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574 A multicenter, longitudinal study of natural rubber latex (NRL) allergy in nursing students (NS)
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574
Abstracts
J ALLERGY CLIN IMMUNOL JANUARY 1996
L a t e x A l l e r g e n L e v e l s In Disposable M e d i c a l G l o v e s . GL Sussman MD. Bradley Pueh. DH Beezhnld PhD. Toronto, Ont Dothan, AL, and Sayre, PA. The objective of the study was to differentiate immtmologically between gloves manufactured by the regular powdered process and gloves manufactured using chlorination or polymer coating processes. Three brands of gloves were manufactured within an 8 hour period on the same dip machine, starting with a common batch of compotmded latex to eliminated variability. Four additional brands (3 powdered, one powder-free) were also studied. The gloves were analyzed for total protein using the ASTM 5712 Lowry method, and specifically for latex antigens by immunoassay (LEAP). Latex allergens in the glove extracts were estimated by end point titration skin prick testing (SPT) in latex allergic individuals. Allergenicity was scored as the log of the dilution at which the individuals reacted. No reaction was scored as -1. Extracts were assigned a reactivity score based on mean reactivity in 39 patients. Extrsets from powdered gloves had measurable levels of latex proteins and allergens, while the powderfree gloves were low in protein (below detection) and allergenieity. No difference in allergenieity was observed between the chlorinated powder-flee gloves and the polycoated gloves. While the protein levels determined by the Lowry assay correlated with SPT reactivity (r=0.8), the test was restricted by a high detection limit. Latex allergic individuals react to extracts with protein levels below the 50 ttg/gm deteetion limit. The LEAP assay had a better correlation to SPT reactivity (r=0.94) and became of its greater sensitivity, gloves testing below the minimum of 0.2 I~g/gm may have a significantly lower potential for eliciting skin test reactions in latex allergic individuals.
575
A Muiticenter, Longitudinal Study of Natural Rubber L a t e x ( N R L ) A l l e r g y in Nursing Students
576
(NS) P Steinberg. M.D.. AM Phelev. Ph.D.. CM O'Hara. R.N., Minneapolis~ Minnesota Numerous reports have documented an increasing prevalence of NRL allergy in health care workers, however, the natural history is unknown. As the first phase of a longitudinal study, a questionnaire was distributed to 199 beginning NS at the University of Minnesota, College of St. Catherine, and Bethel College (100% response). 91% of the respondents were female (F) with no significant age differences seen between the sexes [mean 25.3 years, range 19-47 for (F)], [mean 25,7 years, range 20-44 for male (M)]. 15.1% of the respondents reported adverse reactions to NRL products; 14.6% with contact dermatitis, 1.0% with contact urticaria, 0.5% with rhinoconjunctivitis, none with angioedema or enaphylaxis. 49.2% of the respondents had previous surgery, 41,2% with hayfever, 22.1% with allergy to medications, 14.1% with asthma, 13.1% with eczema, 12.1% with food allergy. Previous surgery or h/o allergy were not associated with the presence of current NRL allergy. NRL daily glove use in this population at the time of starting nursing school was 45.5% (20.5% with < 5 pairs, 8.3% with 6-10, 16.7% > 10), No significant glove use differences were reported between sexes. 76.7% of NS with (+) current h/o NRL allergy were using NRL gloves at the time of starting school compared with 37.9% with (-) NRL allergy (p < 0.0001). 33.3% with (+) NRL allergy were using > 10 pairs/day, compared with 9.5% with (-) NRL allergy (p < 0.001). Only 23.3% of (+) NRL allergy group used no gloves compared with 62.1% of (-) N1LL allergy group (p < 0.0001). A high prevalence of self-reported allergy to NRJ., products was observed in beginning NS associated with high daily NRL glove contact.
The relationship between latex allergies, hydration and compromised barriers in s u r g i c a l g l o v e s . Thomnson R BS..Korniewicz D DNSc RN.Bennett J PhD.Kellv K MD.Murali pS PhD.Kurup V PhD.Fink J MD, Hartland WI, Washington DC, Houston "IX, and Milwaukee WI. The increasing incidence of contact and anaphylactic latex sensitivities in Healthcare workers has been attributed, in part, to the leaching of proteins and chemicals from surgical and exam gloves. Defects and voids created by leaching in interstitial matriticies of the latex membrane is replaced by hydration via capillary action with perspiration and bodily fluids end can be measured over time as a loss of electrical resistivity. This study was done to determine if hydrated latex would permit the passage of virus through the membrane.In a pilot study 6 brands of sterile surgical gloves were premeasured over a 60 minute period and sorted into high, medium and low hydration categories. Gloves were then suspended in a 2 liter beaker of surface tension adjusted, 37 ° C, sterile saline. 3 ml aliquot samples were collected outside the glove as controls. Bacteriophage OX174, a surrogate for H1V, in concentration of 10q was added to the inside of the suspended glove. Aliquots were obtained from outside the glove every 10 minutes. At 60 minutes a sterile 27 gauge needle pierced the glove. An aliquot recovered at 65 minutes was a positive control. Viral transmission, measured by plaque counting, detected virus in 4 of 12 gloves. In 1 rapidly hydrating glove brand both samples leaked virus as did 1 in the low and I in the high hydrating categories. Protein measurement by BCA confirmed increasing total protein with hydration. In conclusion surgical gloves, long assumed effective barriers against bloodborne pathogens, may not be as effective as originally thought and, further, improperly manufactured gloves may cause a serious threat to Healthcare workers and patients.
H L A i m m u n o g e n e t i c s a n d t h e s p e c i f i c l g E r e s p o n s e to Hevea latex antigens. HP Ribs Phi). Z Chen Phl). R Cremer MD #, H Allmers MD. X Baur MD, Bochum and fCologne, Germany. The aim of this study was to elucidate the role of HLA-D alleles in latex allergy. We investigated HLA-DRB1,3,4,5 and DQBI alleles on the short arm of chromosome 6 by the PCR-SSO typing technique. 80 health care workers (HCWs) and 84 spina bifida patients, who had been strongly exposed to latex, and 90 nonaffected blood donors (controls) were examined. 52 out of 80 latex-exposed HCWs showed positive anti-latex-lgE values with the PharmaciaCAP system or EAST (>0.35 kU/l). 42 out of 84 latex-exposed spina bifida patients were latex-positive. The statistical analysis (Chisquare test with Yates correction) of the typing results revealed an elevated DR4 frequency in latex-lgE-positive HCNVs when compared with latex-negative subjects (42% vs 29%; p f n . s . ) and with controls (42% vs 24%; p<0.05). Additionally, we observed a correlation between DR4 positivity and serum reactivity to the 4.7 kDa herein in 9 out of 10 sera tested for HLA and by EAST. In Hey b l-positive HCWs the frequencies of DR1 and DR4 were slightly elevated. Analysis in spina bifida patients revealed an increased frequency of DR1 (31%) when compared with latex-negative patients (24%) and controls (17%). in comparison with controls, Hey b 1-positive spirm bifida patients showed also an elevated DR1 frequency (33% vs 17%; 7tz=3.31). The distribution of DQB1 frequencies revealed no striking differences. These data indicate a slight correlation between c,ertain HLA-D alleles and latex.type I'sensitization.
573
574
Abstracts
J ALLERGY CLIN IMMUNOL JANUARY 1996
L a t e x A l l e r g e n L e v e l s In Disposable M e d i c a l G l o v e s . GL Sussman MD. Bradley Pueh. DH Beezhnld PhD. Toronto, Ont Dothan, AL, and Sayre, PA. The objective of the study was to differentiate immtmologically between gloves manufactured by the regular powdered process and gloves manufactured using chlorination or polymer coating processes. Three brands of gloves were manufactured within an 8 hour period on the same dip machine, starting with a common batch of compotmded latex to eliminated variability. Four additional brands (3 powdered, one powder-free) were also studied. The gloves were analyzed for total protein using the ASTM 5712 Lowry method, and specifically for latex antigens by immunoassay (LEAP). Latex allergens in the glove extracts were estimated by end point titration skin prick testing (SPT) in latex allergic individuals. Allergenicity was scored as the log of the dilution at which the individuals reacted. No reaction was scored as -1. Extracts were assigned a reactivity score based on mean reactivity in 39 patients. Extrsets from powdered gloves had measurable levels of latex proteins and allergens, while the powderfree gloves were low in protein (below detection) and allergenieity. No difference in allergenieity was observed between the chlorinated powder-flee gloves and the polycoated gloves. While the protein levels determined by the Lowry assay correlated with SPT reactivity (r=0.8), the test was restricted by a high detection limit. Latex allergic individuals react to extracts with protein levels below the 50 ttg/gm deteetion limit. The LEAP assay had a better correlation to SPT reactivity (r=0.94) and became of its greater sensitivity, gloves testing below the minimum of 0.2 I~g/gm may have a significantly lower potential for eliciting skin test reactions in latex allergic individuals.
575
A Muiticenter, Longitudinal Study of Natural Rubber L a t e x ( N R L ) A l l e r g y in Nursing Students
576
(NS) P Steinberg. M.D.. AM Phelev. Ph.D.. CM O'Hara. R.N., Minneapolis~ Minnesota Numerous reports have documented an increasing prevalence of NRL allergy in health care workers, however, the natural history is unknown. As the first phase of a longitudinal study, a questionnaire was distributed to 199 beginning NS at the University of Minnesota, College of St. Catherine, and Bethel College (100% response). 91% of the respondents were female (F) with no significant age differences seen between the sexes [mean 25.3 years, range 19-47 for (F)], [mean 25,7 years, range 20-44 for male (M)]. 15.1% of the respondents reported adverse reactions to NRL products; 14.6% with contact dermatitis, 1.0% with contact urticaria, 0.5% with rhinoconjunctivitis, none with angioedema or enaphylaxis. 49.2% of the respondents had previous surgery, 41,2% with hayfever, 22.1% with allergy to medications, 14.1% with asthma, 13.1% with eczema, 12.1% with food allergy. Previous surgery or h/o allergy were not associated with the presence of current NRL allergy. NRL daily glove use in this population at the time of starting nursing school was 45.5% (20.5% with < 5 pairs, 8.3% with 6-10, 16.7% > 10), No significant glove use differences were reported between sexes. 76.7% of NS with (+) current h/o NRL allergy were using NRL gloves at the time of starting school compared with 37.9% with (-) NRL allergy (p < 0.0001). 33.3% with (+) NRL allergy were using > 10 pairs/day, compared with 9.5% with (-) NRL allergy (p < 0.001). Only 23.3% of (+) NRL allergy group used no gloves compared with 62.1% of (-) N1LL allergy group (p < 0.0001). A high prevalence of self-reported allergy to NRJ., products was observed in beginning NS associated with high daily NRL glove contact.
The relationship between latex allergies, hydration and compromised barriers in s u r g i c a l g l o v e s . Thomnson R BS..Korniewicz D DNSc RN.Bennett J PhD.Kellv K MD.Murali pS PhD.Kurup V PhD.Fink J MD, Hartland WI, Washington DC, Houston "IX, and Milwaukee WI. The increasing incidence of contact and anaphylactic latex sensitivities in Healthcare workers has been attributed, in part, to the leaching of proteins and chemicals from surgical and exam gloves. Defects and voids created by leaching in interstitial matriticies of the latex membrane is replaced by hydration via capillary action with perspiration and bodily fluids end can be measured over time as a loss of electrical resistivity. This study was done to determine if hydrated latex would permit the passage of virus through the membrane.In a pilot study 6 brands of sterile surgical gloves were premeasured over a 60 minute period and sorted into high, medium and low hydration categories. Gloves were then suspended in a 2 liter beaker of surface tension adjusted, 37 ° C, sterile saline. 3 ml aliquot samples were collected outside the glove as controls. Bacteriophage OX174, a surrogate for H1V, in concentration of 10q was added to the inside of the suspended glove. Aliquots were obtained from outside the glove every 10 minutes. At 60 minutes a sterile 27 gauge needle pierced the glove. An aliquot recovered at 65 minutes was a positive control. Viral transmission, measured by plaque counting, detected virus in 4 of 12 gloves. In 1 rapidly hydrating glove brand both samples leaked virus as did 1 in the low and I in the high hydrating categories. Protein measurement by BCA confirmed increasing total protein with hydration. In conclusion surgical gloves, long assumed effective barriers against bloodborne pathogens, may not be as effective as originally thought and, further, improperly manufactured gloves may cause a serious threat to Healthcare workers and patients.
H L A i m m u n o g e n e t i c s a n d t h e s p e c i f i c l g E r e s p o n s e to Hevea latex antigens. HP Ribs Phi). Z Chen Phl). R Cremer MD #, H Allmers MD. X Baur MD, Bochum and fCologne, Germany. The aim of this study was to elucidate the role of HLA-D alleles in latex allergy. We investigated HLA-DRB1,3,4,5 and DQBI alleles on the short arm of chromosome 6 by the PCR-SSO typing technique. 80 health care workers (HCWs) and 84 spina bifida patients, who had been strongly exposed to latex, and 90 nonaffected blood donors (controls) were examined. 52 out of 80 latex-exposed HCWs showed positive anti-latex-lgE values with the PharmaciaCAP system or EAST (>0.35 kU/l). 42 out of 84 latex-exposed spina bifida patients were latex-positive. The statistical analysis (Chisquare test with Yates correction) of the typing results revealed an elevated DR4 frequency in latex-lgE-positive HCNVs when compared with latex-negative subjects (42% vs 29%; p f n . s . ) and with controls (42% vs 24%; p<0.05). Additionally, we observed a correlation between DR4 positivity and serum reactivity to the 4.7 kDa herein in 9 out of 10 sera tested for HLA and by EAST. In Hey b l-positive HCWs the frequencies of DR1 and DR4 were slightly elevated. Analysis in spina bifida patients revealed an increased frequency of DR1 (31%) when compared with latex-negative patients (24%) and controls (17%). in comparison with controls, Hey b 1-positive spirm bifida patients showed also an elevated DR1 frequency (33% vs 17%; 7tz=3.31). The distribution of DQB1 frequencies revealed no striking differences. These data indicate a slight correlation between c,ertain HLA-D alleles and latex.type I'sensitization.