727 Screening of latex allergy by skin prick test (SPT) i a general allergy practice

S246

Abstracts

J ALLERGY CLIN IMMUNOL JANUARY 2000

727 Screening

728

for Latex

Allergy

by Skin

Prick

Test (SPT)

in a Gen-

eral Allergy Practice DH Dreyjts. B Frase,: CC Randolph Waterbury Hospital, Yale School of Medicine, Waterbury, CT We determined the frequency of Skin Prick Test (SPT) reaction

available for IgE to latex. However, Hamilton et al. (1999) showed that based on latex allergy history, they vary in sensitivity and specificity. Moreover. EIA only indicate whether binding of patient serum IgE to latex antigens (“sensitization”) has occurred. not whether the

to a latex glove extract in a population of approximately 500 consecutive children and adults presenting to a general allergy practice in the Northeast United States. Approximately 70% of patients test-

IgE resulted specifically from exposure to latex or from common, cross-reacting allergens, or if it is clinically important. An atopic individual with latex exposure may have rhinoconjunctivitis, asthma or

ed were atopic and approximately 35% had a history or clinical diagnosis of asthma. SPT reagent was generated from Baxter Bodyguard surgical gloves and standardized by a RAST competition

dermatitis from IgE antibodies that cross-react with latex. Further, the predictive value of a positive test for latex-specific IgE decreases when latex allergy is not highly prevalent in the population tested.

assay at approximately 2000 AU courtesy of Dr. J. Yunginger (Mayo Clinic, Rochester, MN) as described previously (I). Few (less than 1%) of allergic individuals without either health care occupation or other significant latex exposure were sensitized to

During the past year allergy”, based on nurses, a third-year dresser, a radiology

latex as determined by SPT. No adverse events were related to screening. Individuals identified by SPT screening often had a history consistent with unsuspected latex exposure, such as the use of

cer, who was the only male, and ranged in age from 27 to 88 years. Some were reluctant to continue jobs or undergo dental or medical procedures that exposed them to latex, having been warned this could

latex gloves for household cleaning. Latex SPT screening using a standardized testing reagent and an unselected population presenting to a general allergy practice appears to be safe and useful. I. Randolph, CR and Fraser. B. (1996) Allergy and Asthma Proc.

be life-threatening. The technician had allergic rhinitis; the student had allergic rhinitis and mild asthma. and one of the nurses had possible mild asthma. The hairdresser and a second nurse reported urticaria from latex gloves. Only the student had a food (cashew)

l7:89-9

allergy; no patient had spina bitida. multiple surgeries or other risk factors for latex sensitivity. Anti-latex IgE measured by Alastat or Pharmacia CAP EIA was undetectable (co.35 IU/ml) in seven

I.

Parameters of Natural Rubber Latex (NRL) Sensitization Decrease in Health Care Workers (HCW) Following Reduction of NRL Exposure F Ruk$ P Schiipf; B Przyhilla Klinik und Poliklinik

fiir

Dermatologie

und Allergologie.

patients and borderline positive (0.49 IU/ml, Alastat Class l/VI) in the technician. Latex glove use testing was offered to each patient, provided vital signs and baseline spirometry (in the asthmatics) were

Ludwig-Maximilians-

Universitit, Munich. Germany The longterm course of manifest NRL allergy (NRLA) or of NRL sensitization (NRLS) is not yet clear. We assessed the course

normal, and all agreed to this procedure. We used a modification of the methods of Turjanmaa et al. (I 995) and Hamilton and Adkinson (1997). We tested one hand with a powderfree latex examination

of parameters of sensitization NRLA. In a first study period been identified by skin prick

in HCW with diagnosed NRLS or 81 HCW with NRLS or NRLA had tests (SPT) with various NRL test

glove and the other with a vinyl glove. First, we inserted the patient‘s index finger into the glove: if there was no reaction after I5 min. the entire glove was worn. If there was no reaction after I5 min, the dor-

solutions (conclusive reactions in 61. 75.3%) and/or by a finding of NRL-specific IgE antibodies (sIgE) in the serum by CAP-FEIA (2 class I in 57. 70.4%): by history and/or challenge tests with NRL

sum of the hand was lightly moistened with water beneath the glove, then a Dermapik was used to pierce the dorsum of each hand through the glove three times within an area of I square cm, then that area was

containing material 31/81 (38.3%) were found to have manifest NRLA. The follow-up investigation was performed after 13.9 f 3.6 months. All patients had avoided intense NRL contact (personal use of NRL-free or unpowdered NRL gloves). In addition. at the work-

massaged 50 times. The glove use test was negative for wheal and flare reactions in each patient. All resumed normal activities, and none have reported adverse reactions to latex. Our experience suggests that until a skin test reagent becomes availahle, latex glove use testing may be helpful when patients have ambiguous history and negative or insigniticant levels of latex-specific IgE.

place powdered NRL gloves had been gradually replaced by unpowdered gloves for all employees. A complete loss of SPT reactions to NRL was found in 8/6l HCW (I 3.1%). Among those with demonstrable sIgE to NRL at the first examination, at the follow-up sIgE had disappeared in 13/57 (22.8%). declined by at least one class in I9157 (33.3%). increased by one class in I157 (1.8%). and remained within the same class in 24157 (42.1%) decline or disappearance of sIgE was comparable NRLS or NRLA (19/34. 55.9% vs. 13/23. 56.5%). out SPT reaction or without sIgE to NRL at the first

(p
found not to react also at the follow-up. NRLA had been lost completely by l/38 HCW. None of those diagnosed to have NRLS at the first investigation was found to have manifest NRLA at the followup. Thus, parameters of NRLS had decreased in a substantial number of HCW after installing preventive measures. It remains to be seen whether in the further course of time also manifest NRLA will subside in a larger number of patients.

7%

eight patients presented to our clinic with “latex an ambiguous complaints. They included three medical student, a credit manager, a former hairtechncian and a patient with terminal colon can-

Latex Gew~m*t

Glove

Use Test to Diagnose *Rush

Medical

Center,

Latex Chicago

Allergy

A Se@~~e*t. A IL tCook County Hos-

pital, Chicago IL Allergist/immunologists may encounter patients who were misdiagnosed with immunoglobulin E (IgE)-mediated latex allergy without verification cially available

of the history. In the USA we do not have a commerskin test. but three enzyme immunoassays (EIA) are

730

Deproteinized Latex Allergic

Latex Condoms (DLC) Are Well Tolerated By Patients DA Lp\fv, P Moudiki, F Lqnadier H6pital

Tenon. Paris, France Deproteinized latex condoms Pontoise. France), which meet

(Manix Crystal& Degan, Cergyinternational norms for condoms,

have been marketed in France to be used by latex allergic patients (LAP) as a substitute for ?classical? natural rubber latex condoms (LC), but tolerance to DLC has not been studied. We recruited I9 LAP (I4 women, 5 men; 21 -60 yrs; I3 were health care workers;) who had previously had I or more immediate hypersensitivity reactions on contact with LC. All I9 reported having had genital pruritus, 8 genital edema, 4 non-genital urticaria, 4 rhinoconjunctivitis and I respiratory distress. Sixteen had used LC for contraception. Only 8 had discussed this problem with their physician. They consented to use IO DLC over a period of 6 weeks and to keep a record of any reactions associated with their use. All subjects had a positive (p-ive) SPT to a standardized latex extract (Stallergenes. Fresnes. France). Seventeen has a p-ive reaction to a puncture

ST through

an LC:

I had a p-ive

(5 mm wheal)