The Clinical Relevance of Natural Rubber Latex-Specific IgE in Patients Sensitized to Timothy Grass Pollen

Abstract

Background: In pollen-allergic patients, cross-reacting allergens including cross-reactive carbohydrate determinants (CCDs) and profilins may result in positive natural rubber latex (NRL)-specific IgE (sIgE) antibody tests but the relationship between this sensitization and clinical NRL type 1 allergy is poorly described. Objective: The aims of this study were to determine the frequency and clinical relevance of NRL sIgE in grass pollen-sensitized individuals and to investigate which NRL allergen components these individuals were sensitized to. Methods: A total of 383 grass-sensitized patients answered questions about NRL allergy symptoms and their stored sera from previous investigations were analyzed for NRL sIgE. Patients with NRL sIgE (n = 32) underwent further investigations comprising medical history, skin prick test with NRL and inhalational allergens, and an additional blood sample. The additional blood samples were analyzed for total IgE and sIgE against NRL, timothy grass, birch, rHev b 1, 3, 5, 6.01, 6.02, 8, 9, 11, rPhl p 12, and MUXF3, which was used as a marker of CCD sensitization. Results: Overall, 9.4% of all grass pollen-sensitized individuals showed IgE sensitization to NRL but only 1.6% had a confirmed type I NRL allergy. CCD and Hev b 8 explained the clinically irrelevant NRL IgE sensitization in 65% of the cases. We found a highly significant correlation between NRL profilin (Hev b 8) sensitization and grass profilin (Phl p 12) sensitization (p < 0.0001). Conclusions: Data from this study support the hypothesis that in patients with grass pollen sensitization, Hev b 8 mono-sensitization has little or no clinical relevance and is caused by cross sensitization from grass profilin (Phl p 12).

Alergia al látex: una revisión sobre los aspectos más importantes

“…Las del tipo inmunológico se pueden subdividir en reacciones mediadas por IgE tipo I (las cuales varían mucho según la vía de exposición [cutánea, percutánea, mucosa o parenteral], la cantidad y características de los alérgenos, el nivel de sensibilización y factores propios del individuo) y reacciones mediadas por células tipo IV. 7,15 Las reacciones no inmunológicas conducen a una dermatitis de contacto irritativa con eritema, descamación y prurito, más común en las manos y en los dedos dorsales. Es una irritación inducida "mecánicamente" o por el pH alcalino de los guantes y es independiente de la composición química de estos.…”

“…Un dato característico de esta forma de presentación es que las lesiones y los síntomas no se extienden más allá del área de la piel directamente expuesta. 15 No es necesaria la exposición previa y usualmente está relacionada con aditivos químicos durante el procesamiento del látex (carbamatos, benzotiazoles, antioxidantes y tiuram). 14 Dermatitis de contacto alérgico o hipersensibilidad tipo IV Las lesiones suelen tener bordes mal definidos y se acompañan de intenso prurito.…”

“…Clínicamente se manifiesta por síntomas cutáneos en forma de urticaria, síntomas respiratorios, rinoconjuntivitis o anafilaxia. 9,15 Numerosos estudios coinciden en señalar que la urticaria de contacto con objetos de látex suele preceder a las manifestaciones sistémicas de NRLA, en especial en pacientes atópicos. 10,11…”

“…Los alimentos con menor implicación son: manzana, remolacha, trigo sarraceno, trigo, harina, zanahoria, cítricos, toronja, avellana, lechuga, durazno, maní, pera, espinaca, fresa, pimiento dulce, tomate, sandía, nuez, fruta de la pasión, papaya y piña. 15…”

Hevealatex-associated allergies: piecing together the puzzle of the latex IgE reactivity profile

“…Consequently, a positive sIgE against crude extracts should always be interpreted with care as it might merely reflect (cross)sensitization rather than a genuine allergy. For example, for latex, it has been shown that ubiquitous structures such as α-1,3-fucose and β-1,2-xylose bearing cross-reactive carbohydrate determinants (CCD) present on glycoproteins of plants and α-1,3fucose bearing CCD of hymenoptera venom glycoproteins [14][15][16][17][18][19] and plant profilins [15][16][17][19][20][21][22][23] can elicit a false-positive latex-sIgE results. Therefore, latex-sIgE should not be used in isolation to diagnose IgE-mediated latex allergy.…”