Sublingual immunotherapy in patients with latex allergy: systematic review and meta-analysis of randomized controlled trials.

Latex allergy (LA) is a commonly observed entity for which sublingual immunotherapy (SLIT) has been shown to be effective in many small randomized clinical trials. The present study was conducted with an aim of systematically reviewing the existing literature on the efficacy and safety of SLIT in patients with LA and to apply the principles of meta-analysis. A search for randomized controlled trials with appropriate search strategy in PubMed and CENTRAL was conducted. Studies with documented clinical history of LA and SLIT administered in any dose, duration and regimen compared with placebo were included. Outcome measures were symptom scores, glove provocation test score, serum IgE levels, induration following latex skin prick test, medication scores and adverse effects. Random effects model was used when moderate to severe heterogeneity was observed and fixed effects model when there was mild heterogeneity. Forest plots for standardized mean difference (95% confidence interval) for all the continuous outcome measures were created. A total of 152 records were identified from the electronic databases and four studies were finally included in the meta-analysis. A statistically significant reduction for induration following glove provocation test (pooled results from two studies) was observed in the SLIT group with SMD of -0.9 [-1.71, -0.08]. No significant differences were observed in any other outcome measures between the interventions. We did not identify significant reduction in most of the outcome measures with SLIT in patients with LA except for glove provocation test score wherein only two studies were included. Large and more randomized controlled trials are required to ascertain and confirm the utility of SLIT in such patients.

Unilateral hand allergic contact dermatitis due to occupational exposure.

BACKGROUND AND OBJECTIVE: Hand dermatitis is the most common subtype of occupation-related skin disease. Regardless of its underlying cause, hand dermatitis results in significant impairment and a negative impact on quality of life. Any case of unilateral hand dermatitis should have a high index of suspicion for an allergic contact dermatitis. CONCLUSION: We report two cases of unilateral hand dermatitis. The first case is a 53-year-old female with a unilateral dermatitis of the left hand. The second case is a 53-year-old male with dermatitis of the right hand. Both cases highlight an interesting presentation of unilateral hand allergic contact dermatitis secondary to an occupational exposure.

Latex-allergic patients sensitized to the major allergen hevein and hevein-like domains of class I chitinases show no increased frequency of latex-associated plant food allergy.

Allergies to certain fruits such as banana, avocado, chestnut and kiwi are described in 30-70% of latex-allergic patients. This association is attributed to the cross-reactivity between the major latex allergen hevein and hevein-like domains (HLDs) from fruit class I chitinases. We aimed to assess the extent of cross-reactivity between hevein and HLDs using sera from latex-allergic patients with and without plant food allergy. Hevein and HLDs of latex, banana, and avocado chitinases were expressed in Escherichia coli as fusion proteins with the maltose-binding protein and purified by affinity chromatography. IgE binding to these proteins was studied in sera from 59 latex-allergic patients and 20 banana-allergic patients without latex allergy by ELISA and ELISA inhibition. Additionally, 16,408 allergic patients' sera were tested for IgE binding to hevein, latex chitinase, and wheat germ agglutinin using an allergen microarray. Hevein-specific IgE was detected in 34/59 (58%) latex-allergic patients' sera. HLDs of latex, banana, and avocado chitinases were recognized by 21 (36%), 20 (34%), and 9 (15%) sera, respectively. In contrast, only one of 20 banana-allergic patients without latex allergy was sensitized to chitinase HLDs. In most tested latex-allergic patients' sera, IgE binding to hevein was only partially reduced by preincubation with HLDs. Among hevein-sensitized, latex-allergic patients, the percentage of plant food allergy (15/34 = 44%) was equal to latex-allergic patients without hevein sensitization (11/25 = 44%). In the general allergic population, 230 of 16,408 sera (1.4%) reacted to hevein and/or a hevein-like allergen. Of these, 128 sera showed an isolated sensitization to hevein, whereas only 17 bound to latex chitinase or wheat germ agglutinin without hevein sensitization. In conclusion, the IgE response to HLDs is elicited by hevein as sensitizing allergen in most cases. Despite considerable cross-reactivity between these allergens, no correlation between latex-associated plant food allergy and sensitization to hevein or HLDs was found.

Allergic contact dermatitis to synthetic rubber following breast augmentation.

Allergic reactions associated with silicone injection and implant were examined in a 50-year-old woman with a granulomatous reaction following breast silicone-gel prosthesis rupture who developed a delayed hypersensitivity to rubber compounds. Patch tests with SIDAPA, dental, and rubber series as well as open tests with latex, silicone and non silicone tubes, open application test with silicone gel, and skin prick test for aero and food-allergens were performed. Total and specific serum IgE measured by CAP-FEIA. Skin tests revealed a delayed-type hypersensitivity to thioureas, thiuram mixture and platinum. Specific IgE to natural rubber latex were found. Allergic contact dermatitis from thioureas, thiurams and platinum might be under-diagnosed, as they are not tested as part of the standard patch test series. Clinicians should consider this diagnosis in patients submitted to several cosmetic treatments.

Cross-reactions between xanthates and rubber additives.

BACKGROUND: We previously described allergic contact dermatitis from xanthates used in the recovery of metals from mining ores. We observed cross-reactions with carbamates, believed to be due to the common "dithio" nucleus shared by both groups. OBJECTIVE: The present study was undertaken to establish the rate of cross-reactions between xanthates and rubber additives. METHODS: Between November 2002 and December 2005, 1,220 consecutive patients were patch-tested with sodium isopropyl xanthate 10% in petrolatum (pet) and with potassium amyl xanthate 10% pet and later 5% pet, in addition to the North American Contact Dermatitis Group standard series and other series as required by their conditions. RESULTS: Fifty-one patients reacted to xanthates, carbamates, or thiurams; 26 reacted to xanthates only, and these reactions were felt to be irritant. Twenty-five patients reacted to xanthates and/or to one or more of the rubber additives, 12 had positive reactions to xanthates and to either carba mix or thiuram mix, 10 reacted to xanthates and carba mix, 9 reacted to xanthates and thiuram mix, and 8 showed positive reactions to xanthates and both mixes. However, 13 patients had positive reactions to carba mix and thiuram mix but did not react to xanthates. Six patients reacted to other rubber additives such as mercaptobenzothiazole, black rubber mix, and mixed dialkyl thioureas. Five of these patients also reacted to xanthates, 4 reacted to xanthates and carba mix, and 3 reacted to xanthates, carba mix, and thiuram mix. CONCLUSIONS: Of patients sensitized to carbamates, thiurams, or mercaptobenzothiazole, 50% exhibit cross-reactions with xanthates. Xanthates are irritants, and their patch-test concentrations should be lowered to 5% or less.

Contact dermatitis to a rubber allergen with both dithiocarbamate and benzothiazole structure.

Contact dermatitis to rubber products are often caused by additives used during manufacture, and diagnosed from patch test with established rubber allergen series. In these series the compounds are divided into separate groups such as thiurams, dithiocarbamates and mercaptobenzothiazoles. The objectives were to investigate the substances with allergenic structures present in a diving mask giving rise to facial dermatitis, also those substances including structures from different groups of rubber chemicals. The rubber material was analysed by high-performance liquid chromatography and diode-array detector. The patient was tested by epicutaneous tests using pure substances, extracts and authentic rubber material. 2-Benzothiazolyl-N,N-diethylthiocarbamylsulfide, was found in the diving mask and the patient showed positive reaction to the pure compound and to extracts of the diving mask. This compound has structures of both mercaptobenzothiazole and thiuram/dithiocarbamate in its formulae. Besides the established groups of rubber accelerators, uncommon allergens with structures from more than one group can be formed or added at vulcanization. Chemical analysis of the product is needed to find these allergens.

Dermatitis alérgica de contacto por gomas negras / Allergic contact dermatitis due to black rubber

Las gomas negras son reconocidas frecuentemente como causantes de dermatitis de contacto alérgica. La mayoría de las alergias a las gomas negras se encuentran en trabajadores de la industria de neumáticos para vehiculos, así como en la fabricación de calzado y otros artículos. Sin embargo, también es posible la sensibilización en los usuarios de esos productos. El caso aquí presentado es el de un niño con una clara sensibilización a la parafenilenodiamina (PPDA) contenida en la goma negra del sitio de apoyo de sus anteojos protectores para natación.

Gastro-intestinal exposure to latex antigens induce allergic responses in mice.

BACKGROUND: Natural rubber latex (NRL) has emerged as a major cause of respiratory allergy among specific exposed groups of individuals. Since latex allergens are dispersed in the environment it is conceivable that latex proteins are both inhaled and ingested. The mechanism of latex allergy and the immune responses following reexposure of latex allergens by the intranasal route was studied in a murine model of latex allergy developed by intragastric sensitization with NRL. METHODS: BALB/c mice were sensitized intragastrically ('ig'), intranasally ('in') or 'ig' followed by 'in' challenge with NRL allergens. The cellular and humoral immune responses, lung function and histological changes were determined. RESULTS: Peripheral blood eosinophilia was observed in the 'ig' and 'ig/in'-NRL-sensitized animals in comparison to normal controls (p < 0.05). The 'ig' group showed a marked increase over control mice in serum total IgE, NRL-specific IgG and IgG subclasses (p < 0.05). Increased levels of IL-4, IL-5, IL-10, and IL-13 were detected in 'ig'-NRL-sensitized mice. Intranasal exposure with NRL after 'ig' sensitization further enhanced the cytokine levels. A tendency towards enhanced stimulation was determined in 'ig'-sensitized mice; a significant difference was shown in the 'ig/in'-group (p < 0.05). Increased airway hyperreactivity was found in 'ig'-NRL-sensitized-mice (15.1 +/- 2.5 vs. 8.9 +/- 1.7 cm H2O x ml(-1) x s, p < 0.05). Mucus secretion from jejunal epithelium and eosinophilic infiltration into the jejunal lamina propria were observed in the 'ig'-NRL-sensitized-mice. CONCLUSIONS: The results demonstrate that intragastric NRL sensitization did not induce specific tolerance, and additional intranasal exposure with latex allergens resulted in systemic allergic manifestations in the murine model.

Alergia al látex en el Servicio de Urgencias y Emergencias / Latex allergy at the Emergency Services

La alergia al látex es una enfermedad con una incidencia desconocida. Sin embargo, los grupos de riesgo mencionados en esta revisión tienen unas probabilidades más altas que la población general de poder padecer síntomas alérgicos, en algunas ocasiones poniendo en peligro sus vidas. El manejo de los pacientes con alergia al látex requiere básicamente adoptar medidas de evitación de productos con látex por lo que debería contarse con ubicaciones y material libre de látex en todos los Servicios de Urgencias. El diagnóstico de la alergia al látex requiere una evaluación alergológica completa, aunque una anamnesis detallada nos puede guiar de un modo fiable hacia un posible diagnóstico. El personal sanitario de los Servicios de Urgencias debería concienciarse de la importancia en la disminución de la utilización de productos con látex en los Servicios de Urgencias, principalmente mediante la utilización de guantes con bajo contenido y libre de polvo lubricante (powder-free), tanto para disminuir el riesgo de desencadenar síntomas en pacientes hipersensibles al látex que desconocen su afección, como para evitar sensibilizaciones futuras en los pacientes que acuden con frecuencia a los Servicios de Urgencias. Además, un ambiente de trabajo de bajo contenido en látex favorece la disminución del riesgo para el propio personal de desarrollar una posible enfermedad ocupacional. Finalmente, sería recomendable la realización de estudios epidemiológicos en nuestro medio para conocer la incidencia real de la alergia al látex tanto en la población general como en los usuarios de los Servicios de Urgencias (AU)

The incidence of latex allergy is unknown. However, the risk groups enumerated in the present review have a higher probability than that in the general population to experience allergic symptoms, which may occasionally be life-threatening. The management of patients with latex allergy basically requires the implementation of exclusion measures for avoiding the use of latex-containing products; for this reason, latex-free premises and material should be available at all Emergency services. The diagnosis of latex allergy demands a full and complete allergologic assessment, though a detailed anamnesis may reliably orient towards its possible diagnosis. The Emergency health care personnel should be made aware of the importance of reducing the use of low-latex-containing products at the Emergency services, mainly through the use of low-latex-content and powder-free gloves, both in order to reduce the risk of inducing symptoms in latex-hypertensitive patients who are not aware of their condition and to prevent future sensitisations in patients who are frequent users of the Emergency servies. Furthermore, a low-latex-content work environment promotes the reduction of the risk of developing a possible occupational disease for the heath care personnel themselves. Finally, epidemiologic studies should be carried out in oru environment in order to assess the true incidence of latex allergy both in the general population and in the users of Emergency services (AU)

A topical cream containing a zinc gel (allergy guard) as a prophylactic against latex glove-related contact dermatitis.

BACKGROUND: Many health care workers are sensitized to the proteins in natural rubber latex and get contact dermatitis as a result of wearing latex gloves. OBJECTIVE: The aim of the study was to evaluate a topical formulation containing a zinc gel (Allergy Guard) as a prophylactic against latex glove-related contact dermatitis. METHODS: The study was carried out with volunteers who exhibited mild to moderate contact dermatitis (type IV) after wearing latex gloves as per the protocol. RESULTS: Allergy Guard significantly reduced skin irritation in volunteers who exhibited type IV hypersensitivity when exposed to latex gloves. Allergy Guard also exhibited a barrier effect as shown by the permeation of chlorophyllin dye into the skin of volunteers. Allergy Guard prevented dermal irritation induced by sodium lauryl sulfate. CONCLUSION: Topical formulations containing a zinc gel may be used to delay or prevent latex sensitivity, especially among health care professionals.