The search of latex sensitization in spina bifida: diagnostic approach

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Abstract
Background: Sensitization to latex has become a major problem in children with spina bifida. Life‐threatening reactions may occur in these patients, therefore the search of latex sensitization must be an active task in all of these children.Objective: To design an approach for the diagnosis of latex sensitization in children with spina bifida.Methods: We studied 100 consecutive unselected patients. Skin prick tests with a commercial latex extract were performed, latex‐specific serum immunoglobulin (Ig) E was determined by CAP test, and risk factors were studied. Originally, patients with an area of latex skin test > 50% of the area of histamine and/or CAP class ≥ 3 were considered sensitized to latex. Diagnostic tests were also performed in a control group of 51 atopic and nonatopic children.Results: After performing a receiver‐operating characteristics curve for both tests we recommend skin tests > 25% of the area of histamine (sensitivity − SEN = 79%, specificity − SPE = 100%, positive predictive value − PPV = 100%, negative predictive value − NPV = 90%), or CAP class ≥ 2 (SEN = 88%, SPE = 100%, PPV = 100%, NPV = 94%) as diagnostic cut‐off points. The anamnesis had a SEN of 44% for diagnosis, and a SPE of 100%. Latex sensitization was associated with more than 5 operations (OR = 8, 95% CI = 3–21.3), a personal history of atopy (OR = 11.5, 95% CI = 2.3–57.1), and serum total IgE ≥ 2 z‐units (OR = 4, 95% CI = 1.6–10).Conclusion: For the routine evaluation of children with spina bifida, we propose a diagnostic algorithm with skin prick tests as a first step and CAP second.

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