97–99 Latex allergy is an immunoglobulin E-mediated hypersensitivity reaction, and its symptoms range from mild urticaria to lifethreatening events (bronchospasm, laryngeal edema, and systemic anaphylaxis) and death. Latex antigen exposure can occur by cutaneous, percutaneous, mucosal, and parenteral routes, and the antigen can be Inhibitors,research,lifescience,medical transferred by direct contact and aerosol, but it is clear that direct mucosal and parenteral exposure poses the greatest

risk of anaphylaxis.100 It has been suggested that the most important factor in latex sensitization is the degree of exposure.101–102 The number of surgical procedures and exposure episodes were the dominant factors in the development of latex allergy among children with selleck inhibitor spinal dysraphism, particularly as neonates and infants.98,103 Conversely, there seemed to be no increased risk of latex allergy associated with age or sex.104 Children with other diseases requiring multiple surgical exposures

with Inhibitors,research,lifescience,medical latex materials seem less prone to sensitization Inhibitors,research,lifescience,medical than children with spinal dysraphism,105–107 and it has been suggested that there is a genetic association between spinal dysraphism and latex sensitivity.106,108 Therefore, it is our belief that all children with spinal dysraphism, especially those undergoing multiple exposures to latex, should avoid subsequent contact to latex whether in the home, office, or hospital environment. The operative risk of severe reactions is not as high in those patients without a history of latex sensitivity. Patients with a history of latex reactions can be safely treated with avoidance of equipment containing latex and premedication. A careful history of latex sensitivity should Inhibitors,research,lifescience,medical be investigated in all patients with spinal dysraphism and, for those with latex allergy, appropriate

safeguards should be maintained during their hospitalization by avoiding latex-containing equipment, gloves, and catheters. Main Points Myelomeningocele is the most common dysraphic malformation and occurs in approximately 1 in 1200 to 1400 Inhibitors,research,lifescience,medical births. Most of those children (60%) are community ambulators, and 80% are socially continent. Occult spinal dysraphias are closed forms of spinal dysraphism in which the skin covers the neural tissue. In most cases a skin marker is present. Recognizing these cutaneous marks is important because they are usually these associated with some form of dysraphism that can cause spinal cord injury and lead to progressive and sometimes sudden neurologic deterioration. Hydrocephalus occurs in approximately 85% of children with myelomeningocele; it does not directly affect the urologic course of the patient, other than when major intra-abdominal procedures are performed in the presence of an indwelling ventriculoperitoneal shunt. The spinal cord fixation commonly referred to as tethered cord may be a result of a variety of conditions.