Diagnosis and treatment of contact urticaria / 中华皮肤科杂志

Contact urticaria is a kind of chronic inducible urticaria, and can be classified into immunologic contact urticaria, non-immunological contact urticaria and contact urticaria of unknown pathogenesis according to pathophysiological mechanisms. The allergens responsible for contact urticaria are various, and there have been increasing reports on contact urticaria induced by related ingredients in cosmetics and by occupational exposure of healthcare workers in recent years. Detailed medical history and physical examination are the key to the diagnosis of contact urticaria, and a variety of skin tests can assist in the diagnosis. The main aim of treatment is to control symptoms, and avoiding contact with allergens is the key to preventing recurrence.

The benefits of latex-free gloves in the operating room environment.

Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.

Management of latex hypersensitivity in the perioperative setting.

Despite the introduction and use of latex-free gloves, natural rubber latex hypersensitivity is still an issue in hospital medicine both for patients and healthcare professionals. Clear understanding of the groups at risk as well as perioperative assessment and management is key to reducing complications and improving safety. In this literature review, we cover the perioperative management of patients with latex hypersensitivity, as well as the implications for healthcare professionals. We also review the cost analyses of latex hypersensitivity in the healthcare system and the evidence available.

Anaphylaxis triggered by prick test with latex extract: a case report

ABSTRACT CONTEXT: Adverse reactions associated with prick tests are rare but may be present as serious systemic reactions. CASE REPORT: A 38-year-old female nursing technician complained of three episodes of anaphylaxis in one year, all in the workplace. To investigate latex allergy, the patient underwent the prick test with latex, and immediately developed a rash, itchy skin, hoarseness, dyspnea and dry cough. Her condition improved promptly after appropriate measures were established for controlling her anaphylaxis. CONCLUSION: The skin test must be performed under medical supervision, since complications that can lead to life-threatening reactions, if support measures are not readily implemented, have been attributed to this test.

[Latex allergy self-report in medical students: prevalence and associated factors]. / Autorreporte de alergia al látex en estudiantes de medicina: prevalencia y factores asociados.

BACKGROUND: Prevalence of latex allergy in medical students is not known. OBJECTIVE: To determine the prevalence of self-reported latex allergy and associated factors in medical students. METHODS: Cross-sectional, analytical study of students with or without self-reported latex allergy. By means of a structured questionnaire, past personal and family history of allergic disease, time and frequency of exposure to latex gloves and symptoms after exposure to products or foods associated with latex allergy were inquired. Logistic regression models were carried out. RESULTS: Out of 854 subjects, 431 (50.5%) were females. Median age was 21 years. Overall prevalence of latex allergy was 4.3% (95% CI = 3.1 to 5.9). Associated risk factors were age (OR = 1.37; 95% CI = 1.05 to 1.79), personal history of atopic dermatitis (OR = 7.32; 95% CI = 3.14 to 17.08), use of gloves ≥ 15/week (OR = 2.59; 95% CI = 1.17 to 5.76), use of latex products (OR = 5.76; 95% CI = 2.15 to 15.49) and fruit allergy (OR = 3.24; 95% CI = 1.27 t o8.27). CONCLUSION: Four out of a hundred students reported latex allergy. Age, personal history of atopic dermatitis, higher frequency of exposure to latex gloves and history of fruit allergy were risk factors for self-report latex allergy.

Antecedentes: La prevalencia de la alergia al látex se desconoce en los estudiantes de medicina. Objetivo: Determinar prevalencia y factores asociados con autorreporte de alergia al látex en estudiantes de medicina. Métodos: Estudio transversal de estudiantes con o sin autorreporte de alergia al látex. Mediante cuestionario estructurado se indagó historia personal y familiar de enfermedad alérgica; tiempo y frecuencia de exposición a guantes de látex y síntomas tras la exposición a productos o alimentos relacionados con alergia al látex. Se realizaron modelos de regresión logística. Resultados: De 854 sujetos, 431 (50.5 %) fueron mujeres. La mediana de edad fue de 21 años. La prevalencia global de alergia al látex fue 4.3 % (IC 95 % = 3.1 a 5.9). Los factores de riesgo relacionados fueron edad (RM = 1.37; IC 95 % = 1.05 a 1.79), historia personal de dermatitis atópica (RM = 7.32; IC 95 % = 3.14 a 17.08), uso de guantes ≥ 15/semana (RM = 2.59; IC 95 % = 1.17 a 5.76), uso de productos con látex (RM = 5.76; IC 95 % = 2.15 a 15.49) y alergia a frutas (RM = 3.24; IC 95 % = 1.27 a 8.27). Conclusión: Cuatro de cada 100 estudiantes reportaron alergia al látex. La edad, la historia personal de dermatitis atópica, la mayor frecuencia de exposición a guantes de látex y antecedente de alergia a frutos fueron factores de riesgo.

[Self-reported prevalence of latex allergy and associated factors in healthcare workers]. / Prevalencia de autorreporte de alergia al látex y factores asociados en trabajadores de la salud.

BACKGROUND: In our country, the prevalence of latex allergy in health personnel has rarely been studied. OBJECTIVE: To determine the prevalence and associated factors to self-reported latex allergy in health care workers. METHODS: A cross-sectional study was conducted among 1,292 health care workers of a second level hospital. All workers were included and they were required to answer a structured questionnaire aimed at identifying latex allergy, atopic personal and family history, exposure to latex gloves and surgical background. Odds ratio (OR) and 95 % confidence interval (95 % CI) were estimated using regression logistic to investigate factors associated to latex allergy. RESULTS: The female to male ratio was 2.4:1. The men age 38.4 ± 11.6 years. The prevalence of latex allergy auto-reported was 9.7 %, with a confidence interval of 95 % (95 % CI) 8.1 %-11.3 %. There was no statistical difference by workplace (p = 0.508). Factors associated with latex allergy included female gender (OR = 1.68; 95 % CI: 1.03-2.73, p = 0.037), personal history of atopy (OR = 4.82; 95 % CI: 3.19-7.26, p < 0.0001), family history of atopic dermatitis (OR = 4.33, 95 % CI: 1.20-4.41) and history of allergy to fruits (OR = 4.33; 95 % CI: 2.62-7.14, p < 0.0001). CONCLUSIONS: Up to 10 out to 100 health workers may have latex allergy. The main factors associated with latex allergy in this study were: being a female, personal or familiar atopy and allergy to fruits.

Antecedentes: pocas veces ha sido estudiada la prevalencia de alergia al látex en personal de la salud en México. Objetivo: determinar la prevalencia de autorreporte de alergia al látex y los factores asociados en trabajadores de la salud. Métodos: estudio trasversal de 1292 trabajadores de la salud de un hospital de segundo nivel, a quienes se les aplicó un cuestionario estructurado para identificar alergia al látex, historia personal y familiar de atopia, exposición a guantes de látex y antecedente de cirugías. La búsqueda de asociaciones entre variables se realizó mediante regresión logística. Se calcularon razones de momios (RM) e intervalo de confianza a 95 % (IC 95 %) Resultados: la relación mujer:hombre fue de 2.4:1. Edad media de 38.4 ± 11.6 años. La prevalencia de alergia al látex fue de 9.7 %, IC 95 %, 8.1-11.3 %. No hubo diferencia estadística por área laboral (p = 0.508). Los factores asociados con la alergia al látex fueron sexo femenino (RM = 1.68; IC 95 %, 1.03-2.73), historia personal de atopia (RM = 4.82; IC 95 %, 3.19-7.26), historia familiar de dermatitis atópica (RM = 4.33; IC 95 %, 1.20-4.41) e historia de alergia a frutos (RM = 2.30; IC 95 %, 2.62-7.14). Conclusiones: hasta 10 % los trabajadores de la salud podría presentar alergia al látex; los principales factores asociados fueron sexo femenino, atopia personal o familiar y alergia a frutos.

Safety of a meningococcal group B vaccine used in response to two university outbreaks.

OBJECTIVE: To assess the safety of meningococcal group B (MenB)-4C vaccine. PARTICIPANTS: Undergraduates, dormitory residents, and persons with high-risk medical conditions received the MenB-4C vaccine two-dose series during mass vaccination clinics from 12/2013 through 11/2014. METHODS: Adverse events (AEs) were identified by 15 minutes of observation postvaccination, spontaneous reports, surveys, and hospital surveillance. Causality was assessed for serious adverse events (SAEs). RESULTS: 16,974 persons received 31,313 MenB-4C doses. The incidence of syncope during the 15-minutes post-dose 1 was 0.88/1000 persons. 2% of participants spontaneously reported an AE (most common were arm pain and fever). 3 SAEs were suspected of being caused by the vaccine, including one case of anaphylaxis. CONCLUSIONS: Most AEs reported were nonserious and consistent with previous clinical trial findings. Measures to prevent injury from syncope and to treat anaphylaxis should be available wherever vaccines are administered. Our safety evaluation supports the use of MenB-4C in response to outbreaks.

Successful extracorporeal resuscitation after perioperative anaphylactic shock during living donor liver transplantation.

A 46-year-old man was admitted for emergent donor hepatectomy. His circulatory condition became unstable 75 minutes after induction and then deteriorated to ventricular fibrillation due to latex-induced anaphylaxis. Following 35 minutes of futile conventional resuscitation without spontaneous cardiac rhythm, extracorporeal resuscitation was initiated and electric cardiac activity returned 10 minutes later. He was discharged home without any sequelae. Extracorporeal cardiopulmonary resuscitation would offer an alternative choice compared with conventional cardiopulmonary resuscitation.

Ambiente látex seguro: relato de dois casos / Latex safe environment: report of two cases

Introdução: a anafilaxia é a forma mais grave de manifestação alérgica e constitui verdadeira emergência médica. A alergia ao látex aumentou muito nos últimos 30 anos, paralelamente ao emprego de produtos derivados no ambiente da saúde, com especial destaque para as luvas. Simultaneamente, medidas preventivas e terapêuticas surgiram no âmbito da Anestesiologia para o adequado manejo de pacientes suscetíveis à alergia ao látex, desde a avaliação pré-anestésica, até a alta hospitalar. A magnitude das reações ao látex varia desde inofensivas placas cutâneas, até o dramático colapso cardiovascular. 1 Objetivo: descrever a abordagem pré-operatória de dois pacientes alérgicos ao látex, com ênfase no preparo da sala de cirurgia látex seguro (?latex free?) na Santa Casa de Belo Horizonte e fazer breve revisão bibliográfica sobre a alergia ao látex e suas implicações para o anestesiologista. Métodos: foram selecionados dois casos recentes, abordados em março e abril de 2012, e solicitada autorização por escrito dos pacientes. Para a revisão bibliográfica, foram procuradas publicações indexadas nacionais e estrangeiras sobre o tema. Conclusão: a alergia ao látex representa um problema real, de incidência de 0,2% na população geral, sem considerar os indivíduos com fatores de risco. Assim, medidas preventivas e terapêuticas devem ser do conhecimento do anestesiologista, para o adequado manejo de pacientes susceptíveis. Nesse contexto, merece especial destaque o ambiente látex seguro como principal alternativa preventiva.

Introduction: Anaphylaxis is the most severe form of allergic manifestation and constitutes a true medical emergency. Allergy to latex has increased a lot in the last 30 years parallel to the use of derivative products in healthcare environments with particular emphasis on gloves. At the sametime, preventive measures and therapies have emerged within the Anesthesiology for the appropriate management of patients with allergy to latex, from the pre-anesthetic assessment to hospital discharge. The magnitude of the reactions to latex range from harmless skin plates todramatic cardiovascular collapse.1 Objective: to describe the preoperative approach in two patients allergic to latex, with emphasis on the preparation of an operating room as latex safe (?latex free?) at the Santa Casa de Belo Horizonte and to present a brief bibliographical review about latex allergy and its implications for the anesthesiologist. Methods: we selected two recent cases, in March and April of 2012, and requested written consent from these patients. The literature review included a search of indexed domestic and foreign publications on the topic. Conclusion: latex allergy represents a real problem with 0.2% incidence in the general population, without considering individuals with risk factors. Thus, preventive and therapeutic measures should be known to the anesthesiologist for the appropriate management of susceptible patients. Therefore, latex safe environments deserve special mention as the main preventive alternative.

Avaliação dos elásticos ortodônticos intra-orais de látex e de borracha sintética: estudo in vitro e in vivo / Evaluation of orthodontic intraoral latex elastic and synthetic rubber: study in vitro and in vivo

Os elásticos ortodônticos intermaxilares sintéticos vem sendo cada vez mais utilizados, sendo principalmente indicados para pacientes que apresentam hiper-sensibilidade ao látex. Afim de avaliar e comparar o comportamento de elásticos de látex e sintéticos quanto a perda de força ao longo do tempo, este estudo foi realizado tanto in vitro quanto in vivo. Para o estudo in vitro foram avaliados 15 elásticos de cada material, para cada tempo: 0, 1, 3, 12 e 24 horas. No estudo in vivo, pacientes foram avaliados (N=15), utilizando elásticos de ambos os materiais (látex e sintético), nos mesmos tempos do estudo in vitro. Os elásticos foram transferidos para a máquina de ensaios mecânicos (EMIC DL-500 MF). Os valores da força gerada foram registrados após a distensão dos elásticos a uma distância de 25mm. Foi aplicado o teste t pareado para a amostra clínica e independente para a amostra laboratorial. Foi utilizada a análise de variância (ANOVA) para verificar a variação das forças geradas entre os tempos determinados e o teste post-hoc para identificar entre quais tempos houve diferença significativa. Quanto às forças iniciais geradas (zero hora), os valores para os elásticos sintéticos foram bastante semelhantes entre os estudos laboratorial e clínico e ligeiramente superiores aos dos elásticos de látex. Nos tempos subsequentes, as forças geradas pelos elásticos de látex apresentaram valores superiores. Em relação à degradação do material, ao final de 24 horas, maior percentual foi observado para os elásticos sintéticos, tanto in vitro quanto in vivo. A maior queda nos valores das forças liberadas pelos elásticos de ambos os materiais e nos estudos clínico e laboratorial, ocorreu entre os tempos de 0 e 1 hora, seguida de uma queda gradativa e progressiva até o tempo de 24 horas. Os elásticos de látex apresentaram um comportamento mais estável no período estudado em relação aos sintéticos, em ambos os estudos.

Synthetic intermaxillary orthodontic elastics are being increasingly used and they are primarily indicated for patients with hypersensitivity to latex. In order to evaluate and compare the behavior of latex and synthetic elastics, as the loss of strength, over time, this study was conducted both in vitro and in vivo. For the in vitro study, 15 of each elastic material was evaluated for each time: 0, 1, 3, 12 and 24 hours. For the in vivo study, patients were evaluated (N = 15) using both elastic materials (latex and synthetic) at the same times settled in vitro study. The rubber bands were transferred to the testing machine (EMIC DL-500 MF). The values of the force were recorded after stretching the elastic to a length of 25mm. Matched to the clinical and independent for laboratory sample t test was applied. Analysis of variance (ANOVA) was used to check the variation of the forces generated between those determined times and the post-hoc test to identify between which times were marked difference . As regards the initial forces (time zero), the values for synthetic elastic were quite similar between laboratory and clinical studies and slightly higher than the latex elastic. In subsequent times, the forces generated by the latex elastic showed higher values. Regarding the material degradation at the end of 24 hours, the highest percentage was observed for synthetic elastic, both in vitro and in vivo. The largest drop in the values of forces unleashed by the elastic of both materials and the clinical and laboratory studies occurred between times of 0 and 1 hour, followed by a gradual decreases until the time of 24 hours. The latex elastic had a more stable behavior during the period studied compared with synthetic, in both studies.

Prevalence of latex allergy in spina bifida patients in Singapore.

BACKGROUND: Latex allergy and its clinical presentation are rising in prevalence across the globe, especially amongst patients with spina bifida (SB). While studies have been well-established in Europe and America, data from Asia are limited. OBJECTIVE: The aim of this study is to investigate the scenario in Singapore. METHODS: 35 subjects with SB, aged 5 to 32 years answered a questionnaire and underwent skin prick test (SPT) using a latex solution, 3 common house dust mites and 3 commonly cross-reacting food allergens (banana, kiwi and avocado). We also noted the relation between latex sensitization with atopy and doctor-diagnosed allergy. The prevalence of cross-reactivity with fruits was also studied. RESULTS: Sensitization to latex (i.e. a positive SPT) was found in 16 (46%, 95% confidence interval 29%-63%) of the subjects. Only 5 (31%) of the subjects who were sensitized to latex had clinical manifestations. Atopy (i.e. positive SPT to house dust mites) was present in 23 (66%) of the subjects and 13 (57%) of them was also sensitized to latex. There was a positive trend between latex sensitization and atopy (81.2% vs. 52.6%, p = 0.076), as well as latex sensitization with those having both atopy and doctor-diagnosed allergy (i.e. asthma, allergic rhinitis, eczema, drug allergy) (93.8% vs. 63.2%, p = 0.032). Only 6 (38%) subjects had allergy to the food allergens tested. CONCLUSION: Almost half of the SB patients in Singapore are sensitized to latex. This number is comparable to that in Europe and America. Positive trend between latex sensitization and those with both atopy and doctor-diagnosed allergy (p = 0.032) is suggestive of a possible cause-effect relationship.

Prevalence of latex allergy in spina bifida patients in Singapore

BACKGROUND: Latex allergy and its clinical presentation are rising in prevalence across the globe, especially amongst patients with spina bifida (SB). While studies have been well-established in Europe and America, data from Asia are limited. OBJECTIVE: The aim of this study is to investigate the scenario in Singapore. METHODS: 35 subjects with SB, aged 5 to 32 years answered a questionnaire and underwent skin prick test (SPT) using a latex solution, 3 common house dust mites and 3 commonly cross-reacting food allergens (banana, kiwi and avocado). We also noted the relation between latex sensitization with atopy and doctor-diagnosed allergy. The prevalence of cross-reactivity with fruits was also studied. RESULTS: Sensitization to latex (i.e. a positive SPT) was found in 16 (46%, 95% confidence interval 29%-63%) of the subjects. Only 5 (31%) of the subjects who were sensitized to latex had clinical manifestations. Atopy (i.e. positive SPT to house dust mites) was present in 23 (66%) of the subjects and 13 (57%) of them was also sensitized to latex. There was a positive trend between latex sensitization and atopy (81.2% vs. 52.6%, p = 0.076), as well as latex sensitization with those having both atopy and doctor-diagnosed allergy (i.e. asthma, allergic rhinitis, eczema, drug allergy) (93.8% vs. 63.2%, p = 0.032). Only 6 (38%) subjects had allergy to the food allergens tested. CONCLUSION: Almost half of the SB patients in Singapore are sensitized to latex. This number is comparable to that in Europe and America. Positive trend between latex sensitization and those with both atopy and doctor-diagnosed allergy (p = 0.032) is suggestive of a possible cause-effect relationship.

Perioperative latex hypersensitivity reactions: an integrative literature review / Hipersensibilidade ao látex no período perioperatório: revisão integrativa da literatura / Hipersensibilidad al latex en el peri-operatório: una revisión integradora de la literatura

This article characterizes hypersensitivity reactions during anesthetic-surgical procedures. This integrative literature review was conducted in the LILACS, CINAHL, COCHRANE and MEDLINE databases including papers published from 1966 to September 2011. A total of 17 case reports, two prevalence studies and one cohort study were identified. Latex reactions were mainly type III and the primary source of intraoperative reaction was latex gloves. The average time for clinical manifestation was 59.8 minutes after anesthetic induction; 44.4% of patients reported a reaction to latex at the pre-anesthetic evaluation. It was determined that the history of allergic reactions to latex obtained in the pre-anesthetic evaluation does not ensure the safety of patients if the staff is inattentive to the severity of the issue. There is also a tendency to initially attribute the anaphylactic event to the anesthetic drugs.

Este estudo teve por objetivo caracterizar as reações de hipersensibilidade ao látex em procedimentos anestésico-cirúrgicos. Foi realizada revisão integrativa da literatura nas bases LILACS, CINAHL, COCHRANE e MEDLINE, com seleção de artigos publicados em periódicos indexados de 1966 a setembro de 2011. Foram identificados 17 relatos de caso, dois estudos de prevalência e um de coorte. As reações ao látex foram majoritariamente do tipo III, e a principal fonte desencadeadora de reações no intraoperatório foram as luvas de látex; o tempo médio para manifestação da reação foi de 59,8 minutos após a indução anestésica; 44,4% dos pacientes relataram episódio de reação ao látex na avaliação pré-anestésica. Identificou-se que a história de episódios de reações a materiais de borracha, ou alimentos, na avaliação pré-anestésica não garante a segurança dos pacientes, se o profissional não estiver alerta à gravidade do problema; no caso de ocorrência de um evento anafilactoide, os profissionais tendem a suspeitar inicialmente dos medicamentos anestésicos.

Este estudio tuvo como objetivo caracterizar las reacciones de hipersensibilidad al látex en la anestesia. Ha sido realizada una revisión integradora de la literatura en LILACS, CINAHL, COCHRANE y MEDLINE, con una selección de artículos publicados en periódicos indexados de 1966 hasta septiembre 2011. Fueron identificados 17 casos clínicos, 2 estudios de prevalencia y 1 de la cohorte. Las reacciones al látex fueron en su mayoría del tipo III y la principal fuente de reacción intra-operatoria fue el contacto con los guantes de látex. El tiempo medio hasta la aparición de respuesta fue de 59.8 minutos después de la inducción, 44,4% de los pacientes informaron una reacción al látex en el periodo pre-anestésico. La historia de reacciones alérgicas al látex en el periodo pre-anestésico no garantiza la seguridad de los pacientes si el profesional no está atento a la gravedad del problema. Al principio, se tiende a atribuir que el efecto de la anafilaxia se debe a los medicamentos anestésicos.

Prevalência de sinais de sensibilidade ao látex em pacientes com mielomeningocele submetidos a múltiplos procedimentos cirúrgicos / Prevalence of sensitivity signals to latex in meningomyelocele patients undergoing multiple surgical procedures

JUSTIFICATIVA E OBJETIVOS: O número de pacientes alérgicos ao látex vem aumentando significativamente. É essencial reconhecê-los para preve nir e aplicar o tratamento adequado. O objetivo do estudo foi avaliar a prevalência de alergia ao látex em pacientes com mielomeningocele. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, os prontuários médicos de pacientes com diagnóstico de mielomeningocele no período de janeiro de 2002 a dezembro de 2007. Os pacientes foram agrupados em alérgicos e não alérgicos. A comparação dos grupos em relação ao gênero foi feita pelo teste do Qui-quadrado, pelo teste t de Student em relação à idade, e o teste de Mann-Whitney para comparação entre os grupos em relação as manifestações clínicas de alergia, número de procedimentos sob anestesia, de internações hospitalares e de cateterizações vesicais. RESULTADOS: O número médio de procedimentos sob anestesia foi de 7 no grupo com alergia e 4 no grupo sem alergia, sendo esta diferença estatisticamente significante (p = 0,028). O número médio de internações hospitalares foi de 4,5 no grupo com alergia e 3,4 no grupo sem alergia e a média de cateterização vesical foi 24,5 nos alérgicos e 21,7 nos não alérgicos. CONCLUSÕES: Os pacientes portadores de mielomeningocele submetidos a múltiplos procedimentos sob anestesia apresentam alto risco de desenvolvimento de sinais clínicos de alergia ao látex. Há necessidade de que pacientes com diagnóstico de mielomeningocele sejam submetidos exclusivamente a procedimentos latex-free, evitando o alto risco de sensibilização e suas complicações. Testes específicos para avaliação da sensibilização, marcadores genéticos e relação látex-fruta poderão contribuir para melhor entendimento dos fatores de risco relacionados à alergia ao látex e formas de prevenção.

BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p = 0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it.

JUSTIFICATIVA Y OBJETIVOS: El número de pacientes alérgicos al látex ha venido aumentando significativamente. Es esencial reconocer los casos para prevenir y aplicar el tratamiento adecuado. El objetivo del estudio, fue evaluar la prevalencia de alergia al látex en pacientes con mielomeningocele. MATERIAL Y MÉTODOS: Fueron evaluadas retrospectivamente, las historias clínicas de pacientes con diagnóstico de mielomeningocele en el período de enero de 2002 a diciembre de 2007. Los pacientes fueron agrupados en alérgicos y no alérgicos. La comparación de los grupos con relación al sexo se hizo por medio del test del Xi-Cuadrado (Xi²), por el test t de Student con relación a la edad, y el test de Mann-Whitney para la comparación entre los grupos, con relación a las manifestaciones clínicas de alergia, número de procedimientos bajo anestesia, de ingresos hospitalarios y de cateterizaciones vesicales. RESULTADOS: El número promedio de procedimientos bajo anestesia fue de 7 en el grupo con alergia y 4 en el grupo sin alergia, siendo que esa diferencia es estadísticamente significativa (p = 0,028). El número promedio de ingresos fue de 4,5 en el grupo con alergia y de 3,4 en el grupo sin alergia, y el promedio de cateterización vesical fue 24,5 en los alérgicos y de 21,7 en los no alérgicos. CONCLUSIONES: Los pacientes portadores de mielomeningocele sometidos a múltiples procedimientos bajo anestesia, presentan un alto riesgo de desarrollar signos clínicos de alergia al látex. Existe la necesidad de que pacientes con diagnóstico de mielomeningocele se sometan exclusivamente a procedimientos latex-free, evitando así el alto riesgo de sensibilización y sus complicaciones. Test específicos para la evaluación de la sensibilización, marcadores genéticos y relación látex-fruta, podrán contribuir para un mejor entendimiento de los factores de riesgo relacionados con la alergia al látex y con las formas de prevención.

Curativo de biomembrana vegetal e hipersensibilidade / Natural-biomembrane dressing and hypersensitivity

FUNDAMENTOS: A biomembrana vegetal do látex da seringueira Hevea brasiliensis tem sido usada como curativo para úlceras cutâneas. OBJETIVOS: Avaliar a segurança da biomembrana vegetal como curativo em relação à hipersensibilidade ao látex. MÉTODOS: Foram selecionados pacientes com úlceras cutâneas constituindo-se os grupos: controle - baixa exposição profissional ao látex (n=17); alta exposição profissional (n=14); ulcerados em uso da biomembrana vegetal (n=13); ulcerados-controle sem uso da biomembrana vegetal (n=14) e casos novos (n=9), submetidos à avaliação pré e após 3 meses de uso da biomembrana vegetal. Todos foram submetidos à avaliação clínico-epidemiológica quanto à hipersensibilidade ao látex e IgE específica (UniCap®), e os grupos controle e controle exposto ao látex ao "patch test". RESULTADOS: A história de hipersensibilidade foi positiva em 64,7 por cento dos pacientes do grupo-controle, 71,4 por cento do controle exposto ao látex, 61,5 por cento dos ulcerados em uso da biomembrana vegetal, 35,7 por cento dos ulcerados-controle, e apenas 22,2 por cento no grupo casos novos. Ao teste de contato dos grupos controle e controle exposto ao látex, apenas um indivíduo do grupo C (baixo contato) apresentou eritema na primeira leitura, negativando-se na segunda. A média de contato com látex no grupo-controle exposto ao látex foi de 3,42 horas/dia. No ensaio fluoroimunoenzimático, a grande maioria dos soros foi classificada como zero (variação 0 a 6). Nenhum soro recebeu classificação acima de 2, não sendo considerada classificação significante para hipersensibilidade (classificação > 4). CONCLUSÃO: A biomembrana vegetal mostrou-se segura como curativo, pois não induziu reações de hipersensibilidade entre os voluntários submetidos ao "patch test", nem entre os usuários da biomembrana vegetal, como demonstrado clinica e imunologicamente pela dosagem de IgE.

BACKGROUND: The natural biomembrane of latex extracted from Hevea brasiliensis has been used as a dressing for skin ulcers. OBJECTIVES: To evaluate how safe the natural biomembrane is in relation to hypersensitivity to latex when used as a dressing. METHODS: We selected patients with skin ulcers, forming the following groups: control - low occupational exposure to latex (n = 17); latex-exposed control - high occupational exposure (n = 14); ulcerated, using the natural biomembrane (n = 13); ulcerated control, not using the natural biomembrane (n = 14); and new cases (n = 9), assessed before and after 3 months of using the natural biomembrane. All patients underwent clinical and epidemiological evaluation for latex hypersensitivity and specific IgE (UniCap®), and the control and latex-exposed control groups underwent the patch test. RESULTS: Hypersensitivity was positive in 64.7 percent of the patients in the control group, 71.4 percent of the patients in the latex-exposed control group, 61.5 percent of the ulcerated using the natural biomembrane, 35.7 percent of the ulcerated control, and only 22 , 2 percent of the new cases. In the patch test of the control and latex-exposed control groups, only one individual in the control group (low contact) showed erythema in the first reading, which became negative in the second. The mean contact with latex in the latex-exposed control group was 3.42 hours / day. In the fluoroimmunoenzymatic assay, most of the sera was classified as zero (range 0-6). No serum was rated above 2, which is not considered significant for hypersensitivity (classification > 4). CONCLUSION: The natural biomembrane proved to be safe as a dressing, for it did not induce hypersensitivity reactions among the volunteers who underwent the patch test or among users of the natural biomembrane, as it was clinically and immunologically demonstrated by IgE levels.

Reação anafilática induzida por látex em paciente submetido à apendicectomia aberta: relato de caso / Latex-induced anaphylactic reaction in a patient undergoing open appendectomy: case report / Reacción anafiláctica inducida por el látex en paciente sometido a la apendicectomía abierta: relato de caso

JUSTIFICATIVA E OBJETIVOS: Embora crescente a incidência de alergia ao látex na população em geral, eventos graves de anafilaxia durante alguns procedimentos cirúrgicos felizmente ainda são raros, porém com morbidade e mortalidade elevados. Não apenas a prevenção, mas o diagnóstico, o pronto tratamento e o acompanhamento dos pacientes acometidos por esse evento representam um desafio para o anestesiologista. O presente relato teve por objetivo descrever um caso de anafilaxia grave ao látex e discutir seu diagnóstico e tratamento. RELATO DO CASO: Paciente do sexo feminino, 39 anos, branca com suspeita diagnóstica de apendicite, é levada para procedimento de urgência sob raquianestesia. Aproximadamente 30 minutos após o início da cirurgia, apresentou quadro de anafilaxia com parada cardiorrespiratória, revertida após tratamento. Um dos cuidados foi o isolamento de eventuais agentes causais, sendo que, posteriormente, a paciente foi encaminhada para unidade de terapia intensiva e evoluiu sem sequelas. A dosagem de IgE-RAST (Radioallergosorbent Test) específico para o látex mostrou-se positiva. A paciente foi encaminhada para acompanhamento com o alergologista. CONCLUSÕES: O anestesiologista deve concentrar esforços na anamnese, mesmo em procedimentos de urgência, estando consciente das limitações que se apresentam nessas ocasiões. O prognóstico de anafilaxia depende do pronto início do tratamento adequado e o diagnóstico não se limita ao momento do evento, mas sim à determinação do fator causal. Criar um meio de acompanhar esses pacientes, a exemplo de outros centros internacionais, parece ser o caminho a ser seguido.

BACKGROUND AND OBJECTIVE: Despite the increase of latex allergy in general population, severe anaphylactic events during some surgical procedures are still rare; however, they are associated with increased morbidity and mortality. Prevention, diagnosis, treatment, and follow-up of patients affected by this event represent a challenge for anesthesiologists. The objective of this report was to describe a case of severe latex-induced anaphylactic reaction and discuss its diagnosis and treatment. CASE REPORT: This is a 39-year-old Caucasian female patient, with a diagnostic suspicion of appendicitis, who underwent an emergency surgery under spinal anesthesia. Approximately 30 minutes after beginning the surgery, the patient developed an anaphylactic reaction with cardiorespiratory arrest, which was reversed after treatment. Possible causative agents were isolated and, posteriorly, the patient was transferred to the intensive care unit, evolving without sequelae. Latex-specific IgE-RAST (Radioallergosorbent Test) was positive. The patient was referred to an allergist for follow-up. CONCLUSIONS: Anesthesiologists should focus on patient's history, even in urgent procedures, being aware of the limitations arising on these situations. The prognosis of anaphylaxis depends on prompt initiation of adequate treatment; diagnosis is not limited to the event occasion, but to the determination of the causative factor. Creating the means of following-up these patients, similar to other international centers, seems to be the example to be followed.

JUSTIFICATIVA Y OBJETIVOS: Aunque exista un aumento en la incidencia de alergia al látex en la población en general, los eventos graves de anafilaxia durante algunos procedimientos quirúrgicos por suerte todavía son raros, aunque con un nivel de morbilidad y mortalidad elevados. La prevención, el diagnóstico, el rápido tratamiento y el seguimiento de los pacientes afectados por ese evento, representan un reto para el anestesiólogo. El presente relato intentó describir un caso de anafilaxia grave al látex y discutir su diagnóstico y tratamiento. RELATO DEL CASO: Paciente del sexo femenino, 39 anos, blanca y con sospecha diagnóstica de apendicitis, que fue derivada a quirófano para un procedimiento urgente bajo raquianestesia. Aproximadamente 30 minutos después del inicio de la cirugía, presentó un cuadro de anafilaxia con parada cardiorrespiratoria, revertida posteriormente al tratamiento. Uno de los cuidados tomados fue el aislamiento de eventuales agentes causales, siendo que, posteriormente, la paciente fue derivada a la Unidad de Cuidados Intensivos y evolucionó sin secuelas. La dosificación de IgE-RAST (Radioallergosorbent Test), específico para el látex fue positiva. La paciente fue derivada para seguimiento con el alergista. CONCLUSIONES: El anestesiólogo debe concentrar sus esfuerzos en la anamnesis, aunque en los procedimientos de urgencia, sea consciente de las limitaciones que se presentan en esas ocasiones. El pronóstico de anafilaxia depende del rápido inicio del tratamiento adecuado, y el diagnóstico no se restringe al momento del evento, sino a la determinación del factor causal. Crear un medio de seguimiento para esos pacientes, como lo hacen otros centros internacionales, parece ser el camino que debe ser secundado.

A case of anaphylactic shock attributed to latex allergy during gastric cancer surgery.

Latex allergy is a known cause of allergic contact dermatitis. It produces mild symptoms, including skin rash and itching, which usually subside in a few days. However, latex allergy can also induce anaphylaxis, a severe type I hypersensitivity reaction that can cause urticaria, angioedema, hypotension, tachycardia, and bronchospasm. We report a case of anaphylactic shock during gastric cancer surgery in a patient with no previous allergic history. Surgery was suspended when hypotension, tachycardia, and wheezing developed. A thorough workup revealed that the patient had a latex allergy. The patient subsequently underwent curative gastrectomy performed with latex-free procedures.

Contact allergic cheilitis secondary to latex gloves: a case report.

BACKGROUND: The purpose of this report is to present a rare case of allergic chelitis secondary to latex in an elderly diabetic patient. There are very few reported cases of allergic cheilitis in literature. Most of the reported cases of allergic chelitis were secondary to cosmetics, tooth pastes or impression materials. Few cases of rubber dam induced allergic cheilitis and stomatitis reported. METHODS: Since the patient was diabetic on insulin therapy and belonged to the elderly age group, utmost caution was observed while performing diagnostic tests and treatment procedures. The use test was performed to detect the allergen (latex) because of short contact time to the skin surface. RESULTS: The patient was followed-up for a period of eight months, complete healing of the lesions was witnessed. The patient has not reported of any lesions later. CONCLUSIONS: Appropriate diagnostic test and interdisciplinary approach in consultation with medical specialists would be ideal for the management of allergic cheilitis especially in diabetic elderly patients.