JULY 1997, VOL 66, NO 1
Association Between Latex Sensitization and Repeated Latex Exposure in Children
F Porri et al
Numerous research studies have documented that children with spina bifida are at high risk for developing allergies to natural rubber latex. To prevent latex sensitization and possible anaphylaxis, allergists and immunologists recommend that children with spina bifida be managed with latex avoidance protocols beginning at birth. Some children with congenital anomalies other than spina bifida also become sensitized to latex; however, little empiric evidence exists to determine if these children also are at high risk for developing allergies to natural rubber latex and if they also should be managed with latex avoidance protocols.
The purpose of this study was to determine if the spina bifida congenital anomaly is itself a risk factor for latex sensitization or if exposures to latex during multiple surgical procedures are the actual risk factor. The researchers also evaluated the children in this study for other latex sensitization risk factors, such as atopy (ie, inherited predisposition to allergies) and ethylene oxide (EO) sensitization.
Sample. The sample consisted of 80 French children between ages one year and 16 years who were divided into three groups. Group A consisted of 29 children who had spina bifida. Group B consisted of 31 children who did not have spina bifida but who had undergone multiple surgical procedures. Group C consisted of 20 children who had either no exposure to general anesthesia or who had undergone general anesthesia once, and these children served as the control group. The children in the three groups were similar in age, gender, and atopic status. The number of previous surgical procedures and perioperative anaphylactic episodes was comparable between the group of children with spina bifida (ie, group A) and those who had undergone multiple surgical procedures but did not have spina bifida (group B).
Methods. The researchers interviewed the children and their parents to identify previous reactions to products made of natural rubber latex (eg, balloons, bottle nipples). To diagnose atopy in the children, the researchers applied prick tests with four common inhalant allergens. They defined atopic status as one or more positive tests to these allergens. They evaluated latex sensitivity in all 80 children by applying skin prick tests with a commercial extract of natural latex and measuring specific immunoglobulin E to latex with the radioallergosorbent test (RAST). The RAST was considered positive if the response was greater than 0.35 Pharmacia RAST U/mL. Any child who had a positive skin prick test or a positive RAST was considered sensitized to latex. The researchers also evaluated each child’s EO sensitization using the RAST. They performed positive and negative control tests with codeine phosphate and coca solutions, respectively. Prick tests were considered positive if wheals measured greater than half the wheal induced by the positive control and greater than the wheal induced by the negative control.
Results. Fifty-nine percent of the children in group A and 55% of the children in group B were hypersensitive to latex; however, none of the children in group C was hypersensitive to latex. Ethylene oxide sensitization followed a similar pattern, with 44% of the children in group A and 19% of the children in group B being sensitive to EO and none of the children in group C being sensitive to EO. Ethylene oxide sensitization was associated with latex sensitization status but not with the number of previous surgical procedures. The incidence of atopy in the latex-sensitized children was twice that of children who were not sensitized to latex, underscoring the relationship between atopy and latex sensitization.
Perioperative nursing implications. This study should heighten perioperative nurses’ awareness of latex sensitization in pediatric surgical patients. It also emphasizes the possibility that all children (ie, not just children with spina bifida) who undergo multiple surgical procedures may be at high risk for latex sensitization. Perioperative nurses play key roles in preventing children’s sensitization to natural rubber latex by minimizing these children’s intraoperative exposures to latex products. One perioperative nursing intervention is to ensure that powderless, low-allergen, latex surgical gloves are used routinely. For surgical patients who are at high risk for latex sensitization, perioperative nurses can institute latex avoidance precautions. Perioperative nurse educators need to provide inservice education programs about screening surgical patients for latex-sensitization risk factors and about nursing care for these high-risk patients.
This study provides an impetus for perioperative nurses to conduct further research about latex sensitization, including studies to identify risk factors. Further research also may identify the prevalence of and risk factors for EO sensitization.
Victoria M. Steelman RN, PhD(c), CNOR
Reprinted with permission, AORN Journal, 66 July 1997, pp 161–162.
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