J ALLERGY CLIN IMMUNOL JANUARY 2000
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)
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
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
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
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
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.
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-
Use Test to Diagnose *Rush
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
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
I had a p-ive
(5 mm wheal)
J ALLERGY CLIN IMMUNOL VOLUME 104, NUMBER 1, PART 2
reaction to a puncture through an DLC. None reacted to a DLC placed on a finger for 15 minutes. No subject had an allergic reaction or any other adverse event associated with contact with the IO DLCs, although several did report having had an allergic reaction on contact with other latex objects, most often gloves, during the study period. We had previously reported (Levy et al.. Allergy 1998; 53: 1107) that 84% of a group of 94 latex allergic patients who had used LC had had an allergic reaction on contact with a condom. In comparison with that result, the present result indicates that DLC induce significantly fewer reactions than LC (x2=45; p
Is Allergic Contact Dermatitis From Natural Rubber Latex (NRL) Common? Thomas Fuchs, Sfephat~ Barrels. Ronald Arnold. Carsten Gurgesell Department of Dermatology, University of Goettingen. Germany BACKGROUND: NRL allergy usually presents as immediatetype hypersensitivity but it may be associated with chronic eczema and it has recently been suggested that NRL should be used as patch test allergen (I). However. experience in patch testing with NRL is limited. METHODS: Therefore. during a 5 year period, 2.233 consecutive patients seen in the department for suspected contact dermatitis were patch tested with an ammonia- and accelerator-free 2 and 4 % (protein content 63ng/ml) NRL prick test extract. Moreover, the rubber chemicals thiuram mix, zinc diethyl dithiocarbamate. mercaptobenzothiazole and N-Isopropyl-N’-phenyl-p-phenylendiamine were also patch tested. Tests were performed according to the recommendations of the ICDRG. RESULTS: The 2 % NRL extract produced no positive reaction in any of the patients tested. 0.75 Q of the patients showed questionnable (?) reactions to the 4% NRL extract. Only one patient had a single positive reaction (+) eclusively in the day 3-reading. In none of these cases, a clinical relevance of the reaction could be observed. In contrast to this, 2.6 % of the patients exhibited positive reactions to at least one of the rubber chemicals. CONCLUSIONS: We conclude that in contrast to the relatively frequent immediate type hypersensitivity to NRL, allergic patch test reactions to NRL are uncommon. Our data confirm the results of a smaller study (2). (I) Wilkinson SM & Beck MH. Br J Dermatol 1996;134:91014. (2) Wakelin SH et al. Contact Dermatitis 1999;40:89-93.
Contact Leukoderma From Industrial and Surgical Rubber Gloves JS Taylor MJ Norris, P Evey Cleveland Clinic Foundation, Cleveland, OH Cutaneous depigmenting chemicals are usually derived from phenol or catechol and contact dermatitis is not always a prerequisite for pigment loss to occut. We report a hospital housekeeper who developed contact leukoderrna of the hands and wrists associated
with rubber glove usagage. Patch testing was performed with the North American Contact Dermatitis Group standard tray, rubber chemicals, and the patient’s work gloves. Positive patch tests occurred at the sites of the Best rubber industrial glove and Perry orthopedic surgeon’s glove and depigmentation was noted at both sites eight weeks later. No positive reactions or pigment loss occurred at the sites of the vinyl gloves, Travenol latex examination glove, or standard tray or rubber chemicals. Topical photochemotherapy with 8-methoxypsoralen and ultraviolet A (PUVA) resulted in almost compete repigmentation after 4.5 months of therapy. The patient had no personal or family history of idiopathic vitiligo and no thyroid or anti-nuclear antibodies were detected. He had no exposure to other known depigmenting chemicals at work or at home. The specific depigmenting chemical was not identified. This is one of very few recent reports of chemical leukoderma from industrial and surgical rubber gloves. 733
The Effects of Intranasal Challenge With MCP-3 and Eotaxin in Human Subjects P Gorski*, U Rutaf. T Wirrczakf, P Kuna*, M Turkowskit, R A/am# *University of Medicine, Lodz, Poland tInstitute of Occupational Medicine, Lodz, Poland *University of Texas, Calvestone. TX, USA Chemokines (CHEMOtactic cytoKINES) are a group of small molecular weight (8-10 kD) compounds which are essential for the directional migration of leukocytes during normal and inflammatory processes. Chemokines belonging to CC family which include RANTES. eotaxin, and MCP-3 induce chemotaxis, and cell signaling of eosinophils. release of histamine from basophils and mast cells. Most of these activities were confirmed in in vitro and in in vivo (animal models) conditions. Although the presence of CC chemokines in body fluids of humans had been previously shown their role have not been explained yet. To provide information about activity of these chemokines in humans we have utilized well described procedure of nasal pool lavage. Allergic volunteers were pretreated intmnasaly with specific allergen and 48 hours later challenged with MCP-3 or eotaxin. At different time points after the challenge the nasal lavage was tested for the number of eosinophils and metachromatic cells, concentration of ECP, mast cell tryptase, and the albumin. Clinical observations have shown that challenge with 1 or 5 mg of eotaxin or MCP-3 induced symptoms of allergic rhinitis. All subjects of the eotaxin challenged group regardless of the dose used for challenge complained from headache and skin itching. One patient developed skin rush. All symptoms appeared IO-20 minutes after the challenge and lasted for less then 48 hours. In MCP-3 challenged group symptoms showed several minutes after the challenge and were gone 6 hours later. Analyses of cellular influx into the nasal mucosa after the challenge with eotaxin showed significant increase in the number eosinophils in 4th and 24th hr of the challenge. Interestingly the number of basophils increased significantly at all time points and in all concentrations of eotaxin used. MCP-3 challenge induced significant influx of eosinophils only at 10 mg dose and in 30th minute. Analyses of cellular mediators influx into nasal mucosa showed significant increase in concentration of ECP in the 24th hr of the challenge with eotaxin at 1 mg and at 5 mg dose. At the same time there was also increase in albumin levels. None of these changes were observed after the MCP-3 challenge. In conclusion, our results confirm a significant role of eotaxin to recruit eosinophils to the site of allergic inflammation and support the role for this chemokine in the patbogenesis of allergic rhinitis. The role of MCP-3 seems to be of lower significance but the number of studies and examined parameters do not definitely exclude this chemokine as an important mediator of inflammation.