Reduction of the protein and powder content of NRL gloves has been recommended to reduce the incidence of latex sensitization and symptoms associated with NRL exposure. A better understanding of the effects of co-exposure with other irritant/sensitizers on the development of NRL allergy will be helpful in developing effective intervention strategies. These studies were conducted to investigate the effect of co-exposure to the common health care contaminants endotoxin and glutaraldehyde on the development of an IgE response to NRL. Endotoxin was tested at 50 -25,000 EU while concentrations of glutaraldehyde tested were representative of the concentrations found in cold sterilant solutions (0.1 - 1 %) and aerosol levels surrounding the permissible exposure limits (PEL, 0.05 - 1 ppm). Female BALB/c mice were concurrently exposed to endotoxin (intranasally, subcutaneously) or glutaraldehyde (dermally) and 25 microg of NRL proteins 5 days a week for up to 17 weeks. Mice were tail bled prior to exposure and bi-weekly thereafter to obtain total and specific serum immunoglobulin levels. Animals exposed concurrently to endotoxin and NRL exhibited a dose dependent decrease in total and NRL specific serum IgE levels reaching >50% suppression and increase in serum IgG1 and IgG2a levels. Mice exposed to glutaraldehyde in concentrations consistent with cold sterilant solutions exhibited decreases in total (>50%) or NRL specific IgE levels when compared to mice exposed to NRL alone. However, upon co-exposure to levels of glutaraldehyde in the range of the PEL a dose responsive increase in both total (3 fold) and NRL specific (>40 fold) IgE was observed. These studies demonstrated that endotoxin induced an immunoglobulin class switch whereas glutaraldehyde augmented the IgE response to NRL proteins.
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