Longitudinal Study on Specific IgE Against Natural Rubber Latex, Banana and Kiwi in Patients with Spina Bifida

Abstract

Objective: Up to 2 out of 3 spina bifida (sb) patients with natural rubber latex (NRL) antibodies (ab) have crossreacting IgE-ab against tropical fruit, due to structural homologies between several NRL antigens and allergenic fruit proteins. It is essential to investigate whether the patients were first sensitized against NRL or fruit, to give recommendations for an evidence-based prophylaxis.

Patients and methods: We investigated sera of 96 sb patients for specific IgE ab against NRL, banana and kiwi as examples for crossreacting fruit by FEIA (ImmunoCAP System, Phadia). These tests were repeated up to 3 times (mean after 2 years, maximum after 7 years).

Results: In the first testing only 2 of 50 NRL-IgE negative patients (4%) had ab against banana or kiwi. 4 of the 46 NRL-IgE positive patients (8%) showed ab against banana (2) or kiwi (2), 3 (7%) against both fruit. Symptoms of fruit allergy were presented by 3 patients, all symptomatic patients had high levels of specific fruit-ab. In the follow-up study 2 patients with low sensitization against NRL lost their NRL ab and their fruit ab, another 2 only the fruit ab, whereas 4 NRL-sensitized patients newly developed ab against banana and 1 against kiwi. Only 2 patients developed ab against fruit without being sensitized against NRL. 7 out of 10 patients with banana and kiwi ab were atopics.

Conclusions: In most cases the sensitization against fruit follows the NRL sensitization. There is no need to recommend sb patients without NRL sensitization to primarily avoid tropical fruit.

Zusammenfassung

Problemstellung: Bis zu 2 von 3 Spina-bifida- (Sb-)Patienten mit Antikörpern (Ak) gegen Naturgummi (NRL) haben kreuzreagierende IgE-Ak gegen tropische Früchte. Dies ist durch strukturelle Homologien zwischen einigen NRL-Antigenen und allergenen Fruchtproteinen bedingt. Es ist aber essenziell zu untersuchen, ob die Patienten zuerst gegen NRL oder Früchte sensibilisiert werden, um Empfehlungen für eine evidenzbasierte Prophylaxe geben zu können.

Patienten und Methoden: Wir untersuchten Seren von 96 Sb Patienten mit FEIA (ImmunoCAP System, Phadia) auf spezifische IgE-Ak gegen NRL, Banane und Kiwi als Beispiele für kreuzreagierende Früchte. Diese Tests wurden bis zu 3-mal wiederholt (Abstand im Mittel 2 Jahre, maximal 7 Jahre).

Ergebnisse: In der ersten Testung hatten nur 2 von 50 NRL-IgE-negativen Patienten (4%) Ak gegen Banane oder Kiwi. 4 der 46 Latex-IgE-positiven Patienten (8%) zeigten Ak gegen Banane (2) oder Kiwi (2), 3 (7%) gegen beide Früchte. Symptome der Fruchtallergie präsentierten 3 Patienten, alle symptomatischen Patienten hatten hohe Frucht-Ak im Serum. In der Verlaufsuntersuchung verloren 2 Patienten mit niedriger Sensibilisierung gegen NRL ihre NRL- und Frucht-Ak, 2 weitere nur die Frucht-Ak. Dagegen entwickelten 4 NRL-sensibilisierte Patienten neue Ak gegen Banane und einer gegen Kiwi. Nur 2 Patienten entwickelten Frucht-Ak, ohne gegen NRL sensibilisiert zu sein. 7 von 10 Patienten mit Bananen- oder Kiwi-Ak waren Atopiker.

Schlußfolgerungen: In den meisten Fällen folgt die Fruchtsensibilisierung der NRL-Sensibilisierung. Daher ist es nicht nötig, Sb-Patienten ohne NRL-Sensibilisierung zu empfehlen, primär tropische Früchte zu meiden.

Key words

natural rubber latex - IgE antibodies - fruit allergy - Spina bifida - latex fruit syndrome

Schlüsselwörter

Naturlatex - IgE Antikörper - Fruchtallergie - Spina bifida - Latex Frucht Syndrom

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