Cytokine Detection in Three Children with Spina Bifida and Health Care Workers with Latex Allergy

Children with spina bifida are known to have a greater incidence of latex allergic reactions including generalized urticaria and anaphylaxis. We present three cases along with data using a sensitive radioimmunosorbent assay (RIA) to three latex proteins and serum interleukin (IL)-4 levels, a cytokine known to regulate IgE production which stimulates mast cell proliferation. A 13-year-old boy with a history of spina bifida and multiple surgeries was diagnosed with latex allergy after a facial rash developed while playing with a rubber ball. Subsequently, the patient was evaluated for a burn injury and developed diffuse urticaria with wheezing after contact with latex gloves during examination. A specific RIA to several latex proteins revealed very high levels of specific IgE to ammoniated latex extract (818 U/ml) and buffered latex and glove extract (> 1,000 U/ml). A 7-year-old boy with a history of spina bifida and multiple surgeries with daily urinary catheterizations was evaluated for a diffuse rash, which occurred 15 times in the past two years. A specific RIA to several latex proteins showed a highly positive reaction to ammoniated, buffered, and glove extract (> 1,000 U/ml). A 14-year-old boy with a history of spina bifida, multiple surgeries, and asthma was evaluated for a local rash on his hands after contact with latex gloves. Latex specific RIA tests were negative. The highest serum IL-4 levels of 40 to 69 pg/ml by a sensitive enzyme-linked immunosorbent assay were noted in these three patients when compared with 16 health care controls. Undetectable levels of serum IL-4 were noted in the first case two months after latex avoidance and decreased serum IL-4 levels were noted in all other health care workers after barrier protection or avoidance.