LATEX ALLERGY
Today, latex allergy and latex precautions in the spina bifida population are well-known issues. Prior to the 1980s, latex allergy was a largely unknown entity. Allergy to latex and the potential for anaphylactic allergic reactions came to medical attention in the 1980s in increasing numbers, with the increase usage of latex gloves for barrier protection from hepatitis and HIV.
With increased awareness since that time, clinical medical facilities typically take precautions with items containing latex and frequently do not allow products that have high loads of allergen, such as latex gloves (especially those with powder), latex balloons, rubber plungers, blood tourniquets, and rubber dams for dental procedures. It is also recommended that toys and other items with latex be avoided.Clinical signs of latex allergy are skin rash, angioe- dema, and, in severe cases, bronchospasm and other symptoms of anaphylactic reaction (74). The prevalence of latex sensitivity (ie, positive IgE skin testing) has been reported as high as 72% in the spina bifida population (125). Spina bifida patients with latex sensitivity are at high risk for anaphylactic response to latex-containing products. The propensity for latex allergy in the spina bifida population is increased by early exposure, specifically on the first day of life, and family of origin atopy. Neurosurgical procedures appear to be correlated with increased latex sensitization; intra-abdominal procedures are not (126,127). Recent studies continue to demonstrate that children with spina bifida have an increased propensity for latex sensitivity and allergy than those who have had multiple surgeries for other diagnoses, implicating that there is something inherent in the condition that predisposes to this allergy (127-129).
In the 1990s, latex-fruit syndrome—most frequently involving the banana, avocado, kiwi, and chestnut cross-reactivity—was reported.
Papaya, mango, bell pepper, fig, tomato, celery, and potato are other foods that are potentially problematic too. This list, although comprehensive, may not include all problematic foods. The cross-reactivity is exhibited on radioallergosorbent test (RAST). There can be allergen cross-reactivity between latex and the proteins in these foods. Latex sensitivity and allergy develop over time; therefore, negative RAST tests are not definitive for future allergic reactions. Furthermore, negative skin tests may or may not be reliable and may depend on the source of the allergen. It is not always clear whether latex sensitization precedes or follows the onset of food allergy (130).A detailed history regarding latex sensitivity and allergy is important. The management of this condition includes a MedicAlert bracelet and education regarding cross-reactivity between latex and foods in the spina bifida population. Avoidance of these foods is important. Avoidance of latex even as early as day one of life and an anaphylaxis kit are recommended (131). Potential risks must be discussed at each visit. Latex immunotherapy may be a treatment in the future, but currently it is not available secondary to adverse reactions (131).