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Aksoy H, Akdeniz N, Karakurt F. Prevalence of Type I Allergy to Latex and Type IV Allergy to Rubber Additives in Turkish Healthcare Workers. Dermatol Pract Concept 2023; 13:e2023187. [PMID: 37557117 PMCID: PMC10412029 DOI: 10.5826/dpc.1303a187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Glove-induced dermatoses are frequently seen among healthcare workers (HCWs) and are often mistakenly defined as latex allergy. OBJECTIVES To determine the prevalences of (i) the symptoms of immediate type hypersensitivity reactions, (ii) the symptoms of hand eczema, (iii) latex sensitization detected using skin prick test (SPT), and (iv) contact hypersensitivity to rubber additives or glove pieces detected using patch test, in Turkish HCWs. METHODS Ninety-eight HCWs were included in the study. All subjects completed a questionnaire. All participants were skin prick tested for latex, and foods previously identified as concomitant allergens in latex-sensitive individuals; patch tested for 7 rubber additives, 3 additional haptens, and glove pieces. RESULTS The mean age was 32.1 (± 9.4) years, and 71 (72.4%) participants were nurses. Eighty-four (85.7%) subjects had a history of mucocutaneous symptoms of immediate-type hypersensitivity occurring within the first 24 hours after latex glove contact, while 9 (9.2%) subjects demonstrated SPT positivity for latex. Eighty (81.6%) subjects had a history of glove-induced hand eczema symptoms, while patch test positivity for the rubber additives or glove pieces was in 17.3%. CONCLUSIONS About one-tenth of those with a history of glove-induced type I hypersensitivity symptoms had true latex allergy, and one-quarter of those with a history of glove-related hand eczema symptoms had contact hypersensitivity to glove products. Therefore, rote avoidance of latex use is generally ineffective in the management of glove-related skin complaints. Individual measures should focus on reducing the use of soaps and disinfectants, and promoting the use of moisturizers, rather than glove choice.
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Affiliation(s)
- Hasan Aksoy
- Dermatologist; Department of Dermatology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Uskudar University Faculty of Medicine, Memorial Atasehir Hospital, İstanbul, Turkey
| | - Fatma Karakurt
- Department of Dermatology, Istanbul Medeniyet University Prof. Dr. Suleyman Yalcin City Hospital, İstanbul, Turkey
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Guayule Natural Rubber Latex and Bi2O3 Films for X-ray Attenuating Medical Gloves. MATERIALS 2022; 15:ma15031184. [PMID: 35161128 PMCID: PMC8839583 DOI: 10.3390/ma15031184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 11/30/2022]
Abstract
Existing natural latex radiation-attenuating gloves (RAGs) contain a high loading of radiation attenuation filler that reduces their mechanical properties to below Food and Drug Administration (FDA) medical glove requirements. RAGs are commonly formulated using Hevea natural rubber latex and lead-based fillers. The former can cause life-threatening allergic responses and the latter are known for their toxicity. In this work, a new lead-free RAG formulation based on circumallergenic guayule natural rubber latex (GNRL) and non-toxic radiation attenuation filler bismuth trioxide (Bi2O3) was developed. GNRL films with Bi2O3 loadings ranging from 0 to 300 PHR at different thicknesses were prepared. Radiation attenuation efficiencies (AE) at 60, 80, 100, and 120 kVp were determined and attenuation isocontour curves predicted film thickness and Bi2O3 loading required to meet or exceed the radiation attenuation requirements of ASTM D7866 and commercial RAGs. Optimal curing conditions for GNRL/Bi2O3 films with 150 PHR Bi2O3 were investigated by varying curing temperatures and time from 87 °C to 96 °C and 65 min to 90 min, respectively. In general, as the loading of the filler increased, the density of the films increased while the thickness decreased. GNRL/Bi2O3 films with 150 PHR Bi2O3 and 0.27 mm provided 5% more AE than RAG market average attenuation at the same thickness. The films with 150 PHR Bi2O3 cured under near-optimal conditions (90 °C/85 min, and 87 °C/65 min) met both the radiation attenuation standard (ASTM D7866) and the natural latex surgeon and examination glove standards (ASTM D3577 and D3578, respectively). Thus, gloves made using our formulations and protocols demonstrated potential to meet and surpass medical natural latex glove standards, offer a single product for both infection control and radiation protection instead of double-gloving, provide a greater degree of comfort to the user, and simultaneously reduce contact reactions and eliminate potential latex allergic reaction.
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Henry N, Icot R, Jeffery S. The benefits of latex-free gloves in the operating room environment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:570-576. [PMID: 32463756 DOI: 10.12968/bjon.2020.29.10.570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.
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Affiliation(s)
- Nader Henry
- Plastic Surgery Trainee, The Queen Elizabeth Hospital, Birmingham
| | - Romelyn Icot
- Scrub Nurse, University College London Hospitals, NHS Foundation Trust
| | - Steve Jeffery
- Consultant Burns and Plastic Surgeon, University Hospitals Birmingham, NHS Foundation Trust
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Tarlo SM, Arif AA, Delclos GL, Henneberger P, Patel J. Opportunities and obstacles in translating evidence to policy in occupational asthma. Ann Epidemiol 2018; 28:392-400. [PMID: 28434545 PMCID: PMC5953844 DOI: 10.1016/j.annepidem.2017.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. METHODS In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. RESULTS AND CONCLUSIONS Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices.
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Affiliation(s)
- Susan M Tarlo
- Department of Medicine, University Health Network, University of Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada; Department of Public Health Sciences, University of Toronto, Ontario, Canada.
| | - Ahmed A Arif
- UNC Charlotte, Department of Public Health Sciences, Charlotte, NC
| | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
| | | | - Jenil Patel
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston
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Wang YX, Xue DT, Liu M, Zhou ZM, Shang J. A novel arctigenin-containing latex glove prevents latex allergy by inhibiting type I/IV allergic reactions. Chin J Nat Med 2016; 14:185-95. [PMID: 27025365 DOI: 10.1016/s1875-5364(16)30015-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 10/22/2022]
Abstract
The present study aimed at developing a natural compound with anti-allergic effect and stability under latex glove manufacturing conditions and investigating whether its anti-allergic effect is maintained after its addition into the latex. The effects of nine natural compounds on growth of the RBL-2H3 cells and mouse primary spleen lymphocytes were determined using MTT assay. The compounds included glycyrrhizin, osthole, tetrandrine, tea polyphenol, catechin, arctigenin, oleanolic acid, baicalin and oxymatrine. An ELISA assay was used for the in vitro anti-type I/IV allergy screening; in this process β-hexosaminidase, histamine, and IL-4 released from RBL-2H3 cell lines and IFN-γ and IL-2 released from mouse primary spleen lymphocytes were taken as screening indices. The physical stability of eight natural compounds and the dissolubility of arctigenin, selected based on the in vitro pharnacodynamaic screening and the stability evaluation, were detected by HPLC. The in vivo pharmacodynamic confirmation of arctigenin and final latex product was evaluated with a passive cutaneous anaphylaxis (PCA) model and an allergen-specific skin response model. Nine natural compounds showed minor growth inhibition on RBL-2H3 cells and mouse primary spleen lymphocytes. Baicalin and arctigenin had the best anti-type I and IV allergic effects among the natural compounds based on the in vitro pharmacodynamic screening. Arctigenin and catechin had the best physical stability under different manufacturing conditions. Arctigenin was the selected for further evaluation and proven to have anti-type I and IV allergic effects in vivo in a dose-dependent manner. The final product of the arctigenin-containing latex glove had anti-type I and IV allergic effects in vivo which were mainly attributed to arctigenin as proved from the dissolubility results. Arctigenin showed anti-type I and IV allergic effects in vitro and in vivo, with a good stability under latex glove manufacturing conditions, and a persistent anti-allergic effect after being added into the latex to prevent latex allergy.
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Affiliation(s)
- Yong-Xin Wang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China
| | - Dan-Ting Xue
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China
| | - Meng Liu
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China
| | - Zheng-Min Zhou
- Jiangsu Guotai International Group Cooperation, Zhangjiagang 215600, China
| | - Jing Shang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing 210009, China; Qinghai Key Laboratory of Tibetan Medicine Pharmacology and Safety Evaluation, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining 810008, China; Jiangsu Key Laboratory of TCM Evaluation and Translational Research, China Pharmaceutical University, Nanjing 210009, China.
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Köse S, Mandiracioğlu A, Tatar B, Gül S, Erdem M. Prevalence of latex allergy among healthcare workers in Izmir (Turkey). Cent Eur J Public Health 2015; 22:262-5. [PMID: 25622485 DOI: 10.21101/cejph.a3912] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to determine prevalence of natural rubber latex (NRL) allergy among healthcare employees and identify sensitive individuals. A total of 1,115 healthcare workers (HCWs) employed in Izmir Tepecik Education and Research Hospital participated in the study. Information on age, gender, occupation, history of allergy, and complaints were collected through a questionnaire. Serum latex-specific IgE level was determined. Among HCWs enrolled in the study, prevalence of latex sensitization was determined as 4.2%. More frequent occurrence of latex allergy was detected among nurses. Family history of allergy and history of personal food allergy were significantly more often noted among individuals with latex allergy. Latex is considered to be the leading source of occupational health problems.
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Supapvanich C, Povey AC, de Vocht F. Respiratory and dermal symptoms in Thai nurses using latex products. Occup Med (Lond) 2013; 63:425-8. [PMID: 23749805 DOI: 10.1093/occmed/kqt068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite known health risks related to the use of powdered latex gloves (PLGs), they are still widely used in hospitals in developing countries due to the high cost of alternatives. AIMS To determine the prevalence of dermal and respiratory symptoms associated with latex glove use in nurses in Thailand and evaluate the influence of previously reported occupational risk factors in this population. METHODS A cross-sectional study in female nurses working in three Thai hospitals. Participants completed a questionnaire on demographics, occupational and personal history, use of latex products at work and dermal and respiratory symptoms attributed to occupational use of latex gloves. RESULTS Of 899 nurses, 18% reported health effects attributed to the use of latex products. After adjustment for confounding, occupational risk factors associated with increased reporting of dermal symptoms included wearing more than 15 pairs of PLG per day (odds ratio (OR): 2.10, 95% confidence interval (CI): [1.32-3.34]), using chlorhexidine (OR: 2.07, 95% CI: [1.22-3.52]) and being an operating theatre nurse (OR: 2.46, 95% CI: [1.47-4.12]). Being a labour ward nurse (OR: 3.52, 95% CI: [1.26-9.85]) was the only factor associated with increased reporting of respiratory symptoms. CONCLUSIONS Continuing use of PLGs in Thai nurses is associated with increased prevalence of dermal symptoms compared with data from developed countries. Measures to reduce such health effects are well established and should be considered. Additionally, replacement of chlorhexidine with an alternative detergent seems advisable.
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Affiliation(s)
- C Supapvanich
- Department of Public Health, Sirindhorn College of Public Health, Yala, Thailand
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Kose S, Tatar B, Atalay S, Erden M, Tatar E. Latex-related allergy in hemodialysis patients. Ren Fail 2013; 35:888-90. [DOI: 10.3109/0886022x.2013.794677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Wang ML, Kelly KJ, Klancnik M, Petsonk EL. Self-reported hand symptoms: a role in monitoring health care workers for latex sensitization? Ann Allergy Asthma Immunol 2012; 109:314-8. [PMID: 23062385 DOI: 10.1016/j.anai.2012.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/09/2012] [Accepted: 08/16/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND The use of powdered natural rubber latex (NRL) gloves increased greatly in the 1980s because of concerns about transmission of blood-borne infections and the subsequent implementation of universal precautions. The most common clinical reactions to glove use are irritant and T-cell-mediated contact dermatitis. However, IgE-mediated immediate reactions to latex have become a serious concern for health care workers (HCWs). The diagnosis of latex allergy requires a comprehensive medical history and diagnostic tests. The skin prick test is the preferred diagnostic method, although it can be time-consuming. OBJECTIVE To determine the role of hand symptoms reported on questionnaires in monitoring HCWs for latex sensitization. METHODS Questionnaires were completed by 804 HCWs at 2 hospitals. Using a positive skin prick test (SPT) result as a criterion standard of latex sensitization, the diagnostic performance of hand symptoms was evaluated. RESULTS Increasing latex glove use was strongly related to increasing reports of hand symptoms. Hand symptoms were highly associated with glove-related respiratory and systemic symptoms. A positive SPT result was seen in 5% of HCWs and increased with the number of hand symptoms: 0 (1.6%), 1 to 2 (3.4%), and 3 to 7 (19.0%). Participants reporting more than 2 hand symptoms were 11 times more likely to have positive SPT results compared with those with 2 or fewer hand symptoms. CONCLUSION Hand symptoms are closely associated with latex sensitization. Questionnaires should be useful in health monitoring for HCWs who use latex gloves.
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Affiliation(s)
- Mei Lin Wang
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia, USA.
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10
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Abstract
Much has been learned from epidemiologic studies conducted in the past 4 decades that can be directly applied to the management of workers affected with occupational asthma. Studies have provided information about host factors, environmental exposure, and occupational agents posing the highest risks for development of severe irreversible airway obstruction and asthma disability. Investigators have developed methods for screening workers at risk and novel interventions that may prevent new cases among exposed worker populations. Less is known about the natural history and chronic morbidity associated with work-aggravated asthma and irritant-induced asthma syndromes; more studies are needed in at-risk worker populations.
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Affiliation(s)
- Andrew M Smith
- Department of Internal Medicine, Division of Immunology, University of Cincinnati, 3255 Eden Avenue, ML 0563, Cincinnati, OH 45267-0563, USA.
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11
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Abstract
Allergy to natural rubber latex is an important clinical condition that occurred after the institution of universal precautions to protect healthcare workers. A rapid increase and production of both examination and surgical gloves resulted in an epidemic of allergy to latex protein. Healthcare workers in both the medical and dental environments, as well as specific groups of individuals including those with spina bifida, myelodysplasia, and food allergies (banana, kiwi, avocado, and others), were at increased risk of sensitization. Clinical symptoms in the latex allergic individual ranged from type I hypersensitivity reaction including rhinoconjunctivitis, asthma, and systemic reaction to type IV hypersensitivity reaction, which occur from the chemicals added during the manufacturing process. Diagnosis of latex allergy is based on a clinical history that correlates the development of symptoms in relationship to exposure. In the United States there are no skin tests approved by the Food and Drug Administration. Therefore a combination of clinical judgment and serologic testing such as ImmunoCAP and Immulite is helpful. The primary treatment of latex allergy is avoidance of exposure to the latex protein.
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Affiliation(s)
- Sandra M Gawchik
- Crozer Chester Medical Center, President's House, Chester, PA 19013, USA.
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12
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Palosuo T, Antoniadou I, Gottrup F, Phillips P. Latex medical gloves: time for a reappraisal. Int Arch Allergy Immunol 2011; 156:234-46. [PMID: 21720169 DOI: 10.1159/000323892] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Many hospitals have implemented policies to restrict or ban the use of devices made of natural rubber latex (NRL) in healthcare as precautionary measures against the perceived risk of NRL allergy. Changes in glove technology, progress in measuring the specific allergenic potential of gloves and a dramatic decrease in the prevalence of NRL allergies after interventions and education prompted us to revisit the basis for justifiable glove selection policies. The published Anglophone literature from 1990 to 2010 was reviewed for original articles and reviews dealing with the barrier and performance properties of NRL and synthetic gloves and the role of glove powder. The review shows that NRL medical gloves, when compared with synthetic gloves, tend to be stronger, more flexible and better accepted by clinicians. The introduction of powder-free gloves has been associated with reductions in protein content and associated allergies. Recently, new methods to quantify clinically relevant NRL allergens have enabled the identification of gloves with low allergenic potential. The use of low-protein, low-allergenic, powder-free gloves is associated with a significant decrease in the prevalence of type I allergic reactions to NRL among healthcare workers. Given the excellent barrier properties and operating characteristics, dramatically reduced incidences of allergic reactions, availability of specific tests for selection of low-allergen gloves, competitive costs and low environmental impact, the use of NRL gloves within the hospital environment warrants reappraisal.
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Affiliation(s)
- Timo Palosuo
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland.
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Bozkurt G, Sackesen C, Civelek E, Kalayci O, Akalan N, Cataltepe O. Latex sensitization and allergy in children with spina bifida in Turkey. Childs Nerv Syst 2010; 26:1735-42. [PMID: 20499239 DOI: 10.1007/s00381-010-1185-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 05/11/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE The latex allergy is known as a very frequent problem of children with spina bifida (SB). The aim of this prospective study is to determine the frequency of latex sensitization and allergy in Turkish children with SB and to evaluate the related risk factors. METHODS We enrolled a total of 175 children and collected them in four groups of patients: children with SB, children who had neurosurgical disorders other than SB, atopic children with allergic diseases, and healthy children as control group. All cases were evaluated for latex sensitivity and allergy with skin prick tests and specific IgE. The diagnosis of latex allergy was confirmed with the latex provocation test. RESULTS Ten children with SB, two children with other neurological disorders, and three atopic children with allergic disease were found "sensitized to latex". Among these sensitized children, only one child with SB had latex allergy. Multivariate logistic regression analysis of the children with SB and other neurologic disorders and the whole group of patients showed that skin test positivity, the presence of noncentral nervous system (CNS) surgery, and the number of the operations were significant risk factors for latex sensitization. CONCLUSIONS Our study showed that rates of latex sensitivity and allergy in children with SB in Turkey are significantly lower than published rates in literature. We also found that atopy, the presence of non-CNS operations in children with SB and other neurologic disorder, and total number of operations in the whole group of patients are the most important risk factors for latex sensitization.
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Affiliation(s)
- Gokhan Bozkurt
- Department of Neurosurgery, Hacettepe University, School of Medicine, 06100, Samanpazari, Ankara, Turkey.
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Smith AM, Bernstein DI. Management of work-related asthma. J Allergy Clin Immunol 2009; 123:551-7. [PMID: 19281902 DOI: 10.1016/j.jaci.2008.12.1129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 12/12/2008] [Accepted: 12/17/2008] [Indexed: 01/15/2023]
Abstract
The physician managing work-related asthma (WRA) assumes many roles. The first is to confirm an accurate diagnosis, recognizing that WRA has multiple phenotypes, including sensitizer-induced occupational asthma (OA) caused by high-molecular-weight (HMW) proteins or low-molecular-weight (LMW) chemicals; irritant-induced asthma; and work-exacerbated asthma. Pharmacotherapy for WRA is identical to nonwork-related asthma and should be guided by current asthma guidelines emphasizing control of both asthma impairment and risk domains. It is well established that the majority of workers diagnosed with OA caused by sensitizers experience persistent asthma after leaving the workplace. However, the long-term risk of persistent unremitting asthma can be prevented in a minority of cases, particularly with OA caused by LMW sensitizers, by establishing an early diagnosis of OA and reducing or eliminating exposure. The physician consultant may advise employers on workplace interventions needed to minimize effectively an affected employee's exposure to a causative agent or condition, and what measures are required to prevent new cases of WRA (ie, primary prevention). Although allergen immunotherapy has a putative role in treating and preventing WRA caused by HMW sensitizers, further study is needed.
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Affiliation(s)
- Andrew M Smith
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio 45267-0563, USA
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Ameratunga R, Ameratunga S, Crooks C, Simmons G. Latex glove use by food handlers: the case for nonlatex gloves. J Food Prot 2008; 71:2334-8. [PMID: 19044282 DOI: 10.4315/0362-028x-71.11.2334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is increasing concern that continued exposure to latex products can predispose individuals, particularly those who are atopic (allergy prone), to latex allergy. Latex allergy as a serious hazard has been well documented in the health care industry. There are also well-documented cases of food handlers who have had allergic reactions after the use of latex gloves. The contamination of food with latex proteins by food handlers using latex gloves can also result in potentially severe allergic reactions in latex-allergic consumers. We review latex allergy and present the case for avoiding latex glove use by food handlers in the food and hospitality industries. Adopting the use of nonlatex gloves has benefits for workers, consumers, and the food industry.
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Affiliation(s)
- Rohan Ameratunga
- LabPlus, P.O. Box 110031, Auckland City Hospital, Park Road, Grafton, Auckland 1148, New Zealand.
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Ramos MV, Aguiar VC, Melo VMM, Mesquita RO, Silvestre PP, Oliveira JS, Oliveira RSB, Macedo NMR, Alencar NMN. Immunological and allergenic responses induced by latex fractions of Calotropis procera (Ait.) R.Br. JOURNAL OF ETHNOPHARMACOLOGY 2007; 111:115-22. [PMID: 17141437 DOI: 10.1016/j.jep.2006.10.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 10/30/2006] [Accepted: 10/31/2006] [Indexed: 05/12/2023]
Abstract
Immunological and allergenic responses against the latex of Calotropis procera were investigated in mice by oral and subcutaneous routes. The latex was fractionated according to water solubility and molecular size of its components. The fractions were named as non-dialyzable latex (NDL) corresponding to the major latex proteins, dialyzable latex (DL) corresponding to low molecular size substances and rubber latex (RL) which was highly insoluble in water. Anti-sera against these fractions were assayed for total IgG and IgA titration by ELISA and IgE and IgG(1) were quantified by passive cutaneous anaphylaxis (PCA) in rats and mice, respectively. None of the fractions induced antibodies level increases when mice received latex fractions by oral route and thus, did not develop allergy. Nonetheless, anti-sera of mice sensitized with NDL and RL by subcutaneous route displayed considerable immunological response while DL did not. IgG level augmented consistently against NDL and RL while IgA response was detected only to NDL. NDL and RL induced very strong PCA reactions suggesting that both fractions would contain latex substances involved in allergy. Furthermore, protein analysis of NDL and RL suggests that RL still retain residual proteins abundantly found in NDL that could explain its similar allergenic effect. No IgG(1) reaction was detected in any of the anti-sera tested. According to the results, the proteins of latex of Calotropis procera can provoke allergy by subcutaneous route. The NDL has previously shown to display anti-inflammatory and analgesic activities by intraperitoneal injection. It should be relevant to determine whether NDL could induce such activities when assayed by oral route since it was ineffective to induce allergy by this way.
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Affiliation(s)
- M V Ramos
- Departamento de Bioquímica e Biologia Molecular, Campus do Pici, Universidade Federal do Ceará, Fortaleza, Ceará, CEP, Brazil.
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Barrios CS, Kurup VP, Rickaby DA, Henderson JD, Fink JN, Kelly KJ. Gastro-Intestinal Exposure to Latex Antigens Induce Allergic Responses in Mice. Int Arch Allergy Immunol 2006; 141:158-67. [PMID: 16899983 DOI: 10.1159/000094894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 03/30/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Natural rubber latex (NRL) has emerged as a major cause of respiratory allergy among specific exposed groups of individuals. Since latex allergens are dispersed in the environment it is conceivable that latex proteins are both inhaled and ingested. The mechanism of latex allergy and the immune responses following reexposure of latex allergens by the intranasal route was studied in a murine model of latex allergy developed by intragastric sensitization with NRL. METHODS BALB/c mice were sensitized intragastrically ('ig'), intranasally ('in') or 'ig' followed by 'in' challenge with NRL allergens. The cellular and humoral immune responses, lung function and histological changes were determined. RESULTS Peripheral blood eosinophilia was observed in the 'ig' and 'ig/in'-NRL-sensitized animals in comparison to normal controls (p < 0.05). The 'ig' group showed a marked increase over control mice in serum total IgE, NRL-specific IgG and IgG subclasses (p < 0.05). Increased levels of IL-4, IL-5, IL-10, and IL-13 were detected in 'ig'-NRL-sensitized mice. Intranasal exposure with NRL after 'ig' sensitization further enhanced the cytokine levels. A tendency towards enhanced stimulation was determined in 'ig'-sensitized mice; a significant difference was shown in the 'ig/in'-group (p < 0.05). Increased airway hyperreactivity was found in 'ig'-NRL-sensitized-mice (15.1 +/- 2.5 vs. 8.9 +/- 1.7 cm H2O x ml(-1) x s, p < 0.05). Mucus secretion from jejunal epithelium and eosinophilic infiltration into the jejunal lamina propria were observed in the 'ig'-NRL-sensitized-mice. CONCLUSIONS The results demonstrate that intragastric NRL sensitization did not induce specific tolerance, and additional intranasal exposure with latex allergens resulted in systemic allergic manifestations in the murine model.
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Affiliation(s)
- Christy S Barrios
- Allergy-Immunology Division, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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Koh D, Ng V, Leow YH, Goh CL. A study of natural rubber latex allergens in gloves used by healthcare workers in Singapore. Br J Dermatol 2005; 153:954-9. [PMID: 16225605 DOI: 10.1111/j.1365-2133.2005.06820.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allergy to natural rubber latex (NRL) proteins is a well-recognized health problem among subjects using protective gloves and products made of NRL. There is currently no information on NRL allergen levels in gloves used in Singapore. OBJECTIVES This study aims to quantify the amount of specific allergens (Hev b 1, Hev b 3, Hev b 5 and Hev b 6.02) found in rubber gloves used in Singapore. It also aims to determine if these levels are above thresholds that may cause NRL allergy. It also compares the levels of these specific allergens in gloves used for different purposes, namely gloves used for examination purposes or for surgical procedures. METHODS Forty-nine rubber gloves were obtained from major hospitals and healthcare departments in Singapore and were analysed for their NRL allergen levels. FITkit, based on the enzyme immunometric assay technique, was used to determine the specific allergen levels of Hev b 1, Hev b 3, Hev b 5 and Hev b 6.02 in the gloves. RESULTS Examination gloves had higher NRL allergen content compared with surgical gloves, and powdered gloves had higher allergen content compared with nonpowdered gloves. Among the various allergens, Hev b 5 and Hev b 6.02 were present in larger quantities than Hev b 1 and Hev b 3. Only two of 19 (11%) surgical gloves had the sum of the four allergens (Hev b 1, Hev b 3, Hev b 5, Hev b 6.02) in excess of 1 microg g(-1), which is believed to be a clinically relevant threshold. Among the examination gloves, 25 of 30 (83%) exceeded this level. CONCLUSIONS This study shows that NRL allergen levels are present in the majority of examination gloves used by healthcare workers in Singapore at levels high enough to cause NRL allergy among sensitized persons. The information can serve as evidence for a possible requirement for manufacturers to produce gloves with low NRL allergen levels and to state the allergen level in gloves in the product information.
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Affiliation(s)
- D Koh
- Department of Community, Occupational and Family Medicine, National University of Singapore, Singapore
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19
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Abstract
Since the end of the 19th century, surgeons have used gloves to prevent infectious complications to the patient. The AIDS epidemic of the 1980's sparked the use of universal precautions to protect the surgeon from infection and vice-versa. The interface between surgeon and patient is in effect a two-way street. Surgical techniques must be modified and barrier protection optimized to minimize these risks. A single layer glove is a fragile barrier to blood exposure; unrecognized glove perforations may lead to unrecognized and prolonged exposure. Double gloving, though far from being a widespread practice in France, seems to be the best protection from pathogen exposure. Glove powder and latex allergies have their own inherent risks to both surgeon and patient in the form of latex allergies and adhesive peritonitis. New institutional protocols will be necesssary in order to make powder-free non-latex gloves available to French surgeons.
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Affiliation(s)
- J L Caillot
- Service des Urgences Chirurgicales, Centre Hospitalier Lyon-Sud, Pierre-Bénite, EA 37-38 Faculté de Médecine Lyon-Sud, Oullins.
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Hwang CJ, Cha JY. Mechanical and biological comparison of latex and silicone rubber bands. Am J Orthod Dentofacial Orthop 2003; 124:379-86. [PMID: 14560267 DOI: 10.1016/s0889-5406(03)00564-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Latex rubber bands are routinely used to supply orthodontic force. However, because the incidence of allergic reactions to latex is rising, the use of nonlatex alternatives is increasing, and assessing the mechanical properties of the replacement products is becoming more important. The purposes of this study were to compare the mechanical properties of latex and silicone orthodontic rubber bands through static testing under dry and wet conditions, and to compare their biologic (cytotoxic) properties. Three brands of latex and 1 brand of silicone rubber bands were tested. When extended to 300% of the lumen diameter, the silicone group had an initial force equal to 83% of the product specifications; this was the lowest of the 4 groups. All 4 brands showed notable amounts of force degradation at the 300% extension when subjected to saliva immersion; this approximated a 30% force decay over 2 days. The latex bands all followed a similar pattern of force degradation, whereas the silicone bands showed a greater increase in force decay as the extension length increased. The silicone bands were less cytotoxic than 2 of the 3 types of latex. Although the silicone bands showed the least discrepancy of force degradation between air and saliva conditions, the amount of the force decay was the greatest. Therefore, great improvements in the physical properties of the silicone band are required before they can be considered an acceptable replacement for latex.
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Affiliation(s)
- Chung-Ju Hwang
- Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea.
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Moscato G, Rampulla C. Costs of occupational asthma and of occupational chronic obstructive pulmonary disease. Curr Opin Allergy Clin Immunol 2003; 3:109-14. [PMID: 12750607 DOI: 10.1097/00130832-200304000-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the most recent findings on the costs of occupational asthma and chronic obstructive pulmonary disease, illustrating the different approaches for estimates, the results and the social and financial implications. RECENT FINDINGS Many published data in the literature show that occupational asthma and chronic obstructive pulmonary disease represent a relevant proportion of the total prevalence of these diseases. Previous findings demonstrated that occupational asthma has adverse economic and employment consequences for the worker, and a significant cost related to the claims. Recent studies using a standard method have specifically estimated the cost of the proportion of cases of asthma and chronic obstructive pulmonary disease attributable to occupational exposure out of the total costs of these diseases, and demonstrated that it is significant. Some recent data indicate a beneficial outcome of occupational asthma and a reduction in the number of the claims from primary and secondary preventive intervention at the workplace. SUMMARY In conclusion, occupational asthma and chronic obstructive pulmonary disease are likely to pay a substantial contribution to the total costs of the two disorders. These costs are expected to rise with the increasing prevalence of the diseases. Intervention strategies for effective control and prevention at the workplace should lessen the burden of long-term illness and impact on public health costs.
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Affiliation(s)
- Gianna Moscato
- Department of Pneumology, Fondazione 'Salvatore. Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy.
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22
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Abstract
PURPOSE OF REVIEW To describe the latest developments in the field of occupational asthma and occupational rhinitis in 2001 and 2002. RECENT FINDINGS Several surveillance programs of occupational diseases, such as Observatoire National des Asthmes Professionnels in France, Surveillance of work-related and Occupational Respiratory Diseases in South Africa (SORDSA), Surveillance of Work-related and Occupational Respiratory Diseases (SWORD) in UK, have reported on the frequency of occupational asthma. The causative agents were mainly flour, isocyanates and latex. The common methods of diagnosis - questionnaires, cutaneous tests, Peak Expiratory Flow Rate (PEFR), bronchial hyperresponsiveness - still create controversy. In addition, the specific bronchial challenge, the classical gold standard of diagnosis, has its limitations since it cannot be performed in every case. Other methods have been assessed as inflammatory markers in induced sputum. Occupational rhinitis appears to be a poorly diagnosed condition. SUMMARY Further studies are expected to explore the effect of environmental control and medical surveillance. The key to successful management of occupational asthma and occupational rhinitis may be prospective surveillance of the occurrence of specific IgE antibodies before the onset of allergic symptoms.
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Affiliation(s)
- Gabrielle Pauli
- Department of Pneumology, Lyautey Hospital, Strasburg Cedex, France.
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Abstract
The accurate diagnosis of a latex-allergic individual begins with a comprehensive clinical history. Atopy, food allergies, hand dermatitis, and temporal relationships between allergic symptoms and natural rubber product exposure are risk factors that increase the suspicion of latex allergy. If symptoms are temporally delayed (hours-days) and confined to skin-latex product contact areas, Type IV hypersensitivity should be suspected and patch testing may be performed to identify activated T cells that are specific for selected rubber chemical additives. If ocular, upper and lower airway, and/or systemic allergic symptoms are observed with rapid onset (minutes) following a definable latex exposure, Type I hypersensitivity should be suspected. One or several confirmatory tests for latex-specific IgE antibody in the skin or blood may next be performed to verify a sensitized (IgE antibody positive) state. If the clinical history remains discordant with a skin test or blood test result, in vivo provocation tests may be cautiously considered for adjudication. Diagnostic methods for latex-specific IgE antibody detection in skin and blood are overviewed, with a focus on their performance, advantages, and limitations.
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Affiliation(s)
- Robert G Hamilton
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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