GROWTH HORMONE TREATMENT IN A CHILD WITH LATEX ALLERGY AND MYELOMENINGOCELE.50

Abstract

Latex allergy is recognized with increasing frequency in children with myelomeningocele. A 5 year old female child with a documented history of latex allergy and myelomeningocele was evaluated for poor growth. The patient had a history of rashes/urticaria and one episode of wheezing upon exposure to products made of natural rubber latex. Following an endocrinologic evaluation growth hormone (GH) therapy was planned. GH is routinely dispensed in powdered form in a glass vial with rubber stopper and administered by insulin syringe. The stopper is entered by syringe multiple times (once when the diluent is added and then daily to withdraw the GH for injection), potentially releasing latex particles into the solution, which could be injected into the patient along with the GH. Prior to initiating GH therapy the patient had a positive latex-specific IgE antibody test =7.1 ng/ml (> than 2.0 ng/ml indicates a high propensity for developing an allergic reaction). Because of concern of anaphylaxis, the patient was admitted to the hospital for prick and intradermal skin testing with the prepared GH solution. In order to more closely mimic home administration of GH, the diluent was added 7 days prior to use. The vial was stored inverted (to maximize contact with the rubber stopper) and the rubber stopper entered several times with a needle. The patient's response to this solution of GH (0.74 mg= daily dose) was equal to that of the negative control (saline) while demonstrating an adequate response to the positive control (histamine). The patient has been treated with GH (0.3 mg/kg/week) for a total of 9 months without any adverse reactions. Despite an increase in the latex-specific IgE antibody test to 11.1 ng/ml one month after the initiation of GH therapy, she has never experienced any local nor systemic reactions to the GH and continues on this current therapy. The development of latex allergy in children with myelomeningocele is of increasing concern. Latex allergy should not preclude treatment with GH. With appropriate measures, children with latex sensitivity may be treated with GH without adverse reaction.