An Epidemic of Occupational Allergy to Latex Involving Health Care Workers

Hunt, Loren W.; Fransway, Anthony F.; Reed, Charles E.; Miller, Linda; Jones, Richard T.; Swanson, Mark C.; Yunginger, John W.

doi:10.1097/00043764-199510000-00011

Cited by 104 publications

(63 citation statements)

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“…exposure of the skin to protein Ags is a highly skewed Th2 response (34,43,44). Likewise, contact-induced responses to protein Ags in humans, including latex hypersensitivity reactions and contact urticaria, also involve Th2 generation (45)(46)(47)(48). Given that the vast majority of children with atopic dermatitis eventually develop some form of allergic airway disease, it is plausible that penetration of environmental allergens through the skin could serve as a major mode of systemic Th2 sensitization in atopic individuals.…”

Section: Discussionmentioning

confidence: 99%

IL-13 Is Necessary, Not Simply Sufficient, for Epicutaneously Induced Th2 Responses to Soluble Protein Antigen

Herrick

McKenzie

et al. 2003

The Journal of Immunology

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Th2 responses are clearly involved in the pathogenesis of atopic disease. Thus, understanding the factors responsible for Th2 sensitization at sites of allergen exposure, such as airway and skin, is crucial for directing therapeutic or preventive strategies. Contrary to other models of Th2 sensitization to proteins, we have reported that Th2 responses induced by epicutaneous exposure to OVA are IL-4 independent. Combined deficiency of both IL-4 and IL-13 signaling did prevent Th2 generation, suggesting that IL-13 was mediating these IL-4-independent responses. It was not clear, however, whether IL-13 was simply replacing the need for IL-4 in genetically deficient mice or if IL-13 played a unique role. In the present study, we show that Th2 responses induced by epicutaneous OVA exposure (including lung inflammatory responses after inhaled Ag challenge, OVA-specific IgG1, and draining lymph node IL-5 production) are impaired in IL-13-deficient (IL-13−/−) mice compared with wild type. In contrast, i.p. sensitization of IL-13−/− mice resulted in responses equivalent to wild type. Generation of contact hypersensitivity to dinitrofluorobenzene, which involves Th1 and CD8+ effector cells, was also intact in IL-13−/− mice. Taken together, the data indicate that IL-13 is the major inducer of Th2 generation in the cutaneous microenvironment, being required independently of IL-4. This fact, in combination with the known abundance of IL-13 in atopic dermatitis skin lesions, emphasizes the potentially important role of the skin as a site for Th2 sensitization to environmental allergens, particularly in atopic individuals.

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Section: Discussionmentioning

confidence: 99%

IL-13 Is Necessary, Not Simply Sufficient, for Epicutaneously Induced Th2 Responses to Soluble Protein Antigen

Herrick

McKenzie

et al. 2003

The Journal of Immunology

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“…Health care workers who are atopic develop latex hypersensitivity more frequently than those who are not atopic (Bubak et al 1992;Hunt et al 1995). Taylor and Praditsuwan (1996) reviewed 44 patients with latex hypersensitivity and found that 77% of them were atopic; all but 2 of these patients were health care workers.…”

Section: Discussionmentioning

confidence: 99%

Latex allergy and occupational asthma in health care workers: adverse outcomes.

Amr

Bollinger²

2004

Environ Health Perspect

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The prevalence of natural rubber latex (NRL) allergy has been estimated to be 5-18% in health care workers, and latex exposure has been one of the leading causes of occupational asthma in the last several years. We present the cases of two nurses who developed sensitivity to NRL, both with dermatologic symptoms and respiratory symptoms that included asthma. They were referred to the University of Maryland for evaluation of their allergies, then for occupational and environmental consults. The patients' allergy to NRL was confirmed on the basis of clinical history, a positive skin test to latex, and the presence of latex-specific immunoglobulin E (IgE) serology by radioallergosorbent test (RAST). Both patients worked in the same community hospital for approximately 20 years; one was an endoscopy nurse and the other worked in the emergency department. Following the diagnosis of allergy to latex, both patients avoided direct skin contact with latex, but they continued to work in the same respective environments, where powdered latex gloves and other potentially sensitizing chemicals were used. Instead of improving, the clinical condition of the patients worsened and they remained symptomatic, even after they were removed from their workplace. Their airways reacted to low levels of a variety of sensitizers and irritants in the environment, and they became depressed. Both nurses were referred for vocational rehabilitation.

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“…Consequently, the rate of use of exam gloves in clinical practice rose dramatically (7). To ensure consistent quality in the manufacture of gloves, the U.S. Food and Drug Administration (FDA) introduced a two-part testing protocol in which gloves are first visually inspected and then subjected to a water leak test (5).…”

mentioning

confidence: 99%

PCR-Based Method for Detecting Viral Penetration of Medical Exam Gloves

2002

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The test approved by the U.S. Food and Drug Administration for assessment of the barrier quality of medical exam gloves includes visual inspection and a water leak test. Neither method tests directly the ability of gloves to prevent penetration by microorganisms. Methods that use microorganisms (viruses and bacteria) to test gloves have been developed but require classical culturing of the organism to detect it. We have developed a PCR assay for bacteriophage X174 that allows the rapid detection of penetration of gloves by this virus. The method is suitable for use with both latex and synthetic gloves. The presence of glove powder on either latex or synthetic gloves had no effect on the ability of the PCR assay to detect bacteriophage DNA. The assay is rapid, sensitive, and inexpensive; requires only small sample volumes; and can be automated.In response to a growing need to protect health care workers and patients from the possibility of transmission of human immunodeficiency virus through contact with body fluids, the Occupational Safety and Health Administration issued standard precautions that state that gloves must be worn when "touching blood, body fluids, secretions, excretions, and contaminated items" (17). Consequently, the rate of use of exam gloves in clinical practice rose dramatically (7). To ensure consistent quality in the manufacture of gloves, the U.S. Food and Drug Administration (FDA) introduced a two-part testing protocol in which gloves are first visually inspected and then subjected to a water leak test (5). These tests, while convenient and inexpensive, suffer from a number of drawbacks. Both the visual test for defects and the water leak test, in which an inspector looks for leaks in a glove filled with a liter of water, are subject to operator error. It has also been observed that microorganisms can penetrate gloves that do not show visible water leaks (2, 9). Studies that use microorganisms to gauge the propensities of gloves to permit pathogen penetration examine the question more directly than water leak studies. However, the microbial assays described rely on classical microbiological culture techniques to detect microbial penetration and therefore are more labor-intensive, time-consuming, and expensive than the FDA-approved tests. This report describes an assay for the detection of glove penetration by a small virus, bacteriophage X174. The assay uses PCR to detect the bacteriophage. PCR offers the advantages of being highly sensitive and specific for the agent being detected. With the recent and rapid increase in the availability of laboratory robotics for molecular biology, this PCR assay also has the potential to be automated and therefore made useful in the glove manufacturing setting. Cultures of E. coli were maintained on solid NB medium, made as described above by the addition of 15 g of agar per liter and 1 ml of CaCl 2 and the omission of Tween 80. For plaque analysis of bacteriophage X174, the top agar composition was identical to that of the plate agar, except that the co...

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An Epidemic of Occupational Allergy to Latex Involving Health Care Workers

Cited by 104 publications

References 0 publications

IL-13 Is Necessary, Not Simply Sufficient, for Epicutaneously Induced Th2 Responses to Soluble Protein Antigen

IL-13 Is Necessary, Not Simply Sufficient, for Epicutaneously Induced Th2 Responses to Soluble Protein Antigen

Latex allergy and occupational asthma in health care workers: adverse outcomes.

PCR-Based Method for Detecting Viral Penetration of Medical Exam Gloves

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