Mahmut DOĞRU, Derya ERDOĞAN, İlknur BOSTANCI, Serap ÖZMEN, İBRAHİM KARAMAN, Handan DUMAN

Tekrarlayan abdominal veya gastrointestinal cerrahi uygulanan çocuklarda lateks duyarlılığı

Amaç: Lateks alerjisinin sıklığı tekrarlayan cerrahi girişimlerle artmaktadır. Bu etki özellikle spina bifidalı ve ürogenital anomalili hastalarda araştırılmıştır. Çoğunluğu gastrointestinal sistem cerrahisi şeklinde olan ve iki veya daha fazla sayıda girişim uygulanan çocuklarda lateks alerjisi sıklığının belirlenmesi amaçlandı.Gereç ve Yöntem: Çalışmaya Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi Çocuk Cerrahisi Kliniğinde 01.01.2009 tarihinden önce iki ve daha üzeri sayıda cerrahi girişim uygulanmış olan 27 çocuk ile kontrol grubu olarak herhangi bir alerjik şikayeti ve cerrahi girişim geçirme öyküsü olmayan 25 sağlıklı çocuk alındı. Hasta ve kontrol grubuna aynı allerjenlerle deri prik testleri yapıldı. Total IgE düzeyi değerlendirildi.Bulgular: Hastaların 14’ü (%51,9) erkek olup yaşları 5 ay ile 18 yıl (5,7±4,5) arasında değişmekte idi. Hastalarımızdaki tanıların dağılımında; ilk sırada sekiz (%29,6) hastamızda bulunan anal atrezi yer almaktayken özofagus atrezisi ve korozif madde alımına bağlı gastrointestinal sistem hasarı beş hasta (%18,5) sıklıkla 2. sıklıktaki tanılardı. Hastalara uygulanan cerrahi girişim sayısı 2 ile 21 arasında (ortalama±SD:5,2±4 ortanca:4) değişmekteydi. Latekse temasla gelişen bulgular, ailede alerjik hastalık, IgE yüksekliği, eozinofili, deri testlerindeki duyarlılık açısından gruplar arasında istatistiksel anlamlı farklılık yoktu (p˃0,05). Hasta grubunun sadece birinde (%3,7) lateks alerjisi saptanırken kontrol grubunun hiçbirinde lateks alerjisi saptanmadı.Sonuç: Birden fazla cerrahi girişim (çoğunluğu GIS cerrahisi) uygulanan hastalarda lateks alerjisi açısından kontrole göre istatistiksel anlamlı farklılık saptamadık. Özellikle malignite nedeniyle opere olan hastalar lateksli ürünlerle sık temas ettiklerinden dikkatli izlenmelidir.

Anahtar Kelimeler:

Lateks allerjisi, Cerrahi girişim, Çocuk

Latex sensitivity in children with recurrent gastrointestinal tract or abdominal surgical interventions

Objective: The frequency of latex allergy is increased for repeated surgical interventions. This effect was investigated especially in patients with spina bifida and urogenital anomalies. There is limited data about latex allergy in repeated surgical interventions that were done for other reasons. It was aimed to determine the prevalence of latex allergy in children who underwent two or more interventions especially for gastrointestinal tract surgery.Material and Method: A total number of 27 children who underwent two or more surgical interventions in Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital Department of Pediatric Surgery before 2009, and 25 healthy children with no history of any allergic complaints and surgical intervention were included in the study. Skin prik tests were performed with the same allergens for patient and control groups. Total immunoglobulin E was evaluated.Results: The mean age was 5.7 ± 4.5 (5 months to 18 years) years and 51.9 %(14) of the patients were male. The mean age was 5.9 ± 1.6 (2,7 to 8,4) years and 52 %(13) of the children in the control group. The most diagnoses of the patients were; eight (29.6%) patients with anal atresia, five (18.5%) patients with esophageal atresia and five (18.5%) patients with gastrointestinal damage due to ingestion of caustic materials. The number of surgical procedures varied between 2 to 21 (mean±SD:5.2 ± 4, median: 4). Seven (26%) patients underwent surgery more than five. Between two groups there was no significant difference for developing findings with contact to latex, family history of allergic disease, IgE elevation, eosinophilia and skin prik tests (p< 0.05). Latex allergy was detected in any of the control group, while only one patient (3,7%) was allergic to latex in the patient group.Conclusion: Children who underwent more than one surgical intervention for gastrointestinal tract was not statistically differences in terms of latex allergy compared to controls. Especially those operated for malignancy patients should be monitored carefully because they have frequent contact with latex products.

Keywords:

latex allergy, surgical intervention, child,

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-Cabañes N, Igea JM, de la Hoz B, Agustín P, Blanco C, Domínguez J, Lázaro M, Lleonart R, Méndez J, Nieto A, Rodríguez A, Rubia N, Tabar A, Beitia JM, Dieguez MC, Martínez-Cócera C, Quirce S; Committee of Latex Allergy; SEAIC. Latex allergy: Position Paper. J Investig Allergol Clin Immunol. 2012;22(5):313-30.
Kelly KJ. Latex allergy. In: Leung DYM, Sampson HA, Geha R, Szefler SJ (eds). Pediatric Allergy Principles and Practice. 2nd edition. London: Saunders-Elsevier; 2010.p.631-39.
Cremer R, Lorbacher M, Hering F, Engelskirchen R. Natural rubber latex sensitisation and allergy in patients with spina bifida, urogenital disorders and oesophageal atresia compared with a normal paediatric population. Eur J Pediatr Surg. 2007;17(3):194-8.
Gentili A, Ricci G, Di Lorenzo FP, Pigna A, Masi M, Baroncini S. Latex allergy in children with oesophageal atresia. Paediatr Anaesth. 2003;13(8):668-75.
Degenhardt P, Golla S, Wahn F, Niggemann B. Latex allergy in pediatric surgery is dependent on repeated operations in the first year of life. J Pediatr Surg 2001;36:1535–9.
- Hourihane JO, Allard JM, Wade AM, McEwan AI, Strobel S. Impact of repeated surgical procedures on the incidence and prevalence of latex allergy: a prospective study of 1263 children. J Pediatr 2002;140:479–82.
- Bernardini R, Novembre E, Lombardi E, Mezzetti P, Cianferoni A, Danti AD, Mercurella A, Vierucci A.. Prevalence of and risk factors for latex sensitization in patients with spina bifida. J Urol. 1998;160(5):1775-1778.
- Ozkaya E, Coskun Y, Turkmenoglu Y, Samanci N. Prevalance of latex sensitization and associated risk factors in Turkish children with spina bifida. Pediatr Surg Int. 2010;26(5):535-8.
- Bozkurt G, Sackesen C, Civelek E, Kalayci O, Akalan N, Cataltepe O. Latex sensitization and allergy in children with spina bifida in Turkey. Childs Nerv Syst. 2010;26(12):1735-42.
- Allmers H, Kirchner B, Huber H, Chen Z, Walther JW, Baur X. The latency period between exposure and the symptoms in allergy to natural latex. Suggestions for prevention. Dtsch Med Wochenschr 1996;121:823–8.
- Bostanci I, Yılmaz R, Dallar Y, Tanyer G. Latex sensitivity in hematologic and oncologic non-atopic pediatric patients. Pediatr Asthma Allergy Immunol 2003;16(3):117-20.