NATURAL RUBBER LATEX ALLERGY IN HEALTH CARE
WORKERTheerapan Songnuy
Overview
Background Common Antigens in Latex Epidemiology Clinical Manifestations Diagnosis Management
Background
Natural Rubber : a processed plant product derived from the “cytosol”, or latex of rubber tree
Hevea brasiliensis
John W Yunginger. Natural Rubber Latex Allergy. In Middleton’s 7th Ed : 1019-1026.
Background
Ninety percent of harvested rubber was made into dry sheets for rubber thread products etc.
The remaining, dipped product, is non-coagulated and ammoniated made for rubber gloves, condom & balloons
Most of allergic reactions are from dipped products
John W Yunginger. Natural Rubber Latex Allergy. In Middleton’s 7th Ed : 1019-1026
Background
Rubber gloves is processed by adding various compounds :accelerators, antioxidants, & secondary preservatives
Emulsion of cornstarch & coagulant are also used
Protein content of raw latex is about 15 mg/ml - Latex functional unit is cis-1,4-polyisoprene,
providing structural integrity ( 60%) - Latex cytosol contains enzymes ( 40%)
John W Yunginger. Natural Rubber Latex Allergy. In Middleton’s 7th Ed : 1019-1026
Common Latex Products Balloon Bandages ( adhesive) Blood pressure cuffs Condoms Dental dam Diaphragms Elastic Gloves Pacifiers Tourniquets
Adapted from American Latex Allergy Association . http://www.latexallergyresources.org/topics/. Accessed on Oct
28,2012
Epidemiology
General population incidence is 1-2 % High risk group - patient with spina bifida, the highest incidence 20-67 % - health care workers especially working in operating room, laboratories, or hemo-dialysis centre - atopic patient - patient with multiple surgeries - hand dermatitis - food associated latex allergy Teylor JS, Erek E. Latex allergy: diagnosis and management. Dermatol Ther. 2004; 17(4):289-301
Wakelin SH, White IR. Natural rubber latex allergy. Clin Exp Dermatol. 1999; 24(4):245-248
Adapted from American Latex Allergy Association . http://www.latexallergyresources.org/topics/. Accessed on Oct 28,2012
Latex Allergen
Proteins present in raw latex & rubber products Leached from rubber gloves by skin moisture Be adsorbed to powder inside gloves,
becoming airborne Respirable particles can be shed from powder-
free latex gloves FDA : Powder glove ; < 120 mg of powder Powder-free glove ; < 2 mg of powder Occup Environ Med 2001; 58:479-481
Common Latex Allergens
Clinical and Experimental Allergy 2008;38:898-912
Clinical and Experimental Allergy 2008;38:898-912
Objectives
Material & Method- Health care worker have used gloves- Fujita Health University Hospital- SPT with NRL glove extracts & recombinant allergens- Diagnosis : symptom when expose to latex & SPT + or NRL glove-use test +- Extract of glove : 1 gm into 5ml of phosphate buffer saline Ph 7.2- Measure allergen by ASTM D 5712-95 method- FITkit used to calculate individual allergen
Allergology International 2009;58:347-355
Allergology International 2009;58:347-355
Allergology International 2009;58:347-355
Allergology International 2009;58:347-355.
Allergology International 2009;58:347-355
Allergology International 2009;58:347-355
AllergolInternational 2009;58:347-355
Allergology International 2009;58:347-355
Common allergen
Hev b 6.02 is the most common allergen among HCWs sensitized occupationally
Epidemiology
Objectives
To analyze the prevalence of latex allergy To describe characteristics of health care
worker who has latex allergy
Material & Methods
A self-administered questionnaire : work activity, history of symptoms, allergic reaction to latex products
Skin prick test : commercial latex extracts Serum specific IgE to latex
J Investig Allergol Clin Immunol 2011; 21(6): 459-465
Total workers 620
J Investig Allergol Clin Immunol 2011; 21(6): 459-465
J Investig Allergol Clin Immunol 2011; 21(6): 459-465
J Investig Allergol Clin Immunol 2011; 21(6): 459-465
J Investig Allergol Clin Immunol 2011; 21(6): 459-465
J Investig Allergol Clin Immunol 2011; 21(6): 459-465
J Investig Allergol Clin Immunol 2011; 21(6): 459-465
Allergic to latex (%) Non-Allergic to latex (%)
Latex Allergy in Primary Care Providers
-The prevalence of latex allergy is 5.9%
Latex Allergy in Dental Students:A Cross-Sectional Study
Mukda Vangveeravong MD, Jintana Sirikul MD Tassalapa Daengsuwan MD
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
Objectives
Study the prevalence of latex-related symptoms
Study latex-sensitization Study risk factors
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
Material & Method
A cross-sectional study Dental students Faculty of dentistry, Chulalongkorn
University Dec 2007-May 2008 Questionnaires Skin prick test ; using 3 latex extracts
prepared from Proglove, Doctor Plus gloves & a commercial latex allergen(Stallergens, France)
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
J Med AssoThai 2011; 94(Suppl. 3): S1-S8
Latex Allergy in Dental Students:A Cross-Sectional Study
The prevalence of latex allergy is 5 % Common signs & symptoms : pruritus,
eczema & contact urticaria The latex sensitization rate was 14.2% Risk factors : personal history of allergic
disease, duration & frequency of exposure
Primary prevention should be considered J Med AssoThai 2011; 94(Suppl. 3): S1-S8
Clinical Manifestation
Latex Allergic Contact Dermatitis( type 4)
Irritant Contact Dermatitis (non-immune)
Am Fam Physician 2009; 80(12): 1413-1418
Latex Anaphylaxis
Rapidly increase of latex allergy from 0.5% before 1980 to 20% in 2002 ( France)
Thirty percent of patients had history of symptoms suggestive of latex sensitization
Some countries have implemented reducing latex exposure, incidence became decreased
Anesthesiology 2005 ; 102(5): 897-903Ann Fr Anesth Reanim 2004;23(12):1133-43
Clinical Manifestation
INJ OCCUP INVIRON HEALTH 2011;17:17-23
INJ OCCUP INVIRON HEALTH 2011;17:17-23
INJ OCCUP INVIRON HEALTH 2011;17:17-23
Clinical symptomsSkin : 2.4% urticaria 4.8% rash within 1 hr 3% rash beyond contacted area
Upper respiratory tract : 5.4% coryza 3.8% sneezing spells
Lower respiratory tract : 1.5% cough 1.5% wheezing 1.4% shortness of breath
Anaphylaxis 15 ( 0.3% )
INJ OCCUP INVIRON HEALTH 2011;17:17-23
Diagnosis
Skin testing - commercial extracts - extracts of rubber products
Diagnosis
Latex specific IgE antibodies - strong /weak point - sensitivity - specificity - improved sensitivity by using
recombinant latex protein
Diagnosis
Challenge Studies - Nasal & bronchial inhalation - “ Use test”
Management
Latex avoidance - documentation of latex sensitization - education - provided non-latex gloves/materials - labeling latex products Latex-safe medical environment - level of threshold limit for aeroallergen < 0.6 ng/m3Am J Public Health 1999;89: 1024JACI 1998; 101: 24
Latex Allergy: a follow up study of 1040 health care worker
Filon FL, Radman G. Environ Med 2006;63:121
Objectives: To evaluate incidence/prevalence of latex
related symptoms & latex sensitization between pre & post implementation of powder-free gloves with low latex release
Material & Methods
Subjects : 1040 health care workers At Triestle hospital, Italy Base line 1997-1999 , follow up in 2000-
2002 Evaluate : questionnaires, physical exam,
skin prick test & serum specific IgE antibody
Measure : prevalence of latex related symptoms, sensitization
Results
Environ Med 2006;63:121
Results
Participants characteristics who have symptoms related to latex glove use
- work seniority - work place ; OR, lab, surgery ward - latex glove use per day Odd ratio of possible risk factor and glove related
symptom - SPT to latex - SPT to inhalant allergen - personal atopy - family history of atopy - being female
Environ Med 2006;63:121
Environ Med 2006;63:121
Results
Environ Med 2006;63:121
Implication from this study
Avoidance of unnecessary glove utility Non-powder latex glove in all workers Non-latex glove in sensitization workers
Stop worsening latex symptom Prevent new case of sensitization
Immunotherapy
Subcutaneous immunotherapy with natural rubber latex : decreases skin & respiratory symptoms but induces systemic reaction
Sublingual immunotherapy with a commercial NRL extract : safe & efficacious ( pediatric patient)
JACI 2006; 6: 96Euv Ann Allergy Clin Immunol 2008;40(4):142-147
Conclusion
Latex allergy increased in the past decades following “ universal precaution” policy
High risk group are health care workers & patients with spina bifida
Latex gloves vary in their latex allergen & particles from powdered latex gloves produce airborne latex allergen
Diagnosis requires history , SPT, latex-sIgE Ab or challenge testing
Optimal management includes education & avoidance of latex products
THANK YOU VERY MUCH
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