Latex allergy in children: a follow-up study.

BACKGROUND: Natural rubber latex allergy is an important health problem. Multiple contacts with latex in childhood are a risk factor. Many aspects of this disease are still unknown, one of which is the clinical outcome of these children. The aim of this study was to evaluate the clinical and epidemiological features of latex allergy and compliance with latex avoidance instructions in allergic children. MATERIAL AND METHODS: Seventeen consecutive patients with a history of latex allergy, fruit allergy or chronic urticaria were selected. The patients underwent a skin prick test and determination of specific-IgE to latex at the start and at end of the study (median follow-up: 3 years). At diagnosis, patients with a positive result to one of the tests and a clinical history of latex allergy were considered allergic; patients with a positive test but without a clinical history suggestive of allergy were considered sensitized. These children were given latex avoidance instructions. RESULTS: Eleven children (64.7 %) were classified as allergic and 6 (35.3 %) as sensitized. Five patients had undergone latex-free surgery after diagnosis without incident. During follow-up, 11 patients (8 allergic and 3 sensitized) had contact with latex. Contact occurred in the home in 10 children, and all were symptomatic. Specific-IgE levels to latex at the end of the study were significantly higher in patients who had contact with latex during the follow-up period than in those without latex contact. CONCLUSIONS: Strict compliance with latex avoidance instructions is essential both inside and outside the hospital. Greater emphasis should be placed on reducing latex exposure in the home and school environments, as such contact could maintain positive IgE-antibody levels.

Latex allergy in children: a follow-up study / Alergia al látex en niños. Un estudio de seguimiento

Background: Natural rubber latex allergy is an important health problem. Multiple contacts with latex in childhood are a risk factor. Many aspects of this disease are still unknown, one of which is the clinical outcome of these children. The aim of this study was to evaluate the clinical and epidemiological features of latex allergy and compliance with latex avoidance instructions in allergic children. Material and methods: Seventeen consecutive patients with a history of latex allergy, fruit allergy or chronic urticaria were selected. The patients underwent a skin prick test and determination of specific-IgE to latex at the start and at end of the study (median follow-up: 3 years). At diagnosis, patients with a positive result to one of the tests and a clinical history of latex allergy were considered allergic; patients with a positive test but without a clinical history suggestive of allergy were considered sensitized. These children were given latex avoidance instructions. Results: Eleven children (64.7 %) were classified as allergic and 6 (35.3 %) as sensitized. Five patients had undergone latex-free surgery after diagnosis without incident. During follow-up, 11 patients (8 allergic and 3 sensitized) had contact with latex. Contact occurred in the home in 10 children, and all were symptomatic. Specific-IgE levels to latex at the end of the study were significantly higher in patients who had contact with latex during the follow-up period than in those without latex contact. Conclusions: Strict compliance with latex avoidance instructions is essential both inside and outside the hospital. Greater emphasis should be placed on reducing latex exposure in the home and school environments, as such contact could maintain positive IgE-antibody levels

Antecedentes: Un grupo de riesgo para la alergia al látex es la población infantil que presenta contactos sucesivos con este alérgeno desde edad muy temprana (intervenciones quirúrgicas de repetición). Aún se desconoce el patrón evolutivo de esta patología en esta población. Métodos y resultados: Se seleccionó a 17 pacientes con historia de alergia al látex, a frutas o urticaria crónica. Se realizó prueba cutánea y determinación de IgE específica frente a látex al inicio y al final del seguimiento. Al diagnóstico, los que presentaban alguna de las pruebas positivas con historia sugestiva de hipersensibilidad al látex fueron diagnosticados de alergia y quienes presentaban alguna prueba positiva, sin historia sugestiva, se consideraron sensibilizados. Se les realizaron indicaciones para la evitación de látex. Se diagnosticó a 11 pacientes como alérgicos (64,7%) y 6 (35,3%) como sensibilizados. Se intervino a 5 pacientes después del diagnóstico en quirófano libre de látex sin ninguna complicación. Durante el seguimiento, 11 pacientes (8 alérgicos y 3 sensibilizados) presentaron contactos con látex; 10 de ellos en el domicilio, y todos sintomáticos. La IgE específica frente a látex fue significativamente mayor al final del estudio en los pacientes que transgredieron con respecto a los que cumplieron la evitación (p = 0,007). Conclusiones: Se debe realizar un estricto control de las medidas de evitación en los niños alérgicos al látex en régimen hospitalario, pero consideramos necesario un esfuerzo para alcanzar un control igualmente estricto en el ambiente escolar y familiar de los niños de riesgo con el fin de reducir las transgresiones clínicas domiciliarias, responsables del mantenimiento de la sensibilización en algunos pacientes

A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites.

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1%) were recorded, representing 4.8% of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5% of the administered doses) and occurred in 10 patients (3.8% of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose.

A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1 %) were recorded, representing 4.8 % of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5 % of the administered doses) and occurred in 10 patients (3.8 % of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose (AU)

Se ha llevado a cabo un estudio prospectivo y multicéntrico de farmacovigilancia, con el objetivo de valorar la seguridad de una nueva pauta en inmunoterapia subcutánea de 7 dosis, frente a las 13 de la pauta convencional habitualmente recomendada. El estudio se realizó en 14 centros, incluyéndose 261 pacientes (niños y adultos) con enfermedad alérgica respiratoria por sensibilización a ácaros (Dermatophagoides pteronyssinus y/o farinae). Se administraron un total de 2.290 dosis, todas ellas bajo la supervisión directa de los especialistas participantes. Se registraron 110 reacciones en 63 pacientes (24,1 por ciento), lo que supone un porcentaje sobre el total de dosis administradas del 4,8 por ciento. La mayoría de reacciones (98) fueron locales. Tan sólo 12 fueron sistémicas (0,5 por ciento sobre las dosis administradas) las cuales ocurrieron en 10 pacientes (3,8 por ciento de la muestra). En 10 casos revertieron rápidamente con medicación de alivio, en 1 caso fue necesario bajar la dosis de mantenimiento, y en 1 paciente se decidió retirarle del estudio por padecer 2 crisis asmáticas en dos dosis consecutivas. A la vista de los resultados obtenidos, podemos concluir que la nueva pauta ensayada presenta un adecuado perfil de tolerancia, no existiendo mayor riesgo de reacciones al compararlo con el perfil de la pauta convencional de 13 dosis utilizando idéntico extracto. Además, la nueva pauta supone un notable ahorro en el número de dosis y visitas necesarias para alcanzar la dosis de mantenimiento (AU)