Percutaneous reactivity to natural rubber latex proteins persists in health-care workers following avoidance of natural rubber latex.
Smith-AM; Amin-HS; Biagini-RE; Hamilton-RG; Arif-SAM; Yeang-HY; Bernstein-DI
Clin Exp Allergy 2007 Sep; 37(9):1349-1356
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.
Biological-systems; Work-environment; Worker-health; Health-care-personnel; Health-hazards; Health-protection; Allergic-dermatitis; Allergic-disorders; Allergic-reactions; Statistical-analysis; Statistical-quality-control; Skin-diseases; Skin-disorders; Skin-exposure; Skin-irritants; Skin-sensitivity
Andrew M. Smith, Department of Internal Medicine, Division of Allergy/Immunology, University of Cincinnati, 231 Albert Sabin Way, ML 0563, Cincinnati, OH 45267-0563
Clinical and Experimental Allergy