Latex-allergic children

A comprehensive review of evidence and current recommendations related to pacifier usage

Pacifier usage is controversial, and published recommendations are contradictory. The purposes of this literature review were to provide a comprehensive summary of risks and benefits of pacifier usage based upon the highest levels of evidence available and to provide a reference for nurses to utilize while assisting mothers in making an informed decision. Results indicated that benefits include reported ability to soothe/comfort, decreased risk of sudden infant death syndrome, and a probable synergistic role in adjunctive pain relief. Greatest risks are an increased incidence of acute otitis media, possible negative impact on breast-feeding, and dental malocclusion particularly if usage is greater than 2-3 years. The frequency, intensity, and duration of pacifier use are related to type and extent of all risks.

Erythema multiforme-like eruption due to carbamates and thiuram

Report of a case of erythema multiforme-like eruption due to the use of rubber gloves. After several complementary studies, including epicutaneous and skin prick tests, we concluded that the eruption was secondary to sensitization to carbamates and thiuram. The main differential diagnosis in this case was allergic contact dermatitis to latex in natural rubber gloves. This entity is less frequent than might be expected, because it is usually due to intermediate chemical compounds used in rubber manufacturing, such as vulcanization accelerators; among of these latter compounds are thiurams and carbamates. Erythema multiforme-like eruption is a rare manifestation of contact dermatitis. Several cases have been reported, most of which have been due to contact with plants, metals or topical non-steroidal anti-inflammatory drugs. Its mechanism is still unclear, but it seems to be a type IV hypersensitivity reaction.

Low prevalence of latex sensitivity in South African spina bifida children in Cape Town

Spina bifida children have a high prevalence of latex allergy in studies reported from Europe and the USA. This study investigated the prevalence of latex allergy in a cohort of 24 spina bifida children at the Red Cross Children's Hospital from Cape Town, South Africa. The children were investigated using a detailed questionnaire, skin prick tests (ALK-Abello), ImmunoCap RASTs, Western blotting and ELISA, using the purified latex proteins Hev b1 and Hev b3 and whole latex preparation. A low overall prevalence of latex sensitization of 16.7% was found in the children. Children who were sensitive reacted to water insoluble to Hev b1 and Hev b3 proteins. The low prevalence of latex sensitization in the South African children may not be entirely explained by stringent latex avoidance. The children were from a low socioeconomic social status and 'hygiene' and other factors should be considered.

[Latex allergy in children]

The aim of our study was to determine the prevalence of latex allergy and the clinical features of children with latex allergy.

PATIENTS AND METHODS

We prospectively investigated 243 children consulting in our allergy out-patients unit during 1 year. Parents answered a questionnaire, and children underwent skin prick tests with common allergens and latex. Latex-specific serum immunoglobulin E was determined by CAP test in children with latex sensitization. The results were compared in children with and without latex allergy.

RESULTS

The prevalence of latex allergy was 1.3%. A family history of atopy (75%) and a personal history of previous surgery was associated with latex allergy (P < 0.0001). In children with latex allergy, the frequency of sensitization to inhaled and food allergens, atopic dermatitis, rhinitis and conjunctivitis was higher than in children without latex allergy (P < 0.05). Avocado allergy was the food allergy most commonly associated with clinical symptoms. Balloon was the most common latex product causing symptoms (60%).

CONCLUSIONS

Due to its potential severe consequences, latex allergy should be investigated in children who had undergone multiple surgical procedures and in the children with pollen-food allergy syndrome. Avoidance of latex is an important preventive measure.

IgE-mediated asthma and rhinitis I: a role of allergen exposure?

Exposures to airborne protein antigens, aeroallergens, may cause sensitization with production of Th2-dependent antibodies, including IgE. The IgE antibodies and associated cellular responses are responsible for the allergic airway diseases, allergic rhinitis and allergic asthma, which are increasing in societies with Western life style. Aeroallergens may have different potential to sensitize exposed subjects. Thus, there are only a limited number of important groups of aeroallergens, which are those from house dust mites, cockroaches, pets, pollens, and moulds. Allergy follows to a certain extent the pharmacological/toxicological paradigm of dose-response relationship. Unlike effects of pharmacologically and toxicologically active substances, allergens elicit their adverse effects in a two-stage process. In the first stage the immunologically naïve individual is sensitized to the allergen. In the second stage renewed exposure to the allergen elicits the disease response. Also, high concentrations of aeroallergens may induce immunological tolerance. The scientific literature suggests that many environmental factors contribute to the increase in sensitization and development of airway allergies. Nevertheless, the dose-response relationships apply (within certain limits) both to the sensitization itself and to the exacerbation of the diseases. This suggest that exposure reduction may be one of the methods for reduction of risk, in relation to control of the allergic airway diseases.

Episodic stridor with latex nipple use in a 2-month-old infant

Latex allergy in the pediatric population is most commonly identified in patients who have undergone multiple operations for neural tube defects or exstrophic genitourinary anomalies. However, there are a significant number of children who, without the usual risk factors, clinically and/or serologically appear to be latex allergic. There is sporadic information in the medical literature regarding reactions to latex allergens in household items, especially in patients younger than 1 year old. Several recent reports even support the existence of reactions to latex pacifiers. We report a case of an atopic 2-month-old infant who experienced the previously unreported reaction of repeated stridor on exposure to a latex nipple while feeding. It is important that clinicians recognize stridor as a potential reaction to latex in infants.

Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits

BACKGROUND

Latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant.

OBJECTIVE

Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred.

METHODS

A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an American-style fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. Latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. Immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed.

RESULTS

In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific Hevea species allergen similar to that of the foam layer sample.

CONCLUSION

Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets.