon Strep A), 79.6% (Pharmacia Phadirect Strep A), and 72.6% (Wellcome Reveal Colour Strep A) respectively. The specificity of the four tests was above 90%. Marked variations between different test reagent batches could be observed. The two tests based on the enzyme immunoassay principle proved to be superior to the agglutination tests investigated with respect to sensitivity and reading accuracy. Our results are evaluated in the light of the published literature on these tests.

Influence of haemodialysis and renal transplantation on trace element concentrations in children with chronic renal failure.

Whole blood levels of Cd and Pb (microgram/g Hb), serum concentrations of Sr and Zn and their urinary excretion were measured in healthy, renal transplant and dialyzed children by atomic absorption spectroscopy. Furthermore, before and after dialysis the concentrations of these elements were determined in blood/serum as well as in the dialysis fluid. The predialytic concentrations of Cd, Pb and Sr in blood/serum were significantly increased compared to controls. Haemodialysis had only minor effects on whole blood Cd and Pb levels but serum Sr and Zn concentrations increased as a result of high metal levels in dialysis fluid. Children after renal transplantation showed no alterations in Pb, Sr and Zn concentrations compared to healthy children but whole blood Cd was increased. According to the renal function the Pb, Cd and Zn urinary excretion decreased in the following order: healthy, renal transplant and dialysis children. Sr urinary excretion was increased in haemodialysis and renal transplant patients. In conclusion, we found no Zn deficiency. Elevated blood levels of Cd and Pb and elevated Sr serum concentrations in paediatric patients undergoing dialysis and increased Cd whole blood levels in renal transplant children could be of clinical interest.

[Results and specific problems in unrestricted indications for kidney transplantation in children]. / Ergebnisse und spezifische Probleme bei unbegrenzter Indikation zur Nierentransplantation im Kindesalter.

In Hamburg 22 children had 33 renal transplantations in the time from 1976 till 1982. 58% of all children in this area with end-stage renal disease have now a functioning graft compared to only 11% of the adult patients. This is the result of preferred transplantation in children whenever possible. Retransplantation was more frequent in children (32%) than in adults (19%). 5 years function rate of renal allografts is significantly worse in children than in adults. Growth and degree of rehabilitation are described in 12 pediatric renal allograft recipients who survived with a functioning graft for at least 3 years. Good rehabilitation as indicated by attendance of school and employment was reached in 83% of these patients. Different growth patterns occurred. Clinical factors associated with growth performance include graft function and age at the time of transplantation.