Strategies for distinguishing asymptomatic latex sensitization from true occupational allergy or asthma

Ownby, Dennis R.

doi:10.1016/s1081-1206(10)61648-1

Cited by 6 publications

(6 citation statements)

References 35 publications

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“…The United States does not have licensed commercial latex extracts. As a result, skin testing is done with unstandardized office-prepared latex extracts, which vary widely in allergen content (Ownby 2003). Specific IgE antibodies can also be studied in vitro using a blood test, the RAST assay (Wild and Lopez 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Specific IgE antibodies can also be studied in vitro using a blood test, the RAST assay (Wild and Lopez 2003). Tests for latex-specific IgE such as the RAST are less sensitive and specific than are skin prick tests, with sensitivity ranging between 73 and 80% and specificity ranging between 90 and 97% (Ownby 2003). The laboratory to which this patient’s RAST was sent reports a 30% false-negative rate (Hamilton 1999).…”

Section: Discussionmentioning

confidence: 99%

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Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Green-McKenzie¹,

Hudes²

2005

Environ Health Perspect

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Context: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice.Case Presentation: A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time.Discussion: The patient’s presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work.Relevance to Clinical or Professional Practice: The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Green-McKenzie¹,

Hudes²

2005

Environ Health Perspect

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“…The in vitro determination of specific IgE antibodies to whole latex is not always associated with clinically relevant protein sensitivity. A correct diagnosis is therefore dependent on the use of well-characterised purified allergens and, where appropriate, investigation of the allergenic material in question [6,7,8,9,10]. Once sensitised to latex, patients may experience symptoms such as itchy eyes, runny nose, sneezing, wheezing, coughing, asthma, itchy skin and urticaria and even anaphylaxis [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Occupational Allergy to Latex among Loom Tuners in a Textile Factory

Lopata

Adams²,

Kirstein³

et al. 2007

Int Arch Allergy Immunol

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Background: Occupational allergy to latex is generally reported from occupational groups such as health care workers; however, few reports derive from other occupational settings. Methods: Two male subjects working as loom tuners in a textile manufacturing plant developed severe allergic reactions during the cutting and weaving of elastic bands, initially not suspected to contain latex constituents. Clinical evaluation and lung function tests were supplemented by skin prick testing, specific IgE evaluation and basophil activation assays with extracted elastic bands. Results: Both workers presented with rhinitis, episodes of tight chest and itchy eyes. Initial spirometry was normal with no significant reversibility; however, a histamine challenge test was positive in one worker. Skin prick testing to a battery of common inhalant allergens was negative; however, raised IgE levels were detected to latex using ImmunoCAP. On further testing, the specific IgE response was directed mainly to the major latex allergens rHev b 5, rHev b 6.01, rHev b 6.02 and nHev b 13. Basophils of the two workers, but not the unaffected control subjects, were strongly activated by extracts of the elastic and the cutting dust material. Conclusions: Workers are at high risk of becoming sensitised to latex allergens when exposed to excessive dust produced by loom tuning machines. Latex sensitisation should therefore be considered in workers developing unexplained work-related allergic reactions (including asthma) associated with unlabelled materials in the textile industry.

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“…Finally, mechanical forces, using rollers or rotating blades (mastication), are applied to the rubber. 7 …”

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confidence: 99%