Anaphylaxis from Brazil nut (original) (raw)
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Although severe anaphylatic reactions are rare, allergic or immediate hypersensitivity reactions to natural rubber latex (NRL) have been reported in children with increasing frequency in the last few years. Indubitably, every-day rubber has been employed in thousands and thousands of products for over a century, while recently NRL allergy has been recognized as a substantial medical problem. Children with spina bifida undergoing multiple surgical procedures, as well healthy babies, appear at high risk for NRL allergy, with life-threatening reactions reported during surgery or while playing with balloons. Skin prick testing is the preferred diagnostic method, especially in the prick by prick version. During procedures, Parents of children with latex allergy should take caution that their babies avoid contact with rubber products, and a latex-free environment. Since minimal contacts with NRL products may produce reactions, the primary treatment for latex allergy is avoidance. The cross-reactions regarding the latex-fruit syndrome have recently widened the number of possible reactions.
Latex Allergy and Sensitization in Children with Spina bifida
Pediatric Neurosurgery, 2002
Background: The purpose of this study was to investigate the prevalence rate of latex sensitization and latex allergy among children with spina bifida and to evaluate risk factors for natural rubber latex hypersensitivity. Methods: A total of 34 children between 2.5 and 17 years of age participated in the study. Participants completed a questionnaire and underwent skin prick tests with latex, common aeroallergens and food allergens as well as measurements of specific IgE to latex and food allergens (RAST CAP). Results: The prevalence of latex sensitization and latex allergy was estimated to be 32.4 and 18.8%, respectively. The most common reported clinical manifestation of latex allergy was urticaria. Three out of six symptomatic patients reported anaphylactic reactions. Conclusion: We found that major risk factors for latex sensitization were atopy and a history of numerous operations.
Journal of Allergy and Clinical Immunology, 1997
Background: Some children with spina bifida who are sensitized to latex can have severe reactions, whereas others remain free of symptoms. Objective: Our aim was to study the differences between these two groups of patients. Material and methods: In 110 consecutive children with spina bifida, we identified by means of skin prick tests and serum latex-specific IgE 32 patients sensitized to latex. In these 32 patients, data were collected for sex, age, personal and familial history of atopy, number of cystourethrograms and number of operations, history of intermittent bladder catheterization, serum levels of total lgE in units per milliliter and in z units, levels of latex-specific IgE, and results of skin prick tests. Results: Sixteen patients (50%) had clinical symptoms related to latex. These patients had significantly higher levels of serum specific IgE (32.8 ± 30.7 U/ml vs. 12.8 ± 16.5 U/ml), were more likely to have positive responses on skin tests (100% vs. 75%), had a higher number of operations (10.5 +-6.9 vs. 5.8 ± 2.7), and were more likely to have a personal history of atopy (44% vs. 6%) in comparison with findings for patients who did not have symptoms (p < 0.05 in all cases). A multivariate logistic regression analysis identified the latter two factors as independent synergistic variables to predict symptoms. Conclusions: The number of operations is the main risk factor for latex-related symptoms in sensitized children. Atopy seems to lower the threshold both for sensitization and for the presentation of clinical reactions. (J Allergy Clin Immunol 1997;99:600-4.)
Risk factors for latex hypersensitivity in childhood
Pediatric Allergy and Immunology, 1996
As hypersensitivity to natural rubber latex (NRL) has become an increasingly recognized problem in children, identification of all groups at risk seems important. In this study hypersensitivity to NRL was evaluated in 337 children vi'ith potential risk factors. We identified by questionnaire children's underlying diseases, history of surgical procedures, evidence of atopy and patient's history of NRL-specific reactions. Hypersensitivity to NRL and other allergens relevant in the Dusseldorf area was evaluated by skin prick test and specific IgE. In 9.2% of all children hypersensitivity to NRL was observed. Significant risk factors for hypersensitivity to NRL were, among the underlying diseases, spina bifida (odds ratio 29.2). hydrocephalus internus (10.1), gastrointestinal malformation (5.2) and atopy (2.2). Surgical procedures with significant risk were the implantation of a ventriculo-peritoneal shunt (15.7) and surgery ofthe gastrointestinal tract (3.1). Frequency of surgical procedures correlated (p<O.OOI) with risk of hypersensitivity. Frequent surgery and atopy were found to have an additional effect on the risk of hypersensitivity. Information about previous NRL-specific reactions obtained by questionnaire was of little predictive value when performing multivariate analysis. For children at high risk for hypersensitivity to NRL preoperative evaluation and, in case of bypersensitivity. preventive measures seem to be advised.
Risk factors for latex sensitization in children with spina bifida
Allergologia et Immunopathologia, 2002
Background: Children with spina bifida represent the major risk group for latex sensitization. Purpose: To determine the prevalence of latex sensitization in these children and to identify risk factors. Material and methods: We studied 57 patients with spina bifida. The mean age was 5.6 years and the male/female ratio was 0.8/1. In all patients a questionnaire, skin prick test (SPT) with latex (UCB-Stallergènes, Lofarma and ALK-Abelló), common aeroallergens and fruits (UCB-Stallergènes) and serum determination of total IgE (AlaSTAT) were performed. Results: The prevalence of latex sensitization was 30 %; only two sensitized children (12 %) had symptoms after exposure. Risk factors for latex sensitization were age Ն 5 years (p = 0.008; OR = 6.0; 95 % CI = 1.7-22.1), having at least four previous surgical interventions (p < 0.0001; OR = 18.5; 95 % CI = 3.6-94.8), having undergone surgery in the first 3 months of life (p = 0.008; OR = 5.4; 95 % CI = 0.7-29.2) and total serum IgE Ն 44 IU/ml (p = 0.03; OR = 3.8; 95 %CI = 1.1-13.1). Multiple logistic regression analysis showed that only a history of four or more surgical interventions (p < 0.0001; OR = 26.3; 95 %CI = 2.9-234.2) and total serum IgE Ն 44 IU/ml (p = 0.02; OR = 8.6; 95 % CI = 1.4-53.4) were independently associated with latex sensitization. Sex, family and personal allergic history, hydrocephalus with ventriculoperitoneal shunt, cystourethrograms, intermittent bladder catheterization and atopy were not related to latex sensitization. Conclusions: In children with spina bifida, significant and independent risk factors identified for latex sensitization were multiple interventions and higher levels of total serum IgE. A prospective study will clarify the clinical evolution of assymptomatic children sensitized to latex.
Journal of Allergy and Clinical Immunology, 1996
Background: Latex allergy is quite frequent in patients who have undergone multiple operations, such as children with spina bifida. Objective: This investigation was carried to study the prevalence and risk factors associated with latex allergy in patients with spina bifida. Methods: We studied 100 consecutive patients by skin prick tests and quantified specific IgE to latex with commercial antigens. Results: Twenty-nine patients were sensitized to latex, although 14 (49%) did not report symptoms. There was a statistical association (p < O. 05) between sensitization and age, number of operations, number of cystourethrograms, antecedents of intermittent bladder catheterization, personal antecedents of atopy, the presence of a ventricular-peritoneal shunt, and levels of serum total IgE, the latter both in absolute units per milliliter and relative zunits. Through a forward stepwise multiple logistic regression analysis, the number of operations, serum total IgE in z-units, the presence of a ventricular-peritoneaI shunt, and personal antecedents of atopy were selected as the synergistic variables that most contributed to identification of sensitized patients. The mathematical model so developed had an area under the receiver operating characteristic curve of O. 95. Alternative models always retained two variables, the number of operations and levels of lgE. Conclusion: Allergy to latex is mainly related to the number of operations and to the atopic diathesis of patients. (J Allergy Clin Immunol 1996;98:501-7.)
Latex allergy in children: diagnosis and management
Indian journal of pediatrics
Latex allergy is an increasingly common condition, in both children and health care workers who provide care for them. Subpopulations at particular risk include children with spina bifida, children undergoing multiple surgical procedures, and health care workers in the operating theatre. Chemical additives in latex gloves can cause an irritant or allergic contact dermatitis. Latex proteins are responsible for most of the immediate IgE-mediated hypersensitivity allergic reactions. Symptoms range from rhinitis, conjunctivitis and urticaria to anaphylaxis and death. A latex-directed history is the primary method of identifying latex sensitivity, although both skin and serum testing is available and increasingly accurate. (Latex avoidance should be used in all individuals with a positive skin or blood test or a positive history). The most important preventive measure for patients with or at risk for latex allergy is minimizing direct patient exposure to latex products, most notably late...