[Latex sensitization and allergy in Hospital General de Mexico surgery residents]. / Sensibilización y alergia a látex en residentes quirúrgicos del Hospital General de México.

BACKGROUND: The prevalence of latex allergy ranges from 0.8 to 6.5% and is the second cause of perioperative anaphylaxis. The main risk factors are being a health worker or latex producer, hours of latex gloves or products usage, exposure to other hand irritants, history of atopy, neural tube closure defects or numerous surgeries at early age. OBJECTIVE: To determine the frequency of latex sensitization in resident physicians of the Hospital General de México surgical area. METHODS: Prospective, cross-sectional, descriptive study where skin prick tests were applied to residents of the surgical area of the Hospital General de México, which depends on the Ministry of Health and is located in Mexico City. RESULTS: Ninety-two subjects were included and had skin tests practiced, with 11 surgical specialties participating. Latex sensitization in this population was 11.9%, whereas the presence of latex allergy was 10.8%. CONCLUSIONS: A high frequency of latex sensitization and allergy was demonstrated in Hospital General de Mexico surgery residents, which indicates the need for policies and procedures to be developed for health workers with latex allergy, as well as continuous training of employees on latex allergy.

Antecedentes: La prevalencia de alergia al látex oscila entre 0.8 y 6.5 % y es la segunda causa de anafilaxia perioperatoria. Los principales factores de riesgo son ser trabajador de la salud o productor de látex, horas de utilización de guantes o productos de látex, exposición a otros irritantes de manos, antecedente de atopia, defectos del cierre del tubo neural o numerosas cirugías a edad temprana. Objetivo: Determinar la frecuencia de sensibilización al látex en médicos residentes del área quirúrgica del Hospital General de México. Métodos: Estudio clínico prospectivo, transversal, descriptivo, mediante la realización de prueba de punción cutánea a residentes del área quirúrgica del Hospital General de México, Secretaría de Salud, Ciudad de México. Resultados: Se incluyeron 92 sujetos a los cuales se les realizó pruebas cutáneas, participando 11 especialidades quirúrgicas. La sensibilización al látex en esta población fue de 11.9 % y la presencia de alergia al látex de 10.8 %. Conclusiones: Se demuestró alta frecuencia de sensibilización y alergia al látex en los residentes quirúrgicos del Hospital General de México, lo que indica la necesidad de desarrollar políticas y procedimientos para los trabajadores de salud con alergia al látex y la capacitación continua de empleados sobre alergia al látex.

Development of an Economical Method to Reduce the Extractable Latex Protein Levels in Finished Dipped Rubber Products.

Natural rubber latex (NRL) allergy is caused by the extractable latex proteins in dipped rubber products. It is a major concern for the consumers who are sensitive to the allergenic extractable proteins (EP) in products such as NRL gloves. Objective of this research was to develop an economical method to reduce the EP in finished dipped NRL products. In order to reduce the EP levels, two natural proteases, bromelain from pineapple and papain from papaya, were extracted and partially purified using (NH4)2SO4. According to the newly developed method, different glove samples were treated with a 5% solution of each partially purified enzyme, for 2 hours at 60°C. Residual amounts of in treated samples were quantified using the modified Lowry assay (ASTM D5712-10). Bromelain displayed a 54 (±11)% reduction of the EP from the dipped rubber products, whereas it was 58 (±8)% with papain. These results clearly indicate that the selected natural proteases, bromelain, and papain contribute significantly towards the reduction of the total EP in finished NRL products. Application of bromelain enzyme for the aforementioned purpose has not been reported up to date, whereas papain has been used to treat raw NRL towards reducing the EP.

Jackfruit anaphylaxis in a latex allergic patient.

Several fruits have been reported to crossreact with latex antigen in latex allergy patients but little is known regarding tropical fruits in particular. Here we report the case of a 34-year old nurse who developed anaphylaxis following the ingestion of dried jackfruit (Artocarpus heterophyllus). The patient had a history of chronic eczema on both hands resulting from a regular wear of latex gloves. She and her family also had a history of atopy (allergic rhinitis and/or atopic dermatitis). The results of skin prick tests were positive for jackfruit, latex glove, kiwi and papaya, but the test was negative for banana. While we are reporting the first case of jackfruit anaphylaxis, further research needs to be conducted to identify the mechanisms underlying it. In particular, in-vitro studies need to be designed to understand if the anaphylaxis we describe is due to a cross reactivity between latex and jackfruit or a coincidence of allergy to these 2 antigens.

A review of the pathophysiology, diagnosis, and management of allergic reactions in the dental office.

Since more than 50 million people in the United States have allergies, knowledge of the management of allergic reactions in the dental office is extremely important. Appropriate care may range from a simple referral to a primary care physician to lifesaving measures implemented during acute anaphylactic reactions. The authors present a basic review of the pathophysiology of allergic reactions and provide information detailing the diagnosis and management of allergic reactions that may be encountered in the dental office. Utilizing this information, the dental practitioner and ancillary staff will have a thorough understanding of allergic reactions and be prepared to successfully identify and treat these reactions.

Microarrays of recombinant Hevea brasiliensis proteins: a novel tool for the component-resolved diagnosis of natural rubber latex allergy.

BACKGROUND: Component-resolved diagnosis using microarray technology has recently been introduced in clinical allergology, but its applicability in patients with natural rubber latex (NRL) allergy has not been investigated. OBJECTIVES: To evaluate the utility of microarray-based immunoglobulin (Ig) E detection in the diagnostic workup of NRL allergy and to compare this new diagnostic tool with established methods of NRL-specific IgE detection. METHODS: We investigated 52 adults with immediate-type NRL allergy and 50 control patients. Determination of specific serum IgE against 8 recombinant Hevea brasiliensis allergen components was performed using a customized allergen microarray and a conventional fluorescence enzyme immunoassay (FEIA). RESULTS: The panel of microarrayed allergen components was shown to represent a comprehensive repertoire of clinically relevant NRL proteins. NRL-specific IgE recognition patterns and sensitization rates determined by microarray analysis were similar to those obtained by conventional FEIA. The diagnostic sensitivity rates of combined single-component data were not significantly different for the respective recombinant test system, whereas the sensitivity level of extract-based FEIA analysis was markedly higher. CONCLUSION: The current study provides evidence that microarrays of recombinant NRL allergen components are a suitable new tool for the diagnosis of NRL-specific sensitization.They show performance characteristics comparable to those of current diagnostic tests and could be indicated in small children in whom only limited blood volumes are obtainable. Further large-scale studies in unselected patient populations and in high-risk groups are warranted before the microarray can be introduced into routine management of patients with NRL allergy.

Quality of life in health care workers with latex allergy.

BACKGROUND: Exposure to latex gloves and glove powder makes health care workers (HCWs) particularly susceptible to developing an allergy to latex. AIMS: To assess the impact on the quality of life (QOL) of HCWs who are allergic to latex products before removal from latex exposure and after removal from exposure. METHODS: We studied 39 latex allergic HCWs from the Health & Safety Executive south area. Twenty-nine attended for an assessment with the occupational physician and were asked to fill out a questionnaire. Spirometry, immunoglobulin E levels and latex radioallergosorbent test levels were measured. RESULTS: In total, 29/39 (74%) of patients responded. All of the participants had a type 1 allergy to latex. All individuals reported a significant improvement of symptoms once latex was removed from their working environment. Of those that reported skin complaints, 83% reported that their skin no longer had an impact on their QOL once latex was removed. Over 90% (n = 26) of all participants stated that their eye/nose symptoms had no longer an impact on their QOL and 86% (n = 25) of all participants stated that their respiratory symptoms had no impact on their QOL following the removal of latex from their working environment. Overall, 45% of the respondents had changed jobs: 61% of this group changed to a completely nonclinical post. CONCLUSIONS: On average, 86% of latex allergic HCWs reported that their QOL had improved significantly since their removal from latex. In employees who are latex allergic/sensitized, taking latex avoidance measures results in cessation or diminution of symptoms.

Latex hypersensitivity: a closer look at considerations for dentistry.

Over the past several decades, latex hypersensitivity has become an increasingly common phenomenon in the dental setting. Exposure to latex via direct skin contact or inhalation of airborne allergens from powdered gloves poses the risk of sensitizing both clinicians and their patients. Adverse reactions to latex range from mild irritant contact dermatitis to potentially life-threatening hypersensitivity. The prevalence of these reactions is higher among medical and dental practitioners, those with prior allergies, patients with a history of multiple surgeries and those with spina bifida. The risk of developing latex hypersensitivity increases with prolonged and repeated exposure. The incidence of latex allergy may be reduced through such simple measures as using latex alternatives and powder-free, low-protein gloves. For patients with confirmed latex allergy or those at risk of hypersensitivity, it is critical for dental personnel to be familiar with the range of possibilities for latex exposure and to employ appropriate preventive procedures.

Access to special care dentistry, part 5. Safety.

This article considers the delivery of efficient and effective dental services for patients whose disability and/or medical condition may not be obvious and which consequently can present a hidden challenge in the dental setting. Knowing that the patient has a particular condition, what its features are and how it impacts on dental treatment and oral health, and modifying treatment accordingly can minimise the risk of complications. The taking of a careful medical history that asks the right questions in a manner that encourages disclosure is key to highlighting hidden hazards and this article offers guidance for treating those patients who have epilepsy, latex sensitivity, acquired or inherited bleeding disorders and patients taking oral or intravenous bisphosphonates.

Natural rubber latex allergy in children: clinical and immunological effects of 3-years sublingual immunotherapy.

BACKGROUND: We previously demonstrated that one year of sublingual immunotherapy (SLIT) with natural rubber latex (NRL) was safe and efficacious in paediatric patients with NRL allergy. RESEARCH DESIGN AND METHODS: We studied 12 NRL-allergic children (age 4-15), previously assigned to the treated arm of a double-blind placebo controlled study, who received a commercial latex SLIT for three years. Adverse reactions were monitored. The primary end-point was the NRL glove-use test. As secondary end-points, skin prick test with NRL and NRL serum specific IgE were used. MAIN OUTCOMES MEASURES: No SLIT-related side effects were observed. A significant reduction of the glove-use score was observed after one-year treatment (5.1 +/- 4.2 vs. 14.8 +/- 5.7, p=0.0031). This parameter was further reduced in the second year since SLIT start (2.0 +/- 2.7, p=000007). After 3 years of SLIT all patients had a negative glove-use test (p<0.0001). Baseline wheal areas of skin prick test (6.8 +/- 2.5 mm2) were significantly reduced after 2 (5.3 +/- 1.8 mm2) and 3 years (4.0 +/- 1.8 mm2) of SLIT (p=0.039 and 0.027, respectively). Baseline values of serum specific IgE (23 +/- 34 KU/l) were significantly reduced after 3 years since SLIT start (6.4 +/- 5.0, p=0.0371). CONCLUSIONS: Three years of latex SLIT is safe and consolidates the efficacy previously observed after one year of treatment in paediatric patients.

Peri-anesthetic anaphylaxis.

General anesthesia and anaphylaxis cause profound physiologic changes. When both occur simultaneously, it is often difficult to recognize and identify the medication or product responsible for the latter. Following such an event, the proper assessment, diagnosis, and recommendations are essential to prevent future reactions. This article reviews the more common causes of anaphylaxis during anesthesia.

Trends in adrenaline (EpiPen) dispensing in Israel in 1997-2004.

BACKGROUND: The prevalence of allergic diseases has increased over the last 20 years in the Western world. Reports on the growing use of adrenaline auto-injectors (EpiPen and EpiPen Jr) in several countries may point to increased rates of anaphylactic reactions, increased awareness of the risk of anaphylaxis or both. OBJECTIVES: To evaluate the dispensing rate of EpiPen units in Israel from 1997 to 2004. METHODS: The database of the General Health Services (Clalit) was searched to determine the number of EpiPen units dispensed each year from 1997 to 2004. Data on mortality from anaphylaxis were derived from the Central Bureau of Statistics using International Classification of Diseases, 10th revision codes. RESULTS: The dispensing rate of EpiPen units rose gradually from 1689 in 1997 to 2981 in 2004; an overall increase of 76%. No case of death from anaphylaxis was reported from 1998 to 2000. CONCLUSIONS: The dispensing rate of adrenaline auto-injectors has increased considerably over the last 8 years in Israel, although to a lesser degree than in other countries. This is probably a reflection of updated medical policies, in accordance with the clinical guidelines for the management of anaphylaxis and improved public education. Further studies are needed to determine the prevalence of anaphylactic reactions in Israel.

Myelomeningocele, avocados, and rubber tree plants.

Infants with myelomeningocele and the nurses who care for them have something in common. Both are at higher risk than the general population for developing latex allergies. This article provides a review of the literature regarding latex production, latex allergic responses in children and adults, types of latex allergic reactions, and prevention of latex allergies.

Latex allergen exposure increases exhaled nitric oxide in symptomatic healthcare workers.

The objective of this study was to investigate the clinical and diagnostic impact of baseline exhaled nitric oxide (eNO) levels and latex allergen-induced eNO changes in different healthcare worker groups. Healthcare workers, 31 latex-sensitised and 14 nonsensitised, underwent occupational-type challenge tests with powdered allergenic latex gloves. Sensitised as well as nonsensitised healthcare workers developed a significant eNO increase 1 h after challenge. Conversely, only latex-sensitised employees showed a significant eNO increase 22 h after challenge, which showed a significant relationship with bronchial obstruction (specific airway resistance changes). However, there was no difference in either baseline eNO level or eNO increase after 22 h between asthmatic (n = 13) and rhinitic only (n = 20) responders. The specificity and sensitivity of a 50% eNO increase after 22 h in responders were 100 and 56%, respectively. These results support the assumption that the whole respiratory tract is involved in a combined allergic rhinitis and asthma syndrome. Smoking healthcare workers showed reduced baseline exhaled nitric oxide levels, but, as shown for the first time, an allergen-induced exhaled nitric oxide increase comparable to that of nonsmokers. Corticosteroid therapy inhibited the allergen-induced exhaled nitric oxide change but not the clinical response in the challenge test. These findings suggest that cigarette smoke and corticosteroids initiate distinct molecular mechanisms influencing nitric oxide concentrations in the airways.

[Anaphylactic and anaphylactoid reactions occurring during anaesthesia in France. Seventh epidemiologic survey (January 2001-December 2002)]. / Epidémiologie des réactions anaphylactiques et anaphylactoïdes peranesthésiques en France. Septième enquête multicentrique (Janvier 2001-Décembre 2002).

OBJECTIVES: Hypersensitivity reactions IgE-mediated (anaphylaxis) or non-IgE-mediated (anaphylactoid) reactions occurring during anaesthesia remain a major cause of concern for anaesthesiologists, since these reactions remain usually unpredictable, may be potentially life-threatening even when appropriately treated. The authors report the results of the last 2-year survey (2001, 2002) of such reactions conducted in France by the GERAP (groupe d'etude des reactions anaphylactoides peranesthesiques), and compare these results with their previous published surveys. METHODS: Between January 1, 2001 to December 31, 2002, 712 patients who experienced immune-mediated (anaphylaxis) or non-immune-mediated (anaphylactoid) reactions were referred to one of the 40 allergo-anaesthesia centres members of the GERAP. Anaphylaxis was diagnosed on the basis of clinical history, tryptase measurements during the adverse reaction, and skin tests and/or specific IgE assay. RESULTS: Anaphylactic and anaphylactoid reactions were diagnosed in 491 cases (69%) and 221 cases (31%), respectively. The most common causes of anaphylaxis were neuromuscular blocking agents (NMBA) (n=271, 55%), latex (n=112, 22.3%), and antibiotics (n=74, 14.7%). Succinylcholine (n=102, 37.6%) and rocuronium (n=71, 26.2%) were the most frequently incriminated NMBAs. Cross-reactivity between NMBAs was observed in 63.4 % of cases of anaphylaxis to a NMBA. No difference was observed between anaphylactoid and anaphylactic reactions when the incidences of atopy, food, or drug intolerance were compared. However atopy, asthma and food allergy were significantly more frequent in case of latex allergy, when compared with NMBA allergy. Clinical manifestations were more severe in anaphylaxis. The positive predictive value of tryptase measurement for the diagnosis of anaphylaxis was 95.3%, the negative predictive value 49%. The diagnostic value of specific neuromuscular blocking agent IgE assays was confirmed. CONCLUSION: Our results further corroborate the need for systematic screening in case of immediate hypersensitivity reaction during anaesthesia and for the constitution of allergo-anaesthesia centres to provide expert advice to anaesthesiologists and allergologists.

A review of natural-rubber latex allergy in health care workers.

This brief review of natural-rubber latex (NRL) allergy in health care workers (HCWs) includes the definition of NRL allergy and data on its epidemiology, pathogenesis, diagnostic algorithm, management, long-term outcomes, economic impact, cost-effectiveness of changing facilities to a latex-free environment, and prevention. The data presented suggest that an individual with type I or type IV hypersensitivity to NRL should be able to continue to work in the workplace with careful evaluation and reasonable accommodations. Reducing exposure to latex is a safe and more economical alternative to complete removal of the individual from the place of employment. The use of low-allergen, nonpowdered NRL gloves substantially reduces airborne exposure to latex in most health care settings.