A Patient with an Unknown Latex Allergy Presenting for Sealant Placement.

Dentists should be trained to treat any allergic reaction in a dental office, and in this scenario, allergic reaction to latex-based product (rubber dam) is illustrated. Identification of signs and symptoms related to latex allergies is vital, and all dentists should be trained in the appropriate management of such a patient. The dental management of the scenario describes details of the diagnosis and management of latex-related allergies in a dental office for both adults and children.

Clinical and quality of life assessment in patients with latex allergy during COVID-19 pandemic: Possible protective role of continuous latex immunotherapy.

Introduction: During COVID-19 pandemic, the massive use of Personal Protective Equipment could provoke severe adverse reactions in latex allergy patients and could negatively affect their quality of life. Methods: Trough a survey the study aimed: (a) to evaluate the incidence of allergic reactions in patients with latex allergy during the SARS-CoV-2 pandemic; (b) to evaluate the protective role of continuous latex sublingual immunotherapy (SLIT) during this period; and (c) to evaluate quality of life of natural rubber latex allergy (NRLA) patients during the pandemic. Results: 67 patients (9 males and 58 females, mean age of 45.9 ± 11.4 years) suffering from latex allergy were included in the present study. We recorded among our patients 13 cases (34.2%) of urticarial/angioedema (U/A), 9 cases (23.6%) of respiratory symptoms (dyspnoea, shortness of breath and wheezing) and 7 cases (18.4%) of anaphylaxis. In patients who underwent continuous SLIT, we observed less cases of U/A (p < 0.001), respiratory symptoms (p < 0.001), anaphylaxis (p = 0.003), hospitalizations (p = 0.014) and a lower therapy administration. We compared the results of SF-36 questionnaire in patients who underwent continuous and not-continuous SLIT with a significance differences score between these two groups. Conclusions: Our study is the first that investigated the clinical and quality of life effects of COVID-19 pandemic in NRLA patients.

[Latex allergy: a review on the most important aspects]. / Alergia al látex: una revisión sobre los aspectos más importantes.

This allergy is a hypersensitivity reaction that is triggered by contact with latex. Symptoms vary depending on factors such as route, frequency, and exposure dose, as well as individual susceptibility. The clinical manifestations can be localized at the site of contact with latex or generalized. Exposure can occur directly as a result of contact with the skin and mucous membranes, that is by touching or being touched by objects with latex, or by inhaling (breathing) particles from objects with latex. Contact can also be indirect; for example, by ingesting food that has been handled by a worker wearing latex gloves or by having contact with a person who has been blowing up balloons. The diagnosis of latex allergy is made based on the patient's medical history and on what has been reported in the interrogation, and it is complemented with in vivo studies (such as skin tests and provocation tests) or in vitro studies (determination of specific IgE). The fundamental pillar in the treatment of latex allergy is the education of the patient to achieve the avoidance of products made with this material or the contact and intake of food that has had contact with latex. In view of the foregoing, latex allergy has a great medical and social relevance due to all the safety measures that the patient must take.

La alergia es una reacción de hipersensibilidad desencadenada tras el contacto con el látex. Los síntomas varían dependiendo de factores como la ruta, frecuencia y dosis de exposición, además de la susceptibilidad individual. Las manifestaciones clínicas pueden darse de forma localizada, en el sitio de contacto con el látex, o generalizadas. La exposición puede ocurrir de forma directa como resultado del contacto con la piel y mucosas, por tocar o ser tocado por objetos con látex, o al inhalar partículas provenientes de objetos con látex. El contacto también puede ser indirecto, al ingerir alimentos que fueron manipulados por un trabajador con guantes de látex, al tener contacto con una persona que ha estado inflando globos, por ejemplo. El diagnóstico de alergia al látex se realiza basado en la historia clínica del paciente, lo reportado en el interrogatorio y se complementa con estudios in vivo (como las pruebas cutáneas y las pruebas de provocación) o estudios in vitro (determinación de IgE específica). El pilar fundamental en el tratamiento de la alergia al látex es la educación del paciente para lograr la evitación de productos elaborados con este producto o el contacto e ingesta de alimentos que tuvieron contacto con el látex. Por lo anterior, la alergia al látex tiene una gran relevancia médica y social por todas las medidas de seguridad que debe llevar el paciente.

[Latex allergy: therapeutic options]. / Alergia al látex: opciones terapéuticas.

Latex allergy is a major problem worldwide due to both the severity of the symptomatology it produces and the risk groups that are exposed to it. Complete avoidance is difficult, if not impossible, due to its ubiquity. Natural rubber latex (NRL) is a natural polymer that is released by the Hevea brasiliensis (Hev b) tree, which functions as a protective sealant. It is currently used for the manufacture of health-care products such as tube caps, pistons, masks, and cannulas. The purpose of this review is to highlight the epidemiological, clinical, and diagnostic aspects of NRL allergy, and to conduct a review of the literature on its management through a bibliographic search of articles in databases such as PubMed, Cochrane, UpToDate, and Google Scholar, up to September 2021. About 121 articles were reviewed, of which 76 were used as a reference. We concluded that latex allergy is an entity for which its treatment, even nowadays, is avoidance, despite having a worldwide prevalence of 4.3 % and representing a surgical complication in about 20 % of surgeries with an anaphylactic reaction and a mortality rate that can reach 9 %. The only treatment that could modify the evolution of this disease is immunotherapy, but there are no standardized extracts yet and it has not been possible to determine the safest and most effective way to apply it.

La alergia al látex es un problema importante en el mundo debido a la gravedad de la sintomatología que produce y a los grupos de riesgo expuestos. La evitación completa es difícil, casi imposible, dada su ubicuidad. El látex de caucho natural (LCN) es un polímero secretado por el árbol Hevea brasiliensis (Hev b), que funciona como sellador protector. Actualmente se usa para fabricar productos para el cuidado de la salud como tapones para tubos, pistones, mascarillas y cánulas. El objetivo de esta revisión es resaltar los aspectos epidemiológicos, clínicos y diagnósticos de la alergia al LCN, y realizar una revisión de la literatura sobre su manejo, mediante una búsqueda bibliográfica de artículos en bases de datos como PubMed, Cochrane, UpToDate y Google Académico, hasta septiembre del 2021. Se revisaron aproximadamente 121 artículos, de los cuales se utilizaron 76 como referencia. Concluimos que la alergia al látex es una entidad cuyo tratamiento aún hoy en día es la evitación, a pesar de tener una prevalencia mundial de 4.3 % y representar una complicación quirúrgica de cerca de 20 % de las cirugías con una reacción anafiláctica y una mortalidad que puede llegar a 9 %. El único tratamiento que podría modificar la evolución de esta enfermedad es la inmunoterapia, pero aún no se cuenta con extractos estandarizados y no se ha podido determinar la vía más segura y efectiva.

Patch Testing With a New Composition of the Mercapto Mix-A Multicenter Study from the International Contact Dermatitis Research Group.

BACKGROUND: Mercaptobenzothiazole compounds are associated with allergic contact dermatitis caused by rubber products. Several screening substances have been used for patch testing. OBJECTIVE: To compare the frequency of positive test reactions to a mercapto mix containing a higher concentration of 2-mercaptobenzothiazole with reactions to the combination of 2-mercaptobenzothiazole 2.0% and mercapto mix 2.0%. METHODS: There were 7103 dermatitis patients in 12 International Contact Dermatitis Research Group dermatology departments who were patch tested with 2-mercaptobenzothiazole 2.0% petrolatum (pet.), mercapto mix 2.0% pet., and mercapto mix 3.5% pet. RESULTS: Contact allergy to the 3 test preparations varied among the 12 centers: 2-mercaptobenzothiazole 2.0% pet. (0-2.4%), mercapto mix 2.0% pet. (0-4.9%), and mercapto mix 3.5% pet. (0-1.4%). 2-Mercaptobenzothiazole 2.0% and mercapto mix 2.0% detected a few more positive patients compared with mercapto mix 3.5%, but the difference was statistically insignificant (mercapto mix 2.0% pet., P = 1.0; 2-mercapto-benzothiazole 2.0% pet., P = 0.66). CONCLUSIONS: Mercapto mix 3.5% pet. is not better than 2-mercaptobenzothiazole 2.0% and mercapto mix 2.0% by a difference that is significant. By using only 1 test preparation (mercapto mix 3.5%), an additional hapten could be tested. No cases of suspected/proven patch test sensitization were registered.

Prevalence of latex sensitivity and allergy among physicians of a residency program in a children´s hospital of Buenos Aires. / Prevalencia de sensibilidad y alergia al látex en médicos de un programa de residencia de un hospital pediátrico de Buenos Aires.

Introduction: International publications estimate a 7 %-17 % latex sensitization (LS) prevalence among health care workers, but values in Argentina are unknown. Objectives: To estimate the prevalence of latex sensitization and allergy among residents of a children's hospital using the immediate-reading prick test and to assess associated risk factors in this population. Population and methods: Cross-sectional study. Residents, trainers, and Chief residents of the Departments of Pediatrics, Orthopedics, Surgery and Intensive Care were included between June and October 2017. All of them were administered a questionnaire (assessing atopic diseases and other risk factors) and underwent the immediatereading prick test. Total and latex-specific immunoglobulin E levels were determined in a subgroup of individuals (first- and fourth-year residents, surgical specialties, and intensive care). Results: A total of 113 participants were included. LS prevalence was 7.96 % (95 % confidence interval: 3.70-14.58); 4 participants were allergic to latex. A history of latex-related symptoms (LRS) was significantly associated with a positive result in the immediate-reading prick test (p = 0.0196; odds ratio: 6.13; 95 % confidence interval: 1.44-26.04). There was no association between LS and the year of the residency program. Conclusions: The observed LS prevalence was 7.9 %. There was a significant relation between a history of LRS and a positive result in the immediate-reading prick test.

Introducción. Publicaciones internacionales estiman una prevalencia de sensibilización al látex (SL) en el personal de salud del 7 % al 17 %, y se desconocen los valores en la Argentina. Objetivos. Estimar la prevalencia de sensibilización y alergia al látex en médicos residentes de un hospital pediátrico mediante la prueba epicutánea de lectura inmediata y evaluar factores de riesgo asociados en dicha población. Población y métodos. Estudio de corte transversal. Se incluyeron los residentes, jefes e instructores de Pediatría, Ortopedia, Cirugía y Terapia Intensiva entre junio y octubre de 2017. En todos, se realizó un cuestionario (que evaluó enfermedades atópicas y otros factores de riesgo) y la prueba epicutánea de lectura inmediata. En un subgrupo (residentes de 1ero, 4to año, especialidades quirúrgicas y terapia) se dosó inmunoglobulina E total y específica para látex. Resultados. Se incluyeron 113 participantes. La prevalencia de SL fue del 7,96 % (intervalo de confianza del 95 %: 3,70-14,58); 4 participantes resultaron alérgicos al látex. El antecedente de síntomas relacionados con el látex se asoció significativamente con prueba epicutánea de lectura inmediata + (p = 0,0196; odds ratio 6,13; intervalo de confianza del 95 %: 1,44-26,04). No hubo asociación entre SL y año de residencia. Conclusiones. La prevalencia de SL hallada fue del 7,9 %. Se evidenció una relación significativa entre el antecedente de SRL y un resultado de prueba epicutánea de lectura inmediata positiva.

Hevea latex-associated allergies: piecing together the puzzle of the latex IgE reactivity profile.

Introduction: IgE-mediated Hevea latex allergy and associated food-allergies constitute a significant health issue with serious consequences of diagnostic error. Hence, there is a need for more reliable confirmatory diagnostics.Areas covered: Here, we summarize the major limitations of conventional tests using native extracts and describe how piecing together the IgE reactivity profile can benefit correct diagnosis in difficult cases in whom conventional tests yield equivocal or negative results. A diagnostic algorithm integrating traditional sIgE and component-resolved diagnosis (CRD) is presented.Expert opinion: Moreover, it is clear that the discoveries in the field of the Hevea latex proteome will contribute to our understandings and accurate approach of sometimes complex cross-reactivity phenomena that extend beyond the 'latex-fruit syndrome.'

Current state of occupational latex allergy.

PURPOSE OF REVIEW: During the 1980s, natural rubber latex (NRL) emerged as a major cause of occupational allergy and asthma, especially in healthcare workers using powdered NRL gloves. Increased recognition of NRL allergies and transfer of research findings into prevention strategies resulted into an almost elimination of this health problem. Here, the current knowledge on allergens, their use in diagnostics, prevalence data of occupational NRL allergy and the status of prevention strategy are summarized. RECENT FINDINGS: While the current studies conducted in high-income countries show that prevention measures have reduced NRL allergy, this does not yet apply worldwide. For latex allergy diagnosis, it is important that recombinant allergens as reliable tools are available, because in several European countries and the United States, NRL skin prick test extracts and powdered latex gloves for bronchial challenge test are no longer commercially available, leading to a deficit in diagnostic tools. Due to the fact that latex is suitable with good properties as a raw material for gloves, alternatives with significantly lower protein content and without cross-reactive structures to latex proteins are sought. SUMMARY: Awareness of the sensitization risk associated with the use of latex gloves should still be present in all occupational settings.

Nuevas medidas de diagnóstico eficiente en la hipersensibilidad alérgica al látex / New tests for an efficient diagnosis in allergic hypersensitivity to latex

La alergia al látex es una respuesta alterada de nuestro organismo al contactar con las proteínas que se encuentran en el látex de caucho natural. Los síntomas de la hipersensibilidad alérgica al látex son bastante parecidos a los de la alergia a los alimentos, siendo menos frecuentes los síntomas digestivos y más típicos los cutáneos tras el uso de guantes de látex, y los nasales y/o el asma tras la inhalación del polvo de los guantes de látex o de los globos. En caso de pacientes muy sensibles puede provocar reacciones alérgicas graves si entra en contacto con mucosas o cavidades internas. Se da la paradoja de que el medio hospitalario, es el lugar de más riesgo dada la cantidad existente de látex, tanto directo como indirecto. Las personas alérgicas al látex presentan a menudo reacciones alérgicas cruzadas, a veces graves, tras ingerir determinadas frutas y vegetales. Las reacciones cruzadas se deben a los alérgenos comunes presentes en el látex y en los diferentes alimentos. Es importante utilizar el análisis molecular de alérgenos para detectar falsos diagnósticos a látex por problemas de reactividad cruzada con proteínas de frutas. Indicamos cómo estas nuevas pruebas han sustituido a análisis menos precisos y eficientes, logrando un considerable ahorro de recursos

Latex allergy is an altered response of the body on contact with proteins found in natural rubber latex. The symptoms of allergic hypersensitivity to latex are quite similar to those of food allergy, with the gastrointestinal symptoms being less frequent and the cutaneous ones being more typical after the use of latex and nasal gloves and / or the asthma after the inhalation of the dust from latex gloves or balloons. In the case of very sensitive patients it can cause severe allergic reactions if it comes in contact with mucous membranes or internal cavities. There is a paradox that the hospital environment is the most risky place, given the existing amount of latex in direct and indirect use. People who are allergic to latex often have cross-allergic reactions, sometimes severe, after eating certain fruits and vegetables. The cross-reactions are due to the common allergens present in latex and in different foods. It is important to use molecular allergen analysis to detect false latex diagnoses due to problems of cross-reactivity with fruit proteins. It is indicated how these new tests have replaced less accurate and efficient analyses, achieving a considerable saving of resources

[Coronary vasospasm in a child allergic to latex: Kounis syndrome]. / Vasoespasmo coronario en un niño alérgico al látex: síndrome de Kounis.

Kounis syndrome consists of the simultaneous occurrence of anaphylaxis and acute coronary syndrome. It is a rare entity that may be underdiagnosed in paediatrics. The clinical presentation is variable, atypical and usually unexpected, and it carries possible serious complications such as ventricular arrhythmias, myocardial infarction and sudden death. Therefore, an early diagnosis and treatment for myocardial revascularization and the anaphylactic reaction are crucial. We report the case of an 11-year-old male who, after contact with latex, presented an anaphylactic reaction associated with coronary vasospasm, with rapid and complete recovery after administration of intramuscular adrenaline. The cardiological study ruled out coronary pathology as the cause of the event. The allergy study revealed a latex-fruit (kiwi and pineapple) cross-reactivity syndrome. The patient was diagnosed with type I Kounis syndrome triggered by latex, recommending the avoidance of possible triggers.

El síndrome de Kounis consiste en la aparición simultánea de anafilaxia y síndrome coronario agudo. Se trata de una entidad poco descrita y que puede estar infradiagnosticada en pediatría. Es crucial, por su presentación variable, atípica e inesperada, y por sus posibles complicaciones graves (arritmias ventriculares, infarto de miocardio, muerte súbita), su reconocimiento y tratamiento precoz, dirigido a la revascularización del miocardio y al tratamiento de la reacción anafiláctica concomitante. Se presenta el caso de un varón de 11 años que, tras el contacto con látex, presentó una reacción anafiláctica asociada a vasoespasmo coronario, con recuperación rápida y completa con la administración de adrenalina intramuscular. El estudio cardiológico descartó patología coronaria como causa del evento. El estudio alergológico puso de manifiesto un síndrome de reactividad cruzada látex-frutas (kiwi y piña). Se diagnosticó síndrome de Kounis tipo i desencadenado por látex, y se recomendó evitar posibles factores desencadenantes.

Allergy topics for dental practitioners.

Penicillin allergy, local anesthetic hypersensitivity, latex allergy, contact hypersensitivity, and anaphylaxis are among the allergic reactions encountered in dental practice. This article reviews the literature pertaining to these important areas of overlap between dentistry and allergy/immunology. The epidemiology, diagnosis, and management of penicillin allergy as it relates to dentistry are reviewed. The relevant literature regarding local anesthetic and latex hypersensitivity is discussed. In addition, the presentation, evaluation, and management of contact hypersensitivity, including that to metals, are addressed. Recognition and appropriate treatment of anaphylaxis also are reviewed. This article will help dentists understand potential areas of comanagement with allergists/immunologists to optimize patient care.

Identification and Management of Perioperative Anaphylaxis.

The authors present a case of a patient with multiple episodes of perioperative anaphylaxis. The incidence and the most common causes of perioperative anaphylaxis are reviewed. The most common causes can vary by country and the type of perioperative medications used. The unique environment and the multiple medications and substances used in the anesthesia and surgical setting that make a definitive diagnosis challenging are outlined. A systematic strategy to recognize the reaction, identify the culprit, and direct future management are demonstrated. Management of the patient experiencing perioperative anaphylaxis requires close collaboration between the anesthesia, surgical, and allergy teams.

Allergen-specific IgE to recombinant latex allergens in occupational allergy diagnostics.

OBJECTIVES: Specific challenge tests (SICs) are considered reference tests for allergic occupational diseases diagnosis. However, in numerous cases, SICs cannot be carried out in the diagnosis of allergy to latex due to the risk of generalized reactions. The aim of the study was to evaluate the usefulness of sIgE determination to recombinant latex allergens in diagnostics of occupational respiratory allergy. MATERIALS AND METHODS: The study group comprised 44 healthcare workers (HCW) suspected of suffering from occupational respiratory allergy to latex (they underwent a physical examination, skin-prick tests (SPTs) to common and latex allergens, spirometry and SIC) and 17 controls not occupationally exposed to latex, with a positive sIgE against latex. Each serum was tested for allergen-specific IgE to aeroallergens, latex, eight recombinant latex allergens and CCD-markers. RESULTS: Specific IgE against Hev b5, 6.01, and 6.02 were significantly more frequently detected in HCWs and their mean serum levels were higher compared with the control group. In 26 HCWs with occupational asthma (OA), sensitization to Hev b5, Hev b6.01, Hev b6.02 was significantly more frequent than in 18 HCWs with work-exacerbated asthma (WEA); they had positive results SPT to latex significantly more frequently in comparison with subjects with WEA. CONCLUSIONS: Test for recombinant latex allergens is much more accurate in recognition of latex allergy than test for latex extract, which seems to produce false-positive results in patients with pollen allergy. The measurements of sIgE against recombinant latex allergens Hev b 6.01, 6.02, 5, and 8 are useful in differentiating OA from WEA.

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.

Acute Management, Diagnosis, and Follow-Up of Suspected Perioperative Hypersensitivity Reactions in Flanders 2001-2018.

BACKGROUND: Despite numerous efforts to describe the clinical manifestations and the epidemiology of perioperative hypersensitivity (POH), there remains room to increase awareness among anesthetists and immunologists/allergists. OBJECTIVE: To report the findings of a 17-year survey of suspected POH in Antwerp, Belgium. METHODS: We analyzed clinical and diagnostic data from 715 patients referred because of a suspected POH reaction, between January 1, 2001, and May 31, 2018. A total of 456 patients demonstrating a POH could be queried about subsequent anesthesia. RESULTS: A total of 608 cases formed the final dataset; 208 had a non-life-threatening reaction and 400 a life-threatening reaction. In life-threatening reactions, hypotension was predominating. In the non-life-threatening reactions, 83.9% of the patients displayed cutaneous manifestations. In life-threatening reactions, intravenous adrenaline and fluids were administered in 75.7% and 31%, respectively, and 41.3% had their intervention abandoned. Mast cell activation (MCA) was mainly, but not exclusively, observed in severe grades but did not predict the mechanistic process nor the culprit. A cause was identified in 77.8% of severe and 48.6% of milder cases. Main culprits were neuromuscular blocking agents, latex, cefazolin, and dyes. A total of 156 cases had uneventful anesthesia, except 1 patient who was inadvertently re-exposed to hidden chlorhexidine. CONCLUSIONS: This study highlights that there is room for an improved acute management and an optimized diagnostic workup that should not be restricted to patients with severe reactions and/or showing MCA.