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Mekonnen TH, Yenealem DG, Tolosa BM. Self-report occupational-related contact dermatitis: prevalence and risk factors among healthcare workers in Gondar town, Northwest Ethiopia, 2018-a cross-sectional study. Environ Health Prev Med 2019; 24:11. [PMID: 30764759 PMCID: PMC6376784 DOI: 10.1186/s12199-019-0765-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/30/2019] [Indexed: 11/21/2022] Open
Abstract
Background Occupational skin diseases are the second most common occupational diseases and are responsible for an estimated 25% of all lost work days. Occupational contact dermatitis (OCD) comprises 70–90% of all occupational skin diseases. In Ethiopia, information about the prevalence and factors which determine developments of contact dermatitis is not recognized. The objective of this study was to investigate prevalence and factors influencing the occurrences of occupational-related contact dermatitis among healthcare workers in Gondar town, Northwest Ethiopia. Methods We employed a healthcare-based cross-sectional study from March to April 2018. A stratified sampling method followed by simple random sampling method was used to select 422 participants. The standardized Nordic Occupational Skin Questionnaire was pretested and interviewer-administered for data collection. We used SPSS version 20 to conduct a binary logistic regression analysis. We set ≤ 0.05 p value to ascertain significance and 95% CI with odds ratios to evaluate the strength of associations. Results Response rate was 100%. The majority, 52.4% (N = 221), were males. The mean age was 22.6 (SD ± 6.3) years. The overall prevalence of self-report occupational contact dermatitis in the previous 12 months was 31.5% (N = 133) [95% CI (27, 36.2)]. The highest symptoms indicated was redness, 28.5% (n = 38), followed by burning, 17.3% (n = 23). The hand is the most commonly affected body sites, 22% (N = 93). Hand washing frequency [AOR 1.80, 95% CI (1.10, 3.20)], pairs of hand gloves used per day [AOR 3.22, 95% CI (2.05, 5.87)], personal history of allergy [AOR 2.37, 95% CI (1.32, 4.61)], and lack of health and safety training [AOR 2.12, 95% CI (1.12, 2.25)] were factors considerably associated with contact dermatitis. Conclusions The prevalence of occupational-induced contact dermatitis is common among healthcare workers in Ethiopia. Therefore, our finding indicates that intervention aiming at workers’ health and safety training demands urgent public health responses to tackle the ailment. The result also demonstrates that healthcare workers should be aware of when and how hands should be washed. The number of pairs of gloves used per day should also be taken into consideration while devising prevention strategies.
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Affiliation(s)
- Tesfaye Hambisa Mekonnen
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - Dawit Getachew Yenealem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Beyene Mindaye Tolosa
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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Liu QL, He XZ, Liang K, Xie R, Fang HP, Zhu KJ, Fan YM. Prevalence and risk factors for latex glove allergy among female clinical nurses: a multicenter questionnaire study in China. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2013; 19:29-34. [DOI: 10.1179/2049396712y.0000000012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Smith AM, Amin HS, Biagini RE, Hamilton RG, Arif SAM, Yeang HY, Bernstein DI. Percutaneous reactivity to natural rubber latex proteins persists in health-care workers following avoidance of natural rubber latex. Clin Exp Allergy 2007; 37:1349-56. [PMID: 17845416 DOI: 10.1111/j.1365-2222.2007.02787.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term avoidance of natural rubber latex [Hevea brasiliensis (Hev b)] is currently recommended for health-care workers (HCWs) with established natural rubber latex (NRL) allergy. Percutaneous sensitivity to eight Hev b NRL allergens was evaluated in HCWs in 2000. To date, no studies have evaluated the longitudinal effects of NRL avoidance on percutaneous sensitivity to NRL allergens. OBJECTIVE The aims of this study were to evaluate changes in percutaneous reactivity to non-ammoniated latex (NAL) and NRL allergens in HCWs 5 years after a recommendation to avoid NRL and to evaluate factors that predict the persistence of in vivo sensitivity to NAL and NRL allergens. METHODS Skin prick testing was performed with NAL, seven NRL allergens (Hev b 1, 2, 3, 4, 6.01, 7.01, and 13), and recombinant Hev b 5 (rHev b 5) in 34 HCWs who were initially evaluated in 2000 for occupationally related NRL allergy. Serial 10-fold dilutions of NAL and NRL allergens were employed in skin testing. Sera from the HCWs were assayed for latex and enhanced latex (rHev b 5-enriched allergosorbent)-specific IgE antibodies using the ImmunoCAP assay. RESULTS The prevalence of work-related symptoms significantly decreased between 2000 and 2005 with avoidance of NRL (P<0.05). A >/=100-fold reduction in percutaneous sensitivity to Hev b 2 and Hev b 7 was less likely in those with prior history of systemic reactions to NRL (P=0.0053), reported history of reaction to cross-reactive foods (P=0.014), continued local reactions to NRL gloves (P<0.0001), or high NRL glove exposure since the initial study (P=0.0075). The diagnostic sensitivity and specificity of the latex-specific IgE serology was 54% and 87.5%, respectively, in comparison with NAL skin tests. The addition of rHev b 5 to the ImmunoCAP (enhanced latex) allergosorbent altered the diagnostic sensitivity and specificity of the ImmunoCAP to 77% and 75%, respectively. CONCLUSION While symptoms may resolve quickly with NRL avoidance therapy, detectable IgE indicating continued sensitization remains beyond 5 years, and thus continued avoidance of NRL should be recommended.
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Affiliation(s)
- A M Smith
- Department of Internal Medicine, Division of Allergy/Immunology, University of Cincinnati, Cincinnati, OH, USA.
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Khader Y, Abu-Zaghlan M, Abu-Al Rish I, Burgan S, Amarin Z. Self-reported allergy to latex gloves among health care workers in Jordan. Contact Dermatitis 2005; 53:339-43. [PMID: 16364123 DOI: 10.1111/j.0105-1873.2005.00726.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study is to determine the prevalence of natural rubber latex allergy and its associated factors among health care workers in Jordan based on a self-administered questionnaire. In this cross-sectional study, the data were obtained through a self-reported hand-delivered questionnaire that was distributed to 500 health care workers who use natural rubber latex gloves. A total of 420 (84%) health care workers responded by filling the questionnaire. Of the total number of 420 health care workers who filled the questionnaire, 57 (13.6%) reported allergy to latex gloves. The prevalence of allergy to latex gloves was significantly higher for those who had allergy to some foodstuffs (especially avocado, kiwifruits and chestnuts) or with history of eczema and hay fever. However, allergy to latex gloves was independent of gender, age, job, family history, type of gloves, hours of use/day and number of years of use. It is concluded that a high rate of allergy to latex gloves was reported among health care workers in Jordan.
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Affiliation(s)
- Yousef Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Ahmed SM, Aw TC, Adisesh A. Toxicological and immunological aspects of occupational latex allergy. ACTA ACUST UNITED AC 2005; 23:123-34. [PMID: 15578865 DOI: 10.2165/00139709-200423020-00005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Latex allergy continues to be an important occupational health problem as latex products are used increasingly worldwide, particularly in healthcare. Although there are few epidemiological studies on the incidence of latex allergy, there has been an increase in the number of case reports over the last 10 years and, based on skin-prick tests, estimates of prevalence of latex allergy in healthcare workers range from 2% to 17%. The allergic health effects arise either from the latex proteins, generally causing a type I immediate hypersensitivity reaction, or from the chemicals added to latex during processing, causing a type IV delayed hypersensitivity reaction. Clinical manifestations of latex allergy depend on the route of exposure and occur by direct contact either with skin or mucosa, or by inhalation. The diagnosis of latex allergy is based on the history, skin tests, serological tests and challenge tests. Thirteen latex allergens have been identified and isolated so far from natural rubber latex. They differ in their potential to elicit immunological responses in individuals allergic to latex and thus have been designated as major or minor allergens. In latex gloves, cornstarch powder used as a donning agent carries latex proteins, thereby increasing inhalational and mucosal exposure to latex proteins. There also appears to be a positive correlation between protein content and allergenicity of gloves. The use of powder-free, low-protein gloves is effective in reducing symptoms and markers of sensitisation. Alternatives to latex gloves, such as nitrile or vinyl gloves are available but may be inferior in respect to manual dexterity and biological impermeability.
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Affiliation(s)
- Syed M Ahmed
- Occupational Health Department, Kent and Canterbury Hospital, Canterbury, Kent, UK
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Zeiss CR, Gomaa A, Murphy FM, Weissman DN, Hodgson M, Foster D, Dejativongse S, Colella K, Kestenberg K, Kurup VP, Bush RK, Chiu AM, Kelly KJ, Fink JN. Latex hypersensitivity in Department of Veterans Affairs health care workers: glove use, symptoms, and sensitization. Ann Allergy Asthma Immunol 2004; 91:539-45. [PMID: 14700437 DOI: 10.1016/s1081-1206(10)61531-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This report of the prevalence of latex glove allergy in 3 Department of Veterans Affairs (VA) medical centers was a collaboration of the VA, the Centers for Disease Control and Prevention, and the National Institute for Occupational Safety and Health. OBJECTIVE To enroll and evaluate personnel from across the entire hospital workforce for latex hypersensitivity and to determine the type and extent of latex glove use. METHODS A questionnaire was administered that covered demographics, job category, latex glove use, and current latex glove allergic symptoms. Skin testing to aeroallergens was performed to evaluate the presence of atopy. Blood was drawn for analyses of serum antilatex IgE antibody by CAP assay. RESULTS Of 1,959 subjects, 158 (8.1%) had latex glove-allergic symptoms, a positive latex CAP assay result, or both. In 1,003 subjects who reported latex glove use, 915 (91.4%) used nonpowdered gloves. A total of 133 subjects reported latex glove allergic symptoms, and 36 subjects had positive CAP assay results. Latex sensitization was correlated with atopy, race, and latex glove exposure. Latex symptoms were correlated with atopy, a positive CAP assay result, and latex glove exposure. Of the 133 subjects with latex glove allergic symptoms, only 11 had positive CAP assay results, giving a prevalence of confirmed latex glove allergy of 0.6%. CONCLUSIONS Symptoms attributed to latex gloves and/or latex sensitization occurred in 8.1% of the employee population, with exposure, race, and atopy being the major risk factors. Few symptomatic individuals were sensitized to latex (0.6%). This low rate of confirmed latex glove allergy may have been related to nonpowdered glove use.
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Affiliation(s)
- C Raymond Zeiss
- VA Chicago Health Care System/Lakeside Division, Chicago, Illinois 60611, USA.
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Abstract
Occupational exposure to natural rubber latex has sensitized 10% to 17% of health care personnel in Europe and the United States. The increased incidence of latex allergy is believed to be a direct result of the implementation of standard precautions. The purpose of this literature review is to examine latex allergy studies and discuss the emerging problem of latex allergy in health care personnel. Latex composition, prevalence, clinical manifestations, and populations at risk also are discussed.
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Abstract
BACKGROUND Type 1 natural rubber latex (NRL) allergy prevalence rates quoted vary due to the different populations studied and methodologies used for assessment and investigation of NRL allergy. OBJECTIVES To investigate the rate of type 1 allergy to NRL in health-care workers (HCWs) in a single NHS trust in Wales. METHODS A response rate of 3716 of 5548 (67%) of the employees was obtained with a latex allergy questionnaire administered by the occupational health departments. Type 1 NRL allergy was diagnosed by correlating clinical symptoms, skin prick testing and IgE RAST to latex in the dermatology department. RESULTS The period prevalence (1998-2001) for type 1 clinical latex allergy in HCWs was 25 of 4439 (0.56%). Of the 25 positive HCWs, 18 (72%) were nurses. CONCLUSIONS The low prevalence rate of type 1 NRL allergy should not lead to underestimating the importance of clinically significant NRL allergy and the risks that need to be minimized.
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Affiliation(s)
- M M U Chowdhury
- Department of Dermatology, University Hospital of Wales, Box 100, Heath Park, Cardiff CF14 4XW, UK
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Latex glove sensitivity amongst diagnostic imaging healthcare personnel: a self-reporting investigation. Radiography (Lond) 2003. [DOI: 10.1016/s1078-8174(03)00009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dimich-Ward H, Wymer M, Kennedy S, Teschke K, Rousseau R, Chan-Yeung M. Excess of symptoms among radiographers. Am J Ind Med 2003; 43:132-41. [PMID: 12541267 DOI: 10.1002/ajim.10176] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The prevalence and occupational determinants of miscellaneous symptoms referred to as "Darkroom disease" was compared between radiographers and physiotherapists working in British Columbia, Canada. METHODS The participation rate for the mailout questionnaire survey was 66.1%. A small subset underwent spirometry and methacholine challenge testing. RESULTS Radiographers had a higher prevalence of most symptoms, with an extreme odds ratio of 11.4 for chemical/metallic taste. The percentage of radiographers with non-specific bronchial hyperresponsiveness (NSBHR) was 3 times higher than that of physiotherapists, although the comparison was not statistically significant. Reporting inadequate ventilation, frequently detecting the odor of X-ray processing chemicals and cleaning up spills within the past 12 months were highly associated with most of the symptoms. CONCLUSIONS Our results suggest that differences in the prevalence of symptoms represent a complex process, both in exposure and response to the many constituents found in radiographic processing chemicals. Objective testing of health outcomes and more refined exposure measurements are recommended to further investigate occupational health problems of radiographers.
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Affiliation(s)
- Helen Dimich-Ward
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Horwitz IB, Kammeyer-Mueller J, McCall BP. Workers' compensation claims related to natural rubber latex gloves among Oregon healthcare employees from 1987-1998. BMC Public Health 2002; 2:21. [PMID: 12238952 PMCID: PMC128812 DOI: 10.1186/1471-2458-2-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2002] [Accepted: 09/18/2002] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Occupational reaction to natural rubber latex (NRL) glove use by healthcare employees has been an area of increasing concern. Unfortunately, there is little data demonstrating the prevalence and severity of actual reactivity to NRL. METHOD Occupational reaction to NRL was estimated using workers' compensation claims filed by healthcare employees in Oregon for the period of 1987-1998. For the first ten years, these claims were estimated by source and conditions consistent with NRL glove reactions, while in the last two years a specific code developed in 1997 for NRL glove reactions was also employed. RESULTS The claim rate was on average 0.58 per 10,000 healthcare workers annually, which constituted 0.29% of all workers' compensation claims. The most common condition experienced was dermatitis (80%) and most common body part affected was the hands (55.4%). The majority of claimants, 45 (69.2%), reported taking less than a month off work, suggesting most reactions were minor in nature, although one fatality was reported. The average NRL claim cost was $8,309.48. Overall the average cost per insured healthcare worker was approximately $0.50 per year. The occupational groups with the highest number of claims were nurses (30.8% of claimants) and nursing aides and orderlies (24.6% of claimants). CONCLUSIONS In comparison with other workers' compensation claims filed by healthcare workers during this period, 0.25% of the total was potentially related to NRL gloves. The rare incidence of respiratory and ocular claims is inconsistent with the hypothesis that asthmatic or conjunctival reactions to NRL gloves are common.
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Affiliation(s)
- Irwin B Horwitz
- Industrial Relations Center, University of Minnesota, Minneapolis, USA
| | | | - Brian P McCall
- Industrial Relations Center, University of Minnesota, Minneapolis, USA
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Garabrant DH, Schweitzer S. Epidemiology of latex sensitization and allergies in health care workers. J Allergy Clin Immunol 2002; 110:S82-95. [PMID: 12170248 DOI: 10.1067/mai.2002.124967] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although it is often claimed that health care workers are at increased risk of latex sensitization and type I allergies, there has been no systematic analysis of the epidemiologic studies that are relevant to this conclusion. A systematic analysis of the epidemiologic literature found that, in the past 14 years, there have been 48 epidemiologic studies of type I latex allergy among health care workers. Of these, 2 cohort studies estimated the incidence of latex sensitization by skin prick testing at between 1% and 2.5% per year. Neither compared the risk to that in the general population. The prevalence of sensitization in health care workers varied between 0% and 30%, yet this large variation was unexplained. Increased risk of sensitization was not clearly associated with the duration of work in health care, the time spent wearing latex gloves, the frequency of exposure, the specific job categories, the use of powdered versus nonpowdered latex gloves, the use of latex versus nonlatex gloves, or any measurements of ambient exposure to latex proteins. The epidemiologic studies do not support a conclusion that health care workers are at clearly increased risk of latex sensitization or type I allergies compared to other occupations in the United States. The role of latex gloves in causing latex sensitization and type I allergic symptoms remains poorly defined because of the inconsistent results across studies. Future epidemiologic studies are needed that include measured exposures to latex antigens, that compare health care workers to appropriate referent groups, and that address confounding by atopy, age, sex, and race.
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Affiliation(s)
- David H Garabrant
- Occupational Medicine, University of Michigan School of Public Health and University of Michigan School of Medicine, and the Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48104, USA.
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Saary MJ, Kanani A, Alghadeer H, Holness DL, Tarlo SM. Changes in rates of natural rubber latex sensitivity among dental school students and staff members after changes in latex gloves. J Allergy Clin Immunol 2002; 109:131-5. [PMID: 11799379 DOI: 10.1067/mai.2002.120557] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A high rate of sensitization and clinical allergy to natural rubber latex (NRL) gloves has been reported in dental students and staff members. OBJECTIVE The purpose of this study was to determine whether a change in glove use from high-protein/powdered to low-protein/powder-free latex gloves at a previously surveyed dental school reduced the prevalence of NRL sensitivity among students and staff members. METHODS A cross-sectional study was performed through use of a questionnaire and skin prick testing to low ammoniated NRL extract; the method was similar to that used in a study conducted in 1995. Analyses were performed on the entire groups as well as on a subset of senior students. RESULTS A total of 97 subjects (61 students and 36 staff members) completed the questionnaire and underwent skin prick testing; this compared with 131 subjects in 1995. Percentages of subjects reporting asthma symptoms, rhinitis or conjunctivitis, urticaria, or pruritus within minutes of NRL exposure were 4%, 7%, 6%, and 8%, respectively; the corresponding percentages in the 1995 survey were 7% (P = not significant), 13% (P = not significant), 20% (P =.004), and 22% (P =.005). Results were similar for the subset of senior students, but in addition there were also significantly fewer complaints of rhinoconjunctivitis in 2000 than in 1995 (0% and 12%, respectively; P =.007). Of 97 subjects who underwent skin prick testing, 3 (3%) had positive skin prick test responses of 2+ or greater to NRL; this compared with 13 (10%) of 131 subjects in 1995 (P =.03). There were 3 positive skin test responses among staff members in 2000; there were none among students. CONCLUSIONS Our results suggest a preventive effect on NRL allergy in dental students from the change to low-protein/powder-free NRL gloves in the dental school.
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Affiliation(s)
- M Joan Saary
- Gage Occupational and Environmental Health Unit, University of Toronto, St Michael's and Toronto Western Hospitals
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Affiliation(s)
- D Coggon
- Environmental Epidemiology Unit, Southampton General Hospital, UK.
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Page EH. Prevalence of latex allergy. Ann Allergy Asthma Immunol 2001; 87:164-5. [PMID: 11527252 DOI: 10.1016/s1081-1206(10)62215-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Allergic responses to natural rubber latex (NRL) continue to be reported. In adults, the major exposure is in the occupational setting, especially in relation to NRL glove use by health care workers. Issues addressed over the past year include improving diagnostic methods for NRL allergy and characterization of NRL allergens relevant to various exposure groups and evaluating strategies for prevention and early detection of NRL allergy. Assessment of in vitro tests show good intertest correlation but lower sensitivity compared with skin test responses. NRL allergens have been further characterized as reported in the past year. Development of recombinant Hev b 3, a major NRL allergen relevant to children with spina bifida, enhances the likelihood for improved diagnostic reagents. Preliminary reports of primary preventive strategies suggest that avoidance of high-protein, powdered gloves in health care facilities can be cost-effective and is associated with a decline in sensitized workers.
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Affiliation(s)
- S M Tarlo
- Department of Medicine, University of Toronto, Toronto Western Hospital, Ontario, Canada.
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Abstract
Latex allergy is an IgE-dependent immediate hypersensitivity reaction to latex proteins. Risk factors for latex allergy are contact with latex products and atopy. Children who undergo multiple surgical procedures and healthcare workers are the major groups at risk. Powdered latex gloves are an important source of sensitization. Preventive measures are leading to reduction in latex sensitization and allergic reactions. The prevalence of latex allergy in the general population may be as low as 0.1%, whereas the frequency of latex sensitization is reported to be 7%; this may be due to cross-reacting antipollen IgE. The most important latex allergens have been purified, and some have been cloned and sequenced. Many latex-allergic patients are also allergic to common plant-derived aeroallergens and foods. The structural and biologic relationships among plant-derived food allergens, including latex, explain these clinically important cross-reactions.
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Affiliation(s)
- D A Levy
- Centre d'Allergie, Hopital Tenon, 4, rue de la Chine, 75970 Paris, France.
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