Latex-Free Anesthesia for Craniosynostosis Surgery Associated With Xia-Gibbs Syndrome: A Case Report.

This case report describes the anesthetic management of a one-year-old patient with Xia-Gibbs syndrome, which is a rare genetic condition caused by a mutation in the AHDC1 gene. The procedure involved calvarial vault remodeling and fronto-orbital advancement to correct a left coronal craniosynostosis. In addition, the patient had a history of seizures and latex-fruit syndrome, which necessitated careful preoperative planning and management. Despite the difficulties provided by the patient's cranial abnormalities and the paucity of literature on anesthetic experiences with the condition, the treatment was completed successfully and without complications. Insights are offered about the anesthetic approach for this syndromic pediatric patient undergoing neurosurgery with a high risk of bleeding. It is important to understand and prepare for the perioperative implications of this disease in order to achieve a safe outcome.

Successful treatment of a patient with adult food allergy and severe asthma using omalizumab.

Food allergy is a typical immediate-onset allergic disease in which symptoms are provoked by exposure to the sensitized antigens. Although previous reports have shown that omalizumab has helped children with egg or milk allergy achieve oral immunotherapy safely, there is still no established method for induction of remission in adult food allergy. A 51-year-old woman with oral steroid-dependent severe asthma was treated with omalizumab for 6 years. She had shellfish and wheat food allergy and oral allergy syndrome induced by kiwi and other foods associated with latex-fruit syndrome. Since omalizumab treatment, her food allergy symptoms had disappeared. After 7 years of this treatment, disseminated erythema suddenly appeared; omalizumab was discontinued because of suspected drug-induced eruption. After omalizumab interruption, she felt an itching sensation in her throat with worsened asthma control immediately after wheat ingestion. Readministration of omalizumab improved these symptoms. Thus, we raised the possibility that omalizumab not only improved asthma control but also induced pharmacological remission of the patient's food allergy. Omalizumab may be considered as a treatment option for adult patients with food allergies and severe asthma.

Latex allergy guidelines for people with spina bifida.

An estimated 85% of individuals with spina bifida (SB) survive into adulthood, warranting SB-specific transition to adult healthcare guidelines to address the diverse and complex medical, adaptive, and social needs particular to this condition. Latex allergy constitutes one important health concern for this population that requires ongoing and life-long evidence-based management. This article discusses management of latex allergy according to the SB Latex Allergy Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida, reviews current care models in which such latex allergy guidelines can be implemented, and explores further relevant research topics in SB care relative to latex allergy.

Hevea latex-associated allergies: piecing together the puzzle of the latex IgE reactivity profile.

Introduction: IgE-mediated Hevea latex allergy and associated food-allergies constitute a significant health issue with serious consequences of diagnostic error. Hence, there is a need for more reliable confirmatory diagnostics.Areas covered: Here, we summarize the major limitations of conventional tests using native extracts and describe how piecing together the IgE reactivity profile can benefit correct diagnosis in difficult cases in whom conventional tests yield equivocal or negative results. A diagnostic algorithm integrating traditional sIgE and component-resolved diagnosis (CRD) is presented.Expert opinion: Moreover, it is clear that the discoveries in the field of the Hevea latex proteome will contribute to our understandings and accurate approach of sometimes complex cross-reactivity phenomena that extend beyond the 'latex-fruit syndrome.'

Crystal structure and biochemical characterization of CJP38, a ß-1,3-glucanase and allergen of Cryptomeria japonica pollen.

A 38 kDa ß-1,3-glucanase allergen from Cryptomeria japonica pollen (CJP38) was recombinantly produced in E. coli and purified to homogeneity with the use of Ni-affinity resin. CJP38 hydrolyzed ß-1,3-glucans such as CM-curdlan and laminarioligosaccharides in an endo-splitting manner. The optimum pH and temperature for ß-1,3-glucanase activity were approximately 4.5 and 50 °C, respectively. The enzyme was stable at 30-60 °C and pH 4.0-10.5. Furthermore, CJP38 catalyzed a transglycosylation reaction to yield reaction products with a molecular weight higher than those of the starting laminarioligosaccharide substrates. The three-dimensional structure of CJP38 was determined using X-ray crystallography at 1.5 Å resolution. CJP38 exhibited the typical (ß/α)8 TIM-barrel motif, similar to allergenic ß-1,3-glucanases from banana (Mus a 5) and rubber tree latex (Hev b 2). Amino acid sequence alignment of these proteins indicated that the two-consensus IgE epitopes identified on the molecular surfaces of Mus a 5 and Hev b 2 were highly conserved in CJP38. Their conformations and surface locations were quite similar for these proteins. Sequence and structural conservation of these regions suggest that CJP38 is a candidate allergen responsible for the pollen-latex-fruit syndrome relating to Japanese cedar pollinosis.

Latex sensitization in patients with myelomeningocele: contribution of microarray technique.

Summary: Background. Microarray technique employing molecular allergens is pointed out as a new method to evaluate allergic patients. Objective. To evaluate if microarray technique (ImmunoCAP-ISAC®; I-ISAC®) is similar to fluorescence enzyme immunoassay (FEIA; ImmunoCAP®) in the diagnosis of latex allergy (specific IgE to latex plus symptoms) and latex sensitization (only antibody) in pediatric (9-mo to 14-yrs) patients with myelomeningocele undergone to surgical repair. Methods. Patients underwent skin prick testing (SPT) to latex and food (prick to prick), and dosage of serum specific IgE to latex and recombinant latex allergens (rHev b 1, rHev b 3, rHev b 5, rHev b 6.01, rHev b 6.02, rHev b 8, rHev b 9, and rHev b 11) by ImmunoCAP® and I-ISAC®. Results. The comparison between the two methods showed high level of concordance considering positive and negative results. A statistically significant correlation for rHev b 3 and rHev b 6.01 for the allergic patients, and for rHev b5 and rHev b6.01 for those sensitized to latex, was observed. I-ISAC® is limited to 5 recombinant latex allergens (rHev b 1, 3, 5, 6.01 and 8). Despite the presence of antibodies against pollens, LTP and profilins (I-ISAC®) in some patients, none of them reported symptoms related with intake of fruits and/or vegetables. Conclusion. Both methods are effective in assisting the diagnosis of latex allergy, but differ in the assessment of sensitized pediatric patients with myelomeningocele. The assessment of latex sensitized patients is more complete using the 8 recombinant latex fractions available for ImmunoCAP®, instead of I-ISAC®.

Alergia al látex en un hospital pediátrico: Caracterización y factores de riesgo / Latex allergy in a paediatric hospital: Characteristics and risk factors

Introducción: La prevalencia de sensibilización al látex es variable. Se describen diversos factores de riesgo para la sensibilización al látex, como riesgo genético, atopia y múltiples intervenciones quirúrgicas. Objetivo: Caracterizar los pacientes con sospecha de alergia al látex, analizar sus características clínicas y factores de riesgo. Pacientes y método: Estudio retrospectivo, descriptivo, en niños derivados a la Unidad de Inmunología pediátrica por sospecha de alergia al látex y para confirmación diagnóstica. Se revisaron síntomas por contacto o exposición a materiales con látex. Se identificó factores de riesgo para la sensibilización al látex: patologías con múltiples intervenciones quirúrgicas (espina bífida, mielomeningocele, escoliosis y alteraciones nefrourológicas), atopia (rinitis o asma, dermatitis atópica), y se realizó prick test y/o IgE específica para látex. Se efectuó un modelo de regresión logística multivariado para asociar síntomas de exposición al látex con enfermedades de base y condiciones de riesgo. Resultados: Se reclutaron 106 pacientes, de los cuales 50 fueron analizables. El 96% eran mayores de 5 años de edad al momento del diagnóstico. La mayoría de los factores de riesgo descritos en la literatura eran observables en estos pacientes (múltiples cirugías, malformaciones neurológicas y nefrourológicas, intervenciones quirúrgicas antes del año de edad y cateterismo vesical repetido). Luego de la exposición, las manifestaciones cutáneo-mucosas fueron las más frecuentes (52%), seguidas por las respiratorias (36%). El 100% de los pacientes estaban sensibilizados al látex. Conclusión: La sensibilización y alergia al látex es un problema relevante en niños con factores de riesgo. Los resultados mostrados plantean importantes desafíos en relación con medidas preventivas.

Introduction: The prevalence of latex sensitisation varies according to the population studied. There are various risk factors that increase latex sensitisation, such as genetic risk, atopy, and multiple surgeries. Objective: To characterise patients referred to an Immunology Unit with suspected latex allergy, and to analyse their clinical features and risk factors. Patients and method: A retrospective, descriptive study was conducted on children suspected of latex allergy. Their medical records were reviewed in order to assess symptoms with contact or exposure to latex materials. Known risk factors to latex sensitisation, such as pathologies requiring repeated surgery (spina bifida, myelomeningocele, scoliosis and nephro-urological alterations), atopy (rhinitis, asthma, atopic dermatitis) were investigated. A prick test and/or specific IgE to latex were also performed. A multivariate logistic regression model was performed to find associations between symptoms triggered by exposure to latex with underlying diseases and other risk conditions. Results: A total of 106 patients were enrolled in the study, of whom 50 were evaluable. At diagnosis 96% of patients were older than five years. Most of the risk factors described were observable in these patients, such as multiple surgeries, neurological and nephro-urological malformations, surgery before one year-old, and repeated bladder catheterisation. After latex exposure, mucous cutaneous manifestations were the most common (52%), followed by respiratory symptoms (36%). All patients were sensitised and allergic to latex. Conclusion: Latex allergy is a significant problem in children with risk factors. The results shown in this study raise important challenges for preventive measures and awareness.

[Latex allergy in a paediatric hospital. Characteristics and risk factors]. / Alergia al látex en un hospital pediátrico. Caracterización y factores de riesgo.

INTRODUCTION: The prevalence of latex sensitisation varies according to the population studied. There are various risk factors that increase latex sensitisation, such as genetic risk, atopy, and multiple surgeries. OBJECTIVE: To characterise patients referred to an Immunology Unit with suspected latex allergy, and to analyse their clinical features and risk factors. PATIENTS AND METHOD: A retrospective, descriptive study was conducted on children suspected of latex allergy. Their medical records were reviewed in order to assess symptoms with contact or exposure to latex materials. Known risk factors to latex sensitisation, such as pathologies requiring repeated surgery (spina bifida, myelomeningocele, scoliosis and nephro-urological alterations), atopy (rhinitis, asthma, atopic dermatitis) were investigated. A prick test and/or specific IgE to latex were also performed. A multivariate logistic regression model was performed to find associations between symptoms triggered by exposure to latex with underlying diseases and other risk conditions. RESULTS: A total of 106 patients were enrolled in the study, of whom 50 were evaluable. At diagnosis 96% of patients were older than five years. Most of the risk factors described were observable in these patients, such as multiple surgeries, neurological and nephro-urological malformations, surgery before one year-old, and repeated bladder catheterisation. After latex exposure, mucous cutaneous manifestations were the most common (52%), followed by respiratory symptoms (36%). All patients were sensitised and allergic to latex. CONCLUSION: Latex allergy is a significant problem in children with risk factors. The results shown in this study raise important challenges for preventive measures and awareness.

Prevalencia del síndrome látex-frutas en el estudiante de postgrado de la facultad de odontología de la universidad central de venezuela / Prevalence of the syndrome latex-fruits in dentists of the school of dentristy of the universidad central de venezuela

Los individuos alérgicos a látex pueden presentan reacciones mediadas por inmunoglobulina E (IgE) principalmente a frutas como cambur (banana, plátano), aguacate (palta), castaña y kiwi, lo cual se conoce como síndrome látex-frutas (SLF). Conocer la prevalencia del síndrome látex-frutas en una población conformada por los estudiantes de postgrado de la Facultad de Odontología de la Universidad Central de Venezuela (UCV) previamente diagnosticados con hipersensibilidad tipo I al látex. Se realizó un cuestionario a 27 participantes para conocer los antecedentes de atopia y reacciones alérgicas a frutas y vegetales así como también los factores de riesgo. También se diagnosticó la hipersensibilidad tipo I a aguacate, cambur, kiwi y tomate, mediante la prueba cutánea por técnica de punción superficial como prueba in vivo y un método ELISA utilizando el ENEASystem III como prueba in vitro. Estas dos pruebas diagnósticas arrojaron un total de 11/27 (41%) participantes con el síndrome látex-frutas. Referente a los factores considerados como de riesgo, 6 (55%) tenían antecedentes de atopia, 4 (36%) reportaron antecedentes familiares de alergia y 8 (73%) habían sido sometidos a intervenciones quirúrgicas. En este estudio se encontró una alta prevalencia del síndrome látex-frutas en la población estudiada. Los datos obtenidos sugieren un comportamiento dependiente entre la atopia y los otros factores de riesgo y el síndrome látex-frutas.

The individuals who are allergic to latex reactions are mediated by immunoglobulin E (IgE) mainly of fruit such as banana, avocado, chestnuts and kiwi, which is known as latex-fruit syndrome (LFS). To determine the prevalence of the latex-fruit syndrome in a group of dentists at the School of Dentistry at the Central University of Venezuela (UCV) previously diagnosed with type I hypersensitivity to latex. We conducted a questionnaire to find out the history of atopia, symptoms and allergic reactions to fruits and vegetables and the risk factors. Also we diagnosed type I hypersensitivity to avocado, banana, kiwi and tomato through the skin test technique of "prick by prick " as in vivo test and an ELISA method using the ENEASystem III as evidence in vitro. These two diagnostic tests yielded a total of 11/27 (41 %) participants with the latex-fruit syndrome. Concerning the factors considered as risk, 6 (55 %) had atopia, 4 (36 %) family history of allergy and 8 (73 %) had surgical interventions. This study found a high prevalence of the latex-fruit syndrome in the group studied. The data obtained suggest a behavior dependent between the atopia and other factors of risk and the syndrome latex - fruit.

Síndrome Látex-frutas y su importancia en odontología / Latex-fruit syndrome and its importance in dentistry

Diversos estudios han demostrado que entre un 20% y un 60% de los individuos alérgicos a látex presentan reacciones mediadas por inmunoglobulina E (IgE) a una amplia variedad de alimentos, principalmente a frutas como el cambur (banana, plátano) el aguacate, la castaña y el kiwi, lo cual se conoce como síndrome látex-frutas. El odontólogo debe conocer esta reacción cruzada de alergia a fin de evitar situaciones que puedan poner en riesgo al paciente si no se toman las medidas que garanticen un ambiente seguro libre de látex

Studies have shown that between 20% and 60% of individuals allergic to latex have IgE-mediated reactions (IgE) to a wide variety of foods, mainly fruits like banana, avocado, sweet chestnut and kiwi, which is called latex-fruit syndrome. The dentist should be aware of this allergy cross-reaction to avoid situations that may endanger the patient if not taken measures to ensure a safe environment free of latex

A case of latex fruit syndrome caused by spinach and eggplant / 대한내과학회지

Spinach (Spinacia oleracea) is a widely consumed vegetable, but rarely causes allergic reactions. Spinach contains plenty of histamine derivatives, so it is sometimes difficult to distinguish food allergy from pharmacologic effect of histamine itself in susceptible individuals. Latex exhibits strong cross reactivity with proteins from different fruits, vegetables, and grains, which is called as latex fruit syndrome. A 27 year old female visited emergency room with hives, facial swelling, dyspnea and palpitation immediately after meal. She had been suffering from latex allergy and had experienced an episode of anaphylaxis after eating eggplant 5 months earlier. Skin prick test with spinach extract was positive. Specific IgE to spinach antigens was detected by ELISA. ELISA inhibition test revealed that there is cross reactivity between latex and spinach. Two IgE binding components were detected between 22kD and 36kD, and another two between 16kD and 22kD on IgE-immunoblot analysis.