The latex allergy dogma in spina bifida - how generalisable is the evidence? A cross-sectional study from Southern India challenging Western benchmarks

Abstract

Purpose: Children with spinal dysraphism (SD), and particularly those with open spinal dysraphism (OSD; myelomeningocele/myeloschisis), have historically been classified as a uniquely high-risk population for latex allergy, with most published evidence derived from Western cohorts reporting prevalence rates of 26-70%. Data from low- and middle-income settings remain scarce. This study aimed to determine the prevalence of latex sensitisation and clinical latex allergy in children with SD at a tertiary care centre in southern India and to identify associated risk factors.

Methods: In this cross-sectional study, 79 children with SD (28 OSD, 51 closed spinal dysraphism [CSD]) underwent evaluation comprising a structured atopy history, skin prick testing (SPT) with standardised latex extract, measurement of total serum IgE, and latex-specific IgE classification by PROTIA Allergy-Q immunoblot. Associations were assessed using Fisher's exact test and Mann-Whitney U test; correlations were evaluated using Spearman's rank correlation coefficient.

Results: The mean age was 5.86 ± 4.38 years. Personal atopy was reported in 6.3% and family history of atopy in 34.2%. Two children (2.5%) had a positive SPT for latex (clinical sensitisation). On immunoblot testing, 11 of 78 evaluated children (14.1%) showed serological sensitisation (class ≥ 1), though none demonstrated concordant clinical reactivity on SPT, indicating a dissociation between serological sensitisation and clinical allergy. Sub-analysis by SD subtype revealed serological sensitisation in 6/28 (21.4%) OSD vs. 5/51 (9.8%) CSD (Fisher's exact p = 0.184); SPT positivity was 1/28 (3.6%) in OSD and 1/51 (2.0%) in CSD (p = 1.000). Total IgE was elevated (> 100 IU/mL) in 30.4%. A significant positive correlation was observed between total IgE and age at testing (Spearman's ρ = 0.495, p < 0.001). No significant associations were found between SD type, number of surgeries, or atopy history and test positivity.

Conclusion: Clinical latex allergy in children with SD at our institution was markedly lower than internationally reported rates. The discordance between serological sensitisation and clinical reactivity challenges simplistic interpretations of latex allergy prevalence and underscores the need for region-specific data - including for OSD specifically - to guide clinical protocols.

Keywords: IgE; Latex sensitisation; Myelomeningocele; Prevalence; Skin prick test; Spinal dysraphism.