Subject(s)
Hypersensitivity/etiology , Latex/adverse effects , Spinal Dysraphism/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Prospective Studies , Radioallergosorbent Test , RiskABSTRACT
We interviewed 93 consecutive children with spina bifida who were scheduled for operation to document (a) the prevalence of latex sensitivity, (b) predictors of anaphylactic reaction, and (c) the risk of type I hypersensitivity reaction perioperatively. Of these patients, 9.7% were clinically allergic. Radioallergosorbent testing (RAST) was 89% sensitive. All patients with known latex allergy were premedicated, and rigorous efforts were made to avoid latex exposure. No intraoperative anaphylactic reactions were noted. One postoperative reaction occurred in a history-positive, RAST-negative patient. We conclude that operation can be performed safely in patients with latex allergy.
Subject(s)
Hypersensitivity/etiology , Rubber/adverse effects , Spinal Dysraphism/complications , Adolescent , Adult , Anaphylaxis/prevention & control , Child , Child, Preschool , Female , Humans , Hypersensitivity/diagnosis , Hypersensitivity, Immediate/prevention & control , Infant , Intraoperative Complications/etiology , Male , Premedication , Prospective Studies , Radioallergosorbent TestSubject(s)
Anaphylaxis/immunology , Cerebrospinal Fluid Shunts/instrumentation , Intraoperative Complications/immunology , Meningomyelocele/surgery , Rubber/adverse effects , Basophils/immunology , Child , Humans , Intradermal Tests , Meningomyelocele/immunology , Patch Tests , Prospective Studies , Radioallergosorbent TestABSTRACT
We attempted to determine the prevalence and clinical significance of rubber-specific IgE in a prospective case control study of 32 preoperative children with spina bifida, compared with 45 outpatient controls and 35 age-matched preoperative controls without spina bifida. A latex-specific radioallergosorbent test was positive in 11 of the 32 spina bifida patients (34%), compared with 1 (2%) and 4 (11%) of the respective controls (p less than 0.05). Within the spina bifida group 5 of 11 antibody-positive patients had a history of rubber-associated, intraoperative or otherwise idiopathic allergic episodes and 1 of 21 antibody-negative patients gave such a history (p = 0.012). Children with spina bifida have a significantly greater likelihood than controls of having IgE specific for rubber antigens. In addition, the presence of rubber-specific IgE is associated with a higher frequency of rubber-associated, intraoperative or idiopathic allergic reactions.
Subject(s)
Immunoglobulin E/analysis , Rubber , Spinal Dysraphism/blood , Adolescent , Antigen-Antibody Reactions , Case-Control Studies , Child , Child, Preschool , Female , Humans , Immunoglobulin E/immunology , Male , Prospective Studies , Radioallergosorbent TestABSTRACT
Seven patients with type I hypersensitivity reactions to rubber are reported. Radioallergosorbent testing with crude latex antigen was positive in 6/7 patients. Five patients had coexisting spina bifida, and all had undergone surgery before the development of rubber allergy. Rubber allergy is a new phenomenon that should be in the differential diagnosis of idiopathic anaphylaxis and urticaria.
Subject(s)
Hypersensitivity/etiology , Rubber/adverse effects , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Hypersensitivity/diagnosis , Immunoglobulin E/immunology , Male , Radioallergosorbent Test , Spinal Dysraphism/complicationsABSTRACT
Topical epinephrine is useful in controlling the bleeding of skin graft donor sites. However, the use of exogenous epinephrine during halothane anesthetization increases the risk of cardiac arrhythmias. This study shows that there is no significant increase in plasma epinephrine levels after topical administration of up to 80 cc of 1:500,000 epinephrine, suggesting that the use of this dose in conjunction with halothane anesthesia is safe.
