Natural rubber latex hypersensitivity in health care worker

 Background
 Common Antigens in Latex
 Epidemiology
 Clinical Manifestations
 Diagnosis
 Management

 Natural Rubber : a processed plant
product derived from the “cytosol”, or
latex of rubber tree
 Hevea brasiliensis

John W Yunginger. Natural Rubber Latex Allergy. In Middleton’s 7th Ed : 1019-1026 .

 Ninety percent of harvested rubber was
made into dry sheets for rubber thread
products etc.
 The remaining, dipped product, is non-
coagulated and ammoniated made for
rubber gloves, condom & balloons
 Most of allergic reactions are from dipped
products

John W Yunginger. Natural Rubber Latex Allergy. In Middleton’s 7th Ed : 1019-1026

 Rubber gloves is processed by adding various
compounds :accelerators, antioxidants, &
secondary preservatives

 Emulsion of cornstarch & coagulant are also
used

 Protein content of raw latex is about 15 mg/ml
- Latex functional unit is cis-1,4-polyisoprene,
providing structural integrity ( 60%)
- Latex cytosol contains enzymes ( 40%)

John W Yunginger. Natural Rubber Latex Allergy. In Middleton’s 7th Ed : 1019-1026

Balloon
Bandages ( adhesive)
Blood pressure cuffs
Condoms
Dental dam
Diaphragms
Elastic
Gloves
Pacifiers
Tourniquets

Adapted from American Latex Allergy Association .
http://www.latexallergyresources.org/topics/. Accessed on Oct
28,2012

 General population incidence is 1-2 %
 High risk group
- patient with spina bifida, the highest
incidence 20-67 %
- health care workers especially working in operating
room, laboratories, or hemo-dialysis centre
- atopic patient
- patient with multiple surgeries
- hand dermatitis
- food associated latex allergy
Teylor JS, Erek E. Latex allergy: diagnosis and management. Dermatol Ther. 2004; 17(4):289-301
Wakelin SH, White IR. Natural rubber latex allergy. Clin Exp Dermatol. 1999; 24(4):245-248

Adapted from American Latex Allergy Association .
http://www.latexallergyresources.org/topics/.
Accessed on Oct 28,2012

 Proteins present in raw latex & rubber products
 Leached from rubber gloves by skin moisture
 Be adsorbed to powder inside gloves,
becoming airborne
 Respirable particles can be shed from
powder-free latex gloves
 FDA :
Powder glove ; < 120 mg of powder
Powder-free glove ; < 2 mg of powder

Occup Environ Med 2001; 58:479-481

Clinical and Experimental Allergy 2008;38:898-912

Material & Method
- Health care worker have used gloves
- Fujita Health University Hospital
- SPT with NRL glove extracts & recombinant
allergens
- Diagnosis : symptom when expose to latex
& SPT + or NRL glove-use test +
- Extract of glove : 1 gm into 5ml of phosphate
buffer saline Ph 7.2
- Measure allergen by ASTM D 5712-95 method
- FITkit used to calculate individual allergen

Allergology International 2009;58:347-355

Allergology International 2009;58:347-355

Allergology International 2009;58:347-355 .

AllergolInternational 2009;58:347-355

 Hev b 6.02 is the most common allergen
among HCWs sensitized occupationally

 To analyze the prevalence of latex allergy
 To describe characteristics of health care
worker who has latex allergy

 A self-administered questionnaire : work
activity, history of symptoms, allergic
reaction to latex products
 Skin prick test : commercial latex extracts
 Serum specific IgE to latex

Total workers
620
J Investig Allergol Clin Immunol 2011; 21(6): 459-465

Allergic to latex (%) Non-Allergic to latex (%)


-The prevalence of latex allergy is 5.9%

Mukda Vangveeravong MD, Jintana Sirikul MD
Tassalapa Daengsuwan MD

J Med AssoThai 2011; 94(Suppl. 3): S1-S8

 Study the prevalence of latex-related
symptoms
 Study latex-sensitization
 Study risk factors


 A cross-sectional study
 Dental students
 Faculty of dentistry, Chulalongkorn
University
 Dec 2007-May 2008
 Questionnaires
 Skin prick test ; using 3 latex extracts
prepared from Proglove, Doctor Plus gloves
& a commercial latex allergen(Stallergens,
France)

 The prevalence of latex allergy is 5 %
 Common signs & symptoms : pruritus,
eczema & contact urticaria
 The latex sensitization rate was 14.2%
 Risk factors : personal history of allergic
disease, duration & frequency of exposure
 Primary prevention should be considered

Am Fam Physician 2009; 80(12): 1413-1418

 Rapidly increase of latex allergy from 0.5%
before 1980 to 20% in 2002 ( France)
 Thirty percent of patients had history of
symptoms suggestive of latex sensitization
 Some countries have implemented
reducing latex exposure, incidence
became decreased

Anesthesiology 2005 ; 102(5): 897-903
Ann Fr Anesth Reanim 2004;23(12):1133-43

INJ OCCUP INVIRON HEALTH 2011;17:17-23

Skin :
2.4% urticaria
4.8% rash within 1 hr
3% rash beyond contacted area

Upper respiratory tract :
5.4% coryza
3.8% sneezing spells

Lower respiratory tract :
1.5% cough
1.5% wheezing
1.4% shortness of breath

Anaphylaxis 15 ( 0.3% )

INJ OCCUP INVIRON HEALTH 2011;17:17-23

 Skin testing
- commercial extracts
- extracts of rubber products

 Latex specific IgE antibodies
- strong /weak point
- sensitivity
- specificity
- improved sensitivity by using recombinant
latex protein

 Challenge Studies
- Nasal & bronchial inhalation
- “ Use test”

 Latex avoidance
- documentation of latex sensitization
- education
- provided non-latex gloves/materials
- labeling latex products
 Latex-safe medical environment
- level of threshold limit for aeroallergen
< 0.6 ng/m3
Am J Public Health 1999;89: 1024
JACI 1998; 101: 24

Filon FL, Radman G.
Environ Med 2006;63:121

Objectives:
To evaluate incidence/prevalence of latex
related symptoms & latex sensitization
between pre & post implementation of
powder-free gloves with low latex release

 Subjects : 1040 health care workers
 At Triestle hospital, Italy
 Base line 1997-1999 , follow up in 2000-2002
 Evaluate : questionnaires, physical exam,
skin prick test & serum specific IgE antibody
 Measure : prevalence of latex related
symptoms, sensitization

 Participants characteristics who have
symptoms related to latex glove use
- work seniority
- work place ; OR, lab, surgery ward
- latex glove use per day
 Odd ratio of possible risk factor and glove
related symptom
- SPT to latex
- SPT to inhalant allergen
- personal atopy
- family history of atopy
- being female
Environ Med 2006;63:121

Avoidance of unnecessary glove utility
Non-powder latex glove in all workers
Non-latex glove in sensitization workers

Stop worsening latex symptom
Prevent new case of sensitization

 Subcutaneous immunotherapy with natural
rubber latex : decreases skin & respiratory
symptoms but induces systemic reaction

 Sublingual immunotherapy with a
commercial NRL extract : safe &
efficacious ( pediatric patient)

JACI 2006; 6: 96
Euv Ann Allergy Clin Immunol 2008;40(4):142-147

 Latex allergy increased in the past decades following
“ universal precaution” policy

 High risk group are health care workers & patients with spina bifida

 Latex gloves vary in their latex allergen & particles from powdered
latex gloves produce airborne latex allergen

 Diagnosis requires history , SPT, latex-sIgE Ab
or challenge testing

Optimal management includes education & avoidance of latex
products

Natural rubber latex hypersensitivity in health care worker

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Natural rubber latex hypersensitivity in health care worker