Prevalence of allergy to latex in the pediatric population.

Latex is a substance that is extracted from the plant Hevea Brasiliensis, and world production is 6 million metric tons per year. After gathering it undergoes a series of processes in which ammonia, vulcanization-accelerating additives or anti-oxidants are added. All of this may constitute the antigenic load that latex contains. It is used in medicine for gloves, drainage tubes, dental implants and a growing number of products from condoms to sport products or automobile components. Over fifteen different allergenic bands have been described, with molecular weights of between 2 and 100 kDa. In a joint study, USA-Finland identified three antigenic bands that predominate according to the population type studied (2). In children with spina bifida, congenital urogenital abnormalities or those submitted to multiple surgical interventions, the band of 27 kDa is predominant. This antigen has not been detected in adult serum, which suggests that contact with the antigen is through the mucous membranes and the sensitization is triggered from here. The incidence of allergy to latex in the general population is not known, but it seems to be lower than 1%. Turjanmaa (1) establishes a frequency of 0.125% (1/800) in patients submitted to general surgery. The incidence of sensitization to latex varies according to the population studied. Among the population considered to be at risk are the workers of the health environment, where the incidence is between 2.6 and 16.9%, whereas in the general population the percentage is around 1%. Sensitivity to latex is of great importance in patients suffering from spina bifida, in whom an incidence of between 28 and 67% has been found. We present our experience in a group of children attending our service for the first time for diverse reasons of supposed allergic etiology. The objective is to determine the incidence of sensitization to latex according to the diagnostic methodology [cutaneous test or by determination of specific IgE (CAP)]; according to the type of patient (atopic or non-atopic), the direct relationship with latex material and the role that can be played by a history of surgical intervention. In our experience with 282 children studied in our pediatric allergology service using diverse methods, the incidence of allergy to latex is 3.19%. Nevertheless, if we analyze this percentage we observe that if the diagnosis is based exclusively on cutaneous tests, it is only 1.08%; if to establish a diagnosis we used exclusively the determination of specific IgE (CAP) we would label 7. 2% of our children as allergic. Atopy is a factor that facilitates sensitization. In our sample, the incidence among the atopic population is 4.4%, though this percentage may vary between 1.69% and 9.5% depending on the methodology used. There are several hypotheses for explaining these discrepancies in the diagnostic tests. Although there do not seem to be differences regarding the ammonia content of the different lots, it seems that the differential factor could lie in the type of extract and in whether it is commercial or a natural latex extract. It could be a consequence of the existence of a prophyllin, so it has not been ruled out that a part of the IgE is an antiprophyllin. The presence of different epitopes would mean that each of them has the ability to produce its own specific IgE, though the RAST/CAP was not able to differentiate them and identified them as whole. The rate of allergy to latex in a group of children suffering from myelomeningocele is 80%. At a paediatric level, sensitization to latex is influenced by the means of contact, the duration of the exposure to the antigen and the fact that the exposure occurs early, which in the case of children with myelomeningocele is associated with the immaturity of the defence mechanism of the mucous membranes.