Comparing the enzyme allergosorbens and coated allergen particle tests for latex allergy: which in vitro test should be chosen by an anesthesiologist?

To determine sensitivity and specificity of the enzyme allergosorbens test (EAST) and the coated allergen particle Test (CAP) in detecting specific antibodies against latex, we compared these two methods in a previously investigated sample of an epidemiological study among our anesthesia staff. One hundred one blood samples were tested with EAST and CAP for specific antibodies against latex. Skin test results were used as references. CAP was more sensitive in detecting sensitized individuals than EAST (56% vs 18.8%). Two additional persons with previously negative skin tests were detected. These results suggest that the EAST system is not as sensitive as the CAP system. Therefore, the CAP system should be preferred for the in vitro diagnosis of latex allergy. IMPLICATIONS: Testing for latex allergy requires time-consuming and technically difficult tests. Easy to perform in vitro tests for latex allergy are desirable. Our results indicate that the coated allergen particle test is more sensitive and easy to use than the enzyme allergosorbens test.     

In vivo and vitro in diagnosis of latex allergy at Groote Schuur Hospital

OBJECTIVE: The aim of this study was to evaluate the diagnostic utility of skin-prick tests, radio-allergosorbent tests (CAP RASTs), basophil histamine release, sulphidoleukotriene release and Western blotting in the diagnosis of latex allergy at Groote Schuur Hospital. DESIGN: Patients with a history suggesting latex hypersensitivity were recruited via staff health and allergy clinics at Groote Schuur Hospital. A clinical assessment was followed by laboratory investigation and skin-prick testing. A control group consisted of laboratory and hospital staff who had regular latex exposure but were asymptomatic. SETTING: Hospital-based cohort at Groote Schuur Hospital. PARTICIPANTS: Twenty-three patients with suspected latex allergy; 10 control subjects exposed to, but not clinically sensitive to, latex. MAIN OUTCOME: Skin-prick testing was more sensitive than in vitro diagnostic tests for the diagnosis of latex allergy. RESULTS: Eighteen of 21 (85.7%) of the patients tested had a positive skin-prick test with a commercial latex solution (Allerbioprick) and 17/21 (80%) tested skin-prick-positive with an in-house glove extract. CAP RASTs were positive in 13/23 patients (56.5%), sulphidoleukotriene release was positive in 10/23 (43%), histamine release assay was positive in 10/23 (45%) and Western blots were positive in 8/23 (34.7%). All patients with only urticaria were Western blot-negative and CAP RAST-negative, suggesting that they have very little circulating latex-specific IgE. Although patients who were Western blot-positive tended to have multi-organ involvement, both patients with anaphylaxis were Western blot-negative. CONCLUSION: Latex allergy is a significant clinical problem at Groote Schuur Hospital. Titrated skin-prick testing performed in a controlled environment can safely and reliably confirm the diagnosis in patients who do not give a history of anaphylaxis. The CAP RAST was the most sensitive in vitro test for latex allergy locally available, but lacks sensitivity in patients presenting with urticaria only.     

The role of glycosylation in autoimmune disease

Lack of knowledge concerning latex allergy may lead to a life-threatening adverse reaction to natural rubber latex. Registered nurses need a latex allergy knowledge base to provide latex-safe health care to clients and to create a latex-safe environment. This research explored the current knowledge base of registered nurses as related to (1) the care of clients at risk for latex allergy, or diagnosed with latex allergy, and (2) the provision of a latex-safe environment for all populations. This article describes this research and its implications for nurses. A copy of the Latex Allergy Knowledge Base Self-Assessment Questionnaire is included at the conclusion of the article.     

Latex anaphylaxis

The authors present two case-reports of Latex Anaphylaxis--a rare but dangerous manifestation of latex allergy--, one in a patient belonging to a risk group and the other in a patient without previously identified risk factors. A review of latex allergy, and particularly of latex anaphylaxis, is made focusing on risk groups, aetiology, diagnosis, prevention and therapy. This paper also intends to draw attention to this health problem and stress the fact that it raises several medical and non-medical issues, requiring a multidisciplinary approach and discussion.     

Type I allergies to latex and the aeroallergenic problem

Between 1989 and 1995, a 12-fold increase in latex allergy was documented amongst our patients. Similar findings have been noted elsewhere. Increase in type I allergies to latex has become an international problem. The issues associated with latex allergy are described, including those posed by the ubiquitous nature of latex in medical equipment, and in commonplace domestic objects. The potential for allergic patients to cross react to a variety of fruits or plants is an added problem for sensitized patients. This paper concludes that the universal introduction of powder-free surgical gloves with low protein content would be a very important measure in the prevention of acquired latex allergy.     

Clinical management of latex-allergic children

Latex allergy in children with myelodysplasia and urological anomalies is well recognized. We anesthetized 162 children with latex allergy who underwent 267 anesthetics according to a latex-safe protocol. Medication for allergy prophylaxis was not administered. Our patients were 11.6 +/- 5.8 yr old (range 1-31 yr). Primary diagnoses were myelodysplasia, extrophy of the bladder, and cloacal extrophy. These children had many allergies to medications and foods as well as environmental sensitivities. One patient of 162 (1 procedure of 267) had an allergic reaction after injection of an epidural catheter with bupivacaine and fentanyl. No other patient manifested allergy signs or symptoms. Latex-allergic children can be safely anesthetized using a latex-safe protocol without allergy chemoprophylaxis. These patients require avoidance of latex products or the use of latex products that have been thoroughly washed. IMPLICATIONS: This audit of the medical histories and treatment of 162 children with latex allergy who underwent 267 anesthetics indicates that latex-allergic children can be safely anesthetized if exposure to latex in the medical environment is avoided, and that administration of prophylactic medications to decrease the allergic response is unnecessary.     

Issues and answers in latex sensitivity

Latex sensitivity is a problem for many healthcare professionals. Latex is found in numerous items that a healthcare professional uses on a daily basis, including gloves, tapes, bandages, and catheters. Latex sensitivity can appear as a mild, localized contact reaction, or, in extreme cases, have more sever, systemic effects. Latex not only has the potential to affect a healthcare professional's career, but it can also adversely affect the healthcare professional's life. Several agencies have responded to the increased prevalence of latex-related illnesses, including the Food and Drug Administration and the Centers for Disease Control and Prevention. Lack of a national database and l lack of a government policy mandating the labeling of latex-containing products are just some of the problems that hinder latex research. While there are many unanswered questions regarding latex sensitivity, there are several steps that a healthcare professional can take to protect himself or herself from latex. These include: proper documentation and treatment, preventive measures such as wearing a medical alert tag or bracelet, finding and using latex alternatives in the workplace, and setting up official latex policies within their facilities.     

Latex allergy in health services workers

The studies were performed in 20 workers from the Health Service (13 women and 7 men in the age 25-57) suffering from hand urticaria (6 persons) and hand dermatitis (14 persons) suspected of the allergy to latex gloves. In all patients the familial and personal predispositions to allergy were evaluated by the anamnesis, the estimation of total IgE serum level and the skin prick tests (SPT) with inhalant allergens. The latex allergy was diagnosed by SPT and contact test with standardized extract of the natural latex allergen in the concentration 1000 PNU/ml (Nexter-Allergopharma) and by estimation of specific to latex IgE serum level. In addition to this, contact tests with glove's material as well European standard contact allergens (Hermal) were done and the one with antiseptic substances to which the patient was exposed at his work. The allergy type I to latex gloves was confirmed in all 6 cases with contact urticaria. The SPT with standard extract of the natural latex was more valuable than latex specific IgE in the serum. Contact allergy (type IV) to latex gloves was confirmed in 10 from 14 suspected cases. In the next 4 the allergy to antiseptic substances was the reasons of the illness. The allergy to latex gloves appears more often in women. No case showed the familial predisposition to allergy and only 4 patients additionally suffered from the allergy to pollen and mites. Moreover in both groups of patients we showed the presence of the additional contact allergy to different allergens (to metals and antiseptic substances).     

Understanding latex allergy

Latex allergy is an increasingly important problem in both health-care workers and patients. Predisposing factors to development of latex allergies include a history of atopy or allergy and frequent exposure to latex products. Identified allergens include latex proteins from the rubber tree that remain in manufactured products, as well as smaller molecules that remain from the latex purification and manufacturing process. Latex proteins absorbed to powder in latex surgical and examination gloves may be aerosolized and inhaled. Powder-absorbed latex proteins are thought to be important in triggering of sensitization in susceptible individuals, as well as in elicitation of symptoms in previously sensitized patients. Allergic reactions to latex can include local dermal reactions or generalized immediate hypersensitivity (anaphylactic) reactions. Pathophysiology, signs and symptoms, and treatment of each type of reaction are discussed. Measures to address latex allergy, however, must include measures to decrease exposure to latex antigens both in latex-allergic subjects, to prevent symptoms, and in naive subjects, to prevent sensitization. These measures may include finding, acceptable substitutes for latex in many products.     

The blood coagulation aspects of acute infectious myocarditis]

With the increase in infectious disease epidemics and the need to protect health-care workers, the use of rubber gloves has increased twofold. Recent reports have noted an increase also in the prevalence of natural rubber latex allergy among some of these workers. A newly emerging problem, the allergy has potentially life-threatening consequences for those affected, a fact which has far-reaching ramifications for all those working in contact with latex, critical care nurses in particular. Indeed, the allergy has had a major impact on one such nurse, to the extent that she has had to relinquish her career and make significant changes to her lifestyle. Latex allergy was first recognised in 1927 but has become more prevalent in the last few years. There are two types of reactions, type I and type IV, with symptoms varying from a mild itch to anaphylaxis. Diagnosis is made via a blood or skin test, as well as a patient history. Treatment is to medicate for symptoms, while avoidance is the only way to prevent occurrences. The case study which follows reveals the impact that this allergy can have on a critical care nurse.     

Bacterial vaginosis

This article discusses the potential problem of latex allergy in the school, particularly among students with spina bifida. The origin of the problem, its symptoms, and prevention and management of latex allergy in the school environment are described. The individual roles of school administrator, school nurse, parent, student and other service providers are listed within an Individual Healthcare Plan (IHP). The IHP is proposed as a guide to schools to assist with identification of latex allergy reactions as well as response procedures if an allergic reaction is identified.     

Clinical pharmacokinetics: the basis of laboratory monitoring of drugs (lecture)

The purpose of this article is to educate the dental hygienist about the seriousness of latex allergy and provide background information necessary for treating the latex allergic patient, including basic information on immunology, hypersensitivity reactions, latex, and natural rubber latex. Symptoms of latex allergy, types of reactions, and methods of exposure are discussed. Methods for achieving a minimal latex environment are presented, along with information to treat the patient with latex allergy, which can affect health, career, future, and lifestyle. Because the number of latex-allergic individuals increases daily, a thorough understanding of its diagnosis and implications is necessary for all oral health care workers.     

Rubber latex allergy and the endodontic patient

Increasingly, patients with rubber latex allergy are being seen in dental offices. Health care workers, persons allergic to certain foods and those with certain medical histories are potentially latex-sensitive. This article presents the case of a patient with a history of severe rubber latex allergy and the associated management of an endodontically involved tooth. The possibility of the latex allergic patient being sensitive to gutta-percha obturation material is also raised.     

Characteristics of the dysarthria of multiple system atrophy

Allergy to latex has become an increasing and clinically important problem during last years. Natural rubber latex (NRL) allergy has been acknowledged as a major occupation problem among health-care workers. More recently, NRL allergy also occurs in children with spina bifida and in atopic children. Even patients allergic to various fruits, such as banana and avocado may experience allergic reaction from NRL and vice versa. Different latex allergens have been characterized at the molecular level using varied techniques and heterogeneous latex materials. Little is known about prevalence and clinical relevance of latex sensitization and allergy in the general population although the incidence is increasing in children. The wide spectrum of symptoms of NRL allergy range from mild contact urticaria to asthma and anaphylactic reactions. History is an integral part to identify latex allergy. Different tests (skin prick tests, RAST, Pricking, Use test) have been used to objectively supplement the history. Latex allergy must be prevented by the standardization of medical gloves including the labeling of latex content and allergenicity; furthermore the industrial strategies may also develop new methods of less allergenic gloves and other NRL products.     

Up- and down-regulation of calpain inhibitor polypeptide, calpastatin, in postischemic hippocampus

A dental student developed swelling of the lips and peri-oral urticaria, immediately after placement of a dental rubber dam during a chairside demonstration of clinical dentistry. A provisional diagnosis of a Type I hypersensitivity reaction to natural rubber latex was made and an appointment organised for specialist investigations. The student reported an atopic history and allergy to peanuts. A Radioallergosorbent Test (RAST), to measure Ig-E antibodies to latex, was positive. The dental student was given advice concerning the avoidance of natural rubber latex. Dental staff must be aware of potentially serious reactions to natural rubber latex in the dental surgery.     

Effects of clozapine and haloperidol on baseline levels of vacuous jaw movements in aged rats

BACKGROUND: IgE-mediated hypersensitivity to latex proteins has become a significant clinical problem over the last decade. Nursing and medical staff are at risk because of their occupational exposure to latex. AIMS: To determine the prevalence of type I hypersensitivity to latex allergens in the nursing staff of an Australian hospital. METHODS: A questionnaire which asked about symptoms associated with the use of latex gloves was completed by 140 nurses working in the Alfred Hospital (72 in general medical wards, 68 in intensive care units). Skin prick tests with eluates of five different types of latex glove as well as common aeroallergens (rye pollen and house dust mite) and banana extract were performed. RESULTS: Thirty-one nurses (22%) were skin prick test positive to at least one of the five latex glove eluates. All of these nurses were atopic, having positive skin prick tests to rye pollen or house dust mite. Symptoms of local dryness, itch and erythema associated with glove use were reported by more than half the study group, but not more frequently by those who were skin prick test positive to latex. Urticaria associated with glove use was reported more frequently by those with positive latex skin prick tests (13% vs 4%, p = 0.05). Eighty-seven per cent of the nurses who were latex skin test positive were also positive to banana extract. CONCLUSIONS: IgE-mediated hypersensitivity to latex is common in nurses working in an Australian hospital. Glove associated symptoms were frequently reported, but in most cases the symptoms were more typical of irritant or contact dermatitis rather than type I hypersensitivity reactions. However, the extent of subclinical sensitisation to latex found in this study suggests that symptomatic latex allergy is likely to emerge as an increasing problem for nursing staff in this country.     

Diagnosis of natural rubber latex allergy: multicenter latex skin testing efficacy study. Multicenter Latex Skin Testing Study Task Force

BACKGROUND: No characterized diagnostic natural rubber latex skin testing material is licensed for use in the United States. OBJECTIVE: We have conducted a multicenter clinical skin testing study to document the safety and diagnostic sensitivity and specificity of a candidate Hevea brasiliensis nonammoniated latex (NAL) extract. These data are intended to support the licensing of this reagent for the diagnosis of latex allergy in high-risk populations. METHODS: Three hundred twenty-four subjects (304 adults and 20 children) were classified by their clinical history as having latex allergy (LA group, 124 adults and 10 children) or having no latex allergy (NLA group, 180 adults and 10 children). All subjects provided blood samples and then received sequential puncture skin tests (PSTs) at 1, 100, or 1000 microg/mL protein with a bifurcated needle and NAL (Greer Laboratories) from Malaysian Hevea brasiliensis (clone 600) sap. A 2-stage glove provocation test was used to clarify latex allergy status of individuals with positive history/negative PST result and negative history/positive PST result mismatches. RESULTS: Twenty-four subjects (15%) originally designated as having LA on the basis of their initial clinical history were reclassified to the NLA group on the basis of a negative glove provocation test result. Of the 134 subjects with LA, 54 (40%) were highly sensitive to latex, with a positive PST result at 1 microg/mL NAL. The Greer NAL reagent produced a positive PST rate (sensitivity) of 95% and 99% in subjects with LA at 100 microg/mL and 1 mg/mL, respectively. The negative PST rate (specificity) in 190 subjects with a negative history with the NAL extract at 100 microg/mL and 1 mg/mL, was 100% and 96%, respectively. Immediately after the PST, mild systemic reactions (mainly pruritus) were recorded in 16.1 % of the adults in the LA group and 4.4% of the adults in the NLA group. No reactions required treatment with epinephrine. Only mild delayed reactions were observed in 9.6% (LA group) and 2.8% (NLA group) of subjects 24 to 48 hours after PST. Mean wheal and erythema diameters measured in the 10 children in the LA group with spina bifida at 100 microg/mL and 1 mg/mL were similar to those observed in the adults in the LA group, suggesting that children are not at increased risk for systemic reactions compared with adults. CONCLUSIONS: A suggestive clinical history is necessary but not sufficient for a definitive diagnosis of IgE-dependent latex allergy. These data support the safety and diagnostic efficacy of the Greer NAL, skin test reagent at 100 micro/mL and 1 mg/mL for confirmatory PSTs.     

Latex allergies and adverse reactions: a review of the literature

In the last few years, the allergenic potential of latex has been receiving greater attention. While latex allergies have been widely reported in the literature, the prevalence and severity have rapidly increased in the last few years. The role of rubber in the prevention of HIV infection has played a part in recognizing the allergenic potential, as with increased emphasis on infection control in the dental office has come an increase in complaints of adverse reactions to surgical gloves. A review of the literature reveals latex allergy problems to be not confined to gloves, but to articles of clothing, rubber dam material, and other latex-containing materials. Life-threatening cases have been reported. Little information in the literature concerns the extent of the problem among dental personnel. The dental professional may be faced with not only discomfort for the dental staff, but also compromising reactive possibilities in certain patients. There is a need for development of alternative protective products for the dental office, since elimination of barrier protection is not a viable alternative to infection control.     

Protein affinity map of chemical space

Natural latex from the rubber tree Hevea brasiliensis is an allergen in persons with significant cumulative latex exposure, such as those in the health care and rubber industries, as well as those undergoing repeated surgeries, especially if they undergo surgeries early in life. Symptoms of latex allergy may progress rapidly and unpredictably to anaphylaxis. The prevalence of latex allergy has increased as the use of rubber gloves in health care settings has increased. Airborne latex particles that adhere to the cornstarch used to powder gloves are a significant cause of respiratory symptoms and a source of sensitization. Once an individual has become sensitized, he or she may experience allergic symptoms when exposed to any product containing latex. Diagnosis is made initially by the history. Latex-specific IgE testing and skin prick testing may confirm the suspicion. The most effective strategy in the treatment of latex allergy is avoidance; however, there is a large group of sensitized people who have not been identified and who do not recognize that their symptoms are caused by latex allergy. Physicians caring for latex-sensitive persons must act as their advocates in building awareness of the problem and developing protocols for their safe care. Latex-sensitized persons should be educated about the latex content of common objects.     

Latex allergy: a relevant issue in the general pediatric population

Although latex allergy is a widely recognized problem of the pediatric myelomeningocele population and of frequent users of latex products, it is often overlooked in the general pediatric population. The prevalence of latex in common household items and in medical environments increases one's exposure and thus one's possibility of sensitization to latex. Latex allergy may range from mild local reactions such as erythema to more severe systemic reactions such as asthma or anaphylaxis. The immunoglobulin E-mediated mechanism of these reactions has been confirmed serologically by the presence of latex-specific immunoglobulin E with radioallergosorbent testing. Because avoidance of latex is currently the only way to prevent reactions, the identification of household items that contain latex is extremely important. However, because inadvertent exposure to latex is not uncommon, Medic-Alert bracelets and an Epi-Pen should be provided for children allergic to latex. Pediatric nurses should consider latex allergy as a possible diagnosis in situations of unexplained allergic or anaphylactic reactions and should be aware of optimal therapeutic interventions.