Latex allergies in children with spina bifida: relevance for the pediatric dentist

Brian Schmid DMD 5/7/10

Journal: Pediatric Dentistry
Date: Jan/Feb 1994
Vol: 16(1) 18-22
Main Topic: latex allergies in spina bifida patients
Summary: Children at high risk for latex allergy: spina bifida and myelodysplasia, exstrophy of the bladder and other deemed to have a likelihood of multiple genitourinary operations and urinary catheterizations, neurologicaly impaired bladders.
There have been at least 16 fatalities due to latex allergy in the US. Beyond latex gloves, some of the most common dental supplies containing latex that may be overlooked are radograph packets and rubber dams. 4 cases are presented concerning latex allergies in pediatric dental patients.
Case 1: A pt with myelomeningocele and urinary incompetence developed an allergy despite multiple previous exposures with no reaction. Allergic skin testing revealed a serious alergy to latex. Vinyl gloves were used in addition to a rubber dam made from a cut up vinyl glove and dental treatment was carried out without incident.
Case 2: 10 year with spina bifida developed a latex allergy which required emergency intervention in the form or diphenhydramine without further complications.
Case 3: Presention of a 7 year old with a known latex allergy who had a reaction during the exposure of bitewing radiographs at a private dental office. It was later found that the packet contained no latex, and the allergy was most likely due to the powder from the gloves. Future radiographs were taken wrapped in a vinyl glove.
Case 4: A patient with a history of bilateral inguinal hernia repair and allergy to Penicillins presented to the dental clinic. He had been previously treated with latex gloves, prophy angles and rubber cups. One year prior to the writing of the article he underwent repair of a bladder perforation requiring multiple latex catheterizations. At the last dental visit, placement of a rubber dam brought on an allergic reaction including red eyes and red urticarial lesions around the mouth. Diphenhydramine was used IM. No complications during followup. Six months later, vinyl gloves were used but a latex prophy cup brought on another reaction which was remedied the same way.

The first clinical latex allergy was documented in 1979. Over the years, many additional latex allergies were documented, often in association with spina bifida and/or urogential anomalies. About 1/3 of spina bifida/myelodysplasia patients are seripositive to latex allergens. Patients requiring intermittent self catheterization should be considered high risk for latex allergy. Atopy has been reported in 45-100% of patients with a latex allergy.
Review: While most clinics are becoming more and more latex-free, it is important to take extra precautions for patients with a history of spina bifida or multiple surgeries requiring multiple latex catheterizations.