Latex Contact Research Articles

Hazards of Natural Rubber's MBT and Latex Contact in Injections.

Hazards of Natural Rubber's MBT and Latex Contact in Injections.

A notodontid novelty: Theroa zethus caterpillars use behavior and anti-predator weaponry to disarm host plants.

Unlike most notodontids, Theroa zethus larvae feed on plants that emit copious latex when damaged. To determine how the larvae overcome this defense, we filmed final instars on poinsettia, Euphorbia pulcherrima, then simulated their behaviors and tested how the behaviors individually and combined affect latex exudation. Larvae initially scraped the stem, petiole, or midrib with their mandibles, then secreted acid from their ventral eversible gland (VEG) onto the abraded surface. Scraping facilitated acid penetration by disrupting the waxy cuticle. As the acid softened tissues, the larvae used their mandibles to compress the plant repeatedly, thereby rupturing the latex canals. Scraping, acid application, and compression created withered furrows that greatly diminished latex exudation distal to the furrows where the larvae invariably fed. The VEG in notodontids ordinarily serves to deter predators; when attacked, larvae spray acid aimed directly at the assailant. Using HPLC, we documented that the VEG secretion of T. zethus contains 30% formic acid (6.53M) with small amounts of butyric acid (0.05M). When applied to poinsettia petioles, the acids caused a similar reduction in latex outflow as VEG secretion milked from larvae. VEG acid could disrupt latex canals in part by stimulating the normal acid-growth mechanism employed by plants to loosen walls for cell elongation. Histological examination of cross sections in poinsettia midribs confirmed that cell walls within furrows were often highly distorted as expected if VEG acids weaken walls. Theroa zethus is the only notodontid caterpillar known to use mandibular scraping and VEG acid to disable plant defenses. However, we document that mandibular constriction of petioles occurs also in other notodontids including species that feed on hardwood trees. This capability may represent a pre-adaptation that facilitated the host shift in the Theroa lineage onto latex-bearing plants by enabling larvae to deactivate laticifers with minimal latex contact.

Kounis syndrome as a result of anaphylactic reaction to diclofenac sodium: A case report

Kounis syndrome refers to acute coronary syndromes of varying degrees (myocardial ischaemia to infarction) induced by mast cell activation as a result of allergic and anaphylactic reactions. Following subclinical, acute or chronic allergic reactions, it has a clinical spectrum ranging from chest pain to ST segment elevated myocardial infarction. The trigger of the allergic reaction can be drugs, food, environmental factors (insect bite, bee sting, pollen, latex contact). We present a case of a patient who developed Kounis syndrome as a result of anaphylactic reaction to Voltaren (Diclofenac sodium) which is one of the drugs widely used in the emergency departments as intramuscular pain killer.

UK rates of occupational skin disease attributed to rubber accelerators, 1996-2012.

Natural and synthetic rubbers containing rubber accelerators are well-known causes of allergic contact dermatitis (ACD). Latex contact urticaria (CU) has been widely reported, especially when powdered latex glove use was commonplace. Consequently, interventions to reduce latex exposure by altering glove manufacture were introduced. This study aimed to analyse trends in UK-reported incidence of occupational skin disease associated with rubber accelerators. We analysed cases reported to EPIDERM (part of The Health and Occupation Research network) of occupational ACD caused by natural and synthetic rubber products, between 1996 and 2012. For the studied period, a decreasing incidence of ACD associated with rubber products was found, with an average annual change of -1.2% [95% confidence interval (CI) -3.1 to 0.7]. The number of cases of latex CU (n = 580) significantly declined. The number of cases of ACD caused by mercapto mix and mercaptobenzothiazole (n = 177) and thiuram mix (n = 603) also declined. Reports of ACD associated with carba mix and its constituents (n = 219) increased significantly, by an average annual percentage of 10.1% (95%CI: 6.1-14.2). Twenty-six cases of ACD caused by rarer rubber compounds were identified, highlighting skin disease attributable to less widely recognized chemicals. These data show a falling reported incidence of occupational ACD attributed to rubber chemicals, but within this a significant rise attributable to the constituents of the carba mix. Clinicians should recognize the changing diversity of chemicals used in rubber manufacturing, and consider including carba mix in their baseline series and testing beyond this in suspect cases to avoid false-negative results.

Sonographically Guided Deep Plantar Fascia Injections

To determine the distribution of sonographically guided deep plantar fascia injections in an unembalmed cadaveric model. A single experienced operator completed 10 sonographically guided deep plantar fascia injections in 10 unembalmed cadaveric specimens (5 right and 5 left) obtained from 6 donors (2 male and 4 female) aged 49 to 95 years (mean, 77.5 years) with a mean body mass index of 23.2 kg/m(2) (range, 18.4-26.3 kg/m(2)). A 12-3-MHz linear array transducer was used to direct a 22-gauge, 38-mm stainless steel needle deep to the plantar fascia at the anterior aspect of the calcaneus using an in-plane, medial-to-lateral approach. In each case, 1.5 mL of 50% diluted colored latex was injected deep to the plantar fascia. After a minimum of 72 hours, study coinvestigators dissected each specimen to assess injectate placement. All 10 injections accurately placed latex adjacent to the deep side of the plantar fascia at the anterior calcaneus. However, the flexor digitorum brevis (FDB) origin from the plantar fascia variably limited direct latex contact with the plantar fascia, and small amounts of latex interdigitated with the FDB origin in 90% (9 of 10). In all 10 specimens, latex also covered the traversing first branch of the lateral plantar nerve (FBLPN, ie, Baxter nerve) between the FDB and quadratus plantae muscles. No latex was found in the plantar fat pad or plantar fascia in any specimen. Sonographically guided deep plantar fascia injections reliably deliver latex deep to the plantar fascia while avoiding intrafascial injection. However, the extent of direct plantar fascia contact is variable due to the intervening FDB. On the contrary, the traversing FBLPN is reliably covered by the injection. Deep plantar fascia injections may have a role in the management of refractory plantar fasciitis, particularly following failed superficial perifascial or intrafascial injections, in cases of preferential deep plantar fascia involvement, or when entrapment/irritation of the distal FBLPN is suspected.

Intérêt d’une technique multiplex pour l’identification du profil de sensibilisation chez une patiente présentant une rhino-conjonctivite liée à des polysensibilisations polliniques, associée à de multiples allergies alimentaires

We report the case of a patient suffering of rhinoconjonctivitis related to multisensitizations to pollens and of chronic asthma exacerbated by the exposition to moists, irritative agents and latex contact. She also presented food allergy such as oral syndrome and urticaria. The sensitization profile of the patient was studied by ISAC biochip. We showed that the food manifestations were mostly related to PR-10 proteins of birch, apple, chust without any sensitization to the LTP proteins with a possible role of the banana profillin. The sensitization to latex observed by conventional IgE ImmunoCAP was limited to the profillin. Our results suggest that the sensitization profile of the patient is not in favour of a risk of severe systemic reactions.

Allergic skin disease: investigation of both immediate‐ and delayed‐type hypersensitivity is essential

In our clinic we routinely patch test patients referred from occupational health for the investigation of latex contact urticaria. We also undertake both patch and prick testing (where indicated) in patients referred with persistent dermatitis/eczema. If investigation of allergic skin disease is undertaken by a non-dermatologist, it is unlikely that patch testing will be performed. To carry out a retrospective analysis of patients who had been prick tested to establish whether an incomplete diagnosis would have been reached if patch testing had been omitted. Details of patients who had attended for patch testing between July 2004 and December 2005 were analysed. Patients who had had prick tests and patch testing were identified. The outcomes of prick tests and patch testing were documented together with the clinical relevance. Three hundred and thirty out of 1060 patients referred to the clinic were prick tested. 54.2% patients were referred from dermatologists. 26.6% were referred from occupational health, 68 patients had positive reactions on prick testing of whom 36 had positive patch tests (52.9%), which were of current relevance in 27 patients (39.7%). Nine out of 106 health workers referred to exclude latex contact urticaria had positive prick tests to latex. Fifty of these patients demonstrated delayed-type hypersensitivity with nickel, cobalt, rubber and its additives being the most common allergens found. Of the 262 patients who had negative prick tests, 121 had positive patch tests (46.1%) of current relevance to patient history in 92 subjects (35.1%). While none of the six patients referred for investigation of reaction to local anaesthetics had a positive prick test, one was allergic to local anaesthetic on patch testing. Omission of patch testing from the investigation of allergic skin disease, even when contact urticaria may be the sole suspected diagnosis, would result in the frequent missed diagnosis of contact allergy. We recommend that patients with suspected allergic skin disease are investigated in an environment where investigation of both immediate- and delayed-type hypersensitivity can be undertaken. In particular, patients with atopic eczema, suspected latex rubber allergy, hand dermatitis (particularly occupational) and drug reactions should be targeted to receive both investigations.

Latex allergy in children: a follow-up study

Background Natural rubber latex allergy is an important health problem. Multiple contacts with latex in childhood are a risk factor. Many aspects of this disease are still unknown, one of which is the clinical outcome of these children. The aim of this study was to evaluate the clinical and epidemiological features of latex allergy and compliance with latex avoidance instructions in allergic children. Material and methods Seventeen consecutive patients with a history of latex allergy, fruit allergy or chronic urticaria were selected. The patients underwent a skin prick test and determination of specific-IgE to latex at the start and at end of the study (median follow-up: 3 years). At diagnosis, patients with a positive result to one of the tests and a clinical history of latex allergy were considered allergic; patients with a positive test but without a clinical history suggestive of allergy were considered sensitized. These children were given latex avoidance instructions. Results Eleven children (64.7 %) were classified as allergic and 6 (35.3 %) as sensitized. Five patients had undergone latex-free surgery after diagnosis without incident. During follow-up, 11 patients (8 allergic and 3 sensitized) had contact with latex. Contact occurred in the home in 10 children, and all were symptomatic. Specific-IgE levels to latex at the end of the study were significantly higher in patients who had contact with latex during the follow-up period than in those without latex contact. Conclusions Strict compliance with latex avoidance instructions is essential both inside and outside the hospital. Greater emphasis should be placed on reducing latex exposure in the home and school environments, as such contact could maintain positive IgE-antibody levels.

Indirect latex glove contamination and its inhibitory effect on vinyl polysiloxane polymerization

The inhibitory effect of indirect latex contamination on the polymerization of vinyl polysiloxane (VPS) impression material has been previously reported. However, the transfer of specific elements that cause inhibition has not been confirmed, nor has the removal of such contaminants been reported. This study examined the surfaces of materials commonly used in restorative procedures that were contaminated by indirect latex glove contact and then evaluated for inhibition of polymerization of VPS. The effect of selected cleansing procedures was then studied. Four experimental groups (n = 8) were prepared: (1) clean vinyl gloves (control), (2) clean gingival retraction cords (control), (3) contaminated vinyl gloves, and (4) contaminated gingival retraction cord. Microscopic evaluation of the appearance and the characterization of surface particulate contamination were performed for each. Three cleansing protocols were then evaluated for efficacy in cleaning vinyl glove surfaces contaminated by latex contact (n = 10): (1) brushing with water, (2) brushing with soap/rinsing with water, (3) cleansing with rubbing alcohol. The subsequent degree of VPS polymerization inhibition was evaluated subjectively. A chi-square test was used for data analysis (alpha=.05). Particulate sulfur elements and sulfur-chloride compounds were present on the contaminated substrates. None of the 3 cleansing procedures eliminated polymerization inhibition (P =.33). Residual elemental sulfur remained on all tested surfaces. Particulate sulfur and sulfur-chloride compounds were identified as the particulate contamination that resulted in polymerization inhibition of the tested VPS dental impression material. Removal of these contaminants from the tested vinyl gloves and gingival retraction cord was not possible with the 3 cleansing protocols tested in this study.

FC02.5 Investigation of reactions to dental materials

In dentistry there are many potential allergens and irritants. Patients may have an adverse reaction in minutes, hours or days after dental procedures. Dentists use many metals e.g. mercury in amalgam restorations, which may give an oral lichenoid eruption, and gold, and platinum group metals for inlays, crowns or bridges, which may give allergic reactions. Dentists, for dentures, use acrylate resins extensively and traces of which can give rise to allergic symptoms, though most cases are not ‘allergic’ in origin. Dental personnel have a high frequency of occupational skin problems and may complain of hand dermatitis or itching, facial eruptions or respiratory symptoms. With regard to oral lichenoid lesions, the proportion of patients allergic to mercury on patch testing varies according to series, from 67% down to 8%. In some cases, the mechanism can be irritant as well as allergic. Gold can cause lichenoid eruption or other changes. The role of palladium is still very difficult to judge. Cheilitis is particularly difficult to investigate, as there are many causes. The aetiology is irritant in 33%, allergic contact dermatitis in 25% and atopic eczema in 20%. Benzoates, antioxidants or flavourings in foods sometimes cause lip swelling. Hand dermatitis is common in dental personnel. Common causes are irritancy, latex contact urticaria, and allergic contact dermatitis to acrylates, Myroxolon, fragrance, thiuram and colophonium. In the investigation of reactions in dental patients many things need to be considered and often the cause is not related to the dental materials suspected.

Latex and banana allergies in children with myelomeningocele in the city of Rio de Janeiro

Recently, latex type I hypersensibility reactions were frequently described, mainly in children with myelomeningocele (MMC), which maintain earlier intimate and frequent contact with latex products. Allergic food cross-reactions are well known for many years. Nowadays, latex allergy is frequently associated with food allergies to avocado, banana, kiwi, grapefruit, papaya, chestnut and peach. The objective of this study consisted in identifying the number of patients with myelomeningocele (MMC) and banana-latex clinico-laboratorial sensitization. Questionnaires were applied to 33 children with MMC and blood was collected from 30 to perform latex IgE (RAST Pharmacia), and from 29 to banana IgE. Specific IgE equal or above class I was considered positive. Four children related histories of latex contact urticaria, and one child related a history of urticaria and diarrhea with banana. 14/30 (46.6%) were latex IgE positive, and 4/29 (13.7%) to banana. There was no statistically significant association between variables. We identified high prevalence of latex and banana allergies in patients with MMC and we need more studies to analyze the prevalence of food-latex allergic cross-reactions in children with MMC.

Atopie et urticaire de contact au latex chez l’enfant: Etude chez 27 malades de moins de 15 ans

Although natural rubber latex hypersensitivity is considered as a major problem in adult, it may be still misdiagnosed in childhood. We collected 27 observations of natural rubber latex contact urticaria in children under 15 Years of age, 21 of them aged under 8. All of them where atopic and 19 out of 27 presented with other association paroxystic signs of immediate hypersensitivity, that were lately related to latex allergy (i. e. asthma, rhinitis, conjunctivitis, fainting). Cross-allergy to food allergens was present in 33 p. 100. Average level of specific IgE to natural rubber latex was 21.7 kU/l. One to 4 Years follow up confirmed the benefit of latex eviction on urticaria as well as on associated symptoms. It led to the early detection of ficus allergy in 4 of them. This series confirms that atopy is at high risk for natural rubber latex allergy in children. These data suggest that atopic children are exposed too early to latex devices such as pacifiers, toodles of latex toys. Contact urticaria in children must be considered as a possible marker of other respiratory or general symptoms that may have been misconsidered under other etiologies.

Profil des allergies respiratoires et dermatologiques chez le personnel de santé au Maroc

Health care personnel are confronted in their work to a variety of risks: biological, chemical, physical and allergic. The aim of this study was to assess the prevalence of asthma and allergic disorders, as well as reactions to latex and antiseptics in hospitals and health care centers in eight cities in Morocco. This door-to-door cross sectional study was carried out from May to August 2001. A self-administered, anonymous questionnaire was used to collect the data. Of the 3906 individuals screened, 2831 were included. 53.8% were female, 46.2% male; 16.6% were physicians, 55.5% paramedics, 14.9% manual workers, 11.3% administrators and 1.7% were biologists. The response rate was 73.2%. The mean age was 40.5 years. Prick tests (PT) were done in 496 patients only; the allergenic extracts used included Dermatophagoides pteronyssinus and D. farinae, five grass pollen mix, German cockroach and latex (Stallergenes). The data were analyzed using Epi-Info 6 software. The prevalence of asthma, rhinitis, conjunctivitis, eczema and urticaria was, respectively, 10.4%, 22.8%, 17.4%, 14.0% and 13.5%. A history of drug allergy was reported by 10.7% of the patients; 7.3% reported allergy to an antibiotic. Clinical reactions to latex were reported by 7.1%, to formaldehyde by 7.4% and to glutaraldehyde by 1.0%. The positive PT rate to latex was 5.2%. The prevalence rate of the above-mentioned disorders was significantly higher in patients reporting a parental or familial history of atopy, as well as in women and in biologists. Asthma was considered to be occupational in 2% of the subjects. The prevalence of asthma, rhinitis, conjunctivitis as well as allergy to latex and formaldehyde did not vary significantly according to the city of residence. Latex contact caused urticaria in 5.1%, rhinitis in 3.9%, eczema in 3.1%, conjunctivitis in 2.1%, difficulty in breathing with wheezing in 1.0% and anaphylactic shock in 0.1% of the subjects. Our results show that the risk of allergies in health care personnel in Morocco exists and allergies are of sufficient prevalence that attention must be directed to identifying the risk factors and strategies developed for their management and prevention.

Allergic Reactions to Latex in Myelodysplasia: A Review of the Literature

Current research has identified clinically relevant allergens in natural latex. Children with myelodysplasia are especially considered to be at risk for the development of immunoglobulin E-mediated hypersensitivity, which can lead to life-threatening intraoperative anaphylaxis. A careful medical history is mandatory to identify patients who might be predisposed to anaphylactic reactions. Preventive measures involve primarily the avoidance of latex contact at home and in hospitals for all patients with myelodysplasia. The effectiveness of additional pharmacologic prophylaxis has to be determined further.

Comparison of latex hypersensitivity among patients with neurologic defects

Background: Latex hypersensitivity has been described in discrete populations including health care workers and children with spina bifida (SB). Objective: This study was designed to determine whether the SB population is a unique neuroimmunologic group manifesting this sensitivity. Methods: Four groups of subjects were studied. These included: 36 patients with SB with or without clinical evidence of latex hypersensitivity, 50 patients with spinal cord injury (SCI), and 10 patients with cerebrovascular accidents (CVAs), all of whom were questioned regarding contact with and possible clinical allergic reactions to latex. Ten healthy control subjects were also studied. We used a latex sap extract, previously shown to react with latex-specific IgE in a biotin-avidin ELISA, to determine latex-specific IgE antibody titers and to compare the groups. Results: Responses to questionnaires indicated that neither the patients with SCI nor the patients with CVA had histories suggestive of latex hypersensitivity. In contrast, 72% of the SB population had histories of clinical latex allergy. Comparisons of latex contact among the SB, SCI, CVA, and control groups revealed that the SB and SCI groups had similar latex exposure, whereas the other groups had less exposure. Both the SB and SCI groups had an average of two surgical procedures per year, which was greater than the average for the other groups. Comparisons of IgE latex antibody titers among the groups indicated that only the SB group had significant levels. The mean optical density values for each group were: 0.299 ± 0.177 for patients with SB and positive skin prick test results, 0.072 ± 0.066 for patients with SB and negative skin prick test results, 0.098 ± 0.005 in patients with SCI, 0.073 ± 0.038 in patients with CVA, and 0.053 ± 0.034 in control subjects. The percentages of positive latex IgE antibody detection were 72% for SB, 4% for SCI, 0% for CVA, and 0% for control groups. Conclusions: The results suggest that the SB population is unique in demonstrating IgE responses to latex contact, which may be due to increased latex exposure or altered neuroimmunologic interactions. (J A LLERGY C LIN I MMUNOL 1995;95:950-4.)

THE INDUSTRY PERSPECTIVE ON LATEX

Development of the medical glove has revolutionized protection of health care providers and patient. The manufacture of latex gloves involves the combination of a complex raw material, a variety of chemical additives, and multiparameter processes developed to meet customer requirements. Dermal compatibility issues related to these chemicals have been known since the 1930s, when the first cases of irritant and allergic contact dermatitis due to a variety of rubber products were first documented. With occupational exposure to hepatitis and HIV, there has been a re-emphasis on the importance of hand protection. As would be expected, the increased glove usage has resulted in an increase in frequency of irritant and allergic contact dermatitis (delayed Type IV); however, it is the occurrence and rising incidences of immediate Type I hypersensitivity to allergenic proteins from natural rubber that have caused the greatest concern. Research on this issue is slowed because sensitized individuals recognize different peptide antigens and not all have routine (consistent) latex contact, occupational or otherwise. It is proposed in this article that the cause is multifaceted. This additive approach includes agricultural yield, ripening and fumigation practices, environmental-protection concerns, exposure to powder vehicles of inflammation, chemical contact sensitizers and protein allergens, hospital sterilization practices, rapid supply-demand resolution (i.e., use of poor quality gloves), and increased latex exposure. The result is that individuals become more susceptible and are exposed to more sensitizing allergens, which pushes them toward their threshold of reaction decades before the amount of exposure would have reached the same level in the past. To provide a safe, functional hand covering, manufacturers must endeavor to create hand protection that is durable, biocompatible, and effective. Protection of the health care provider and patient is the primary concern.

Latex allergy: an unfamiliar cause of intra‐operative cardiovascular collapse

We describe severe latex allergy in an 8-year-old girl undergoing elective orthopaedic surgery and anaesthesia. Sudden, profound cardiorespiratory collapse occurred 40 min after induction. During the 1 h period of resuscitation the child required a total of 14.5 ml adrenaline 1 in 10,000. A subsequent latex radioallergosorbent test was very strongly positive. Two weeks later the child presented again for surgery. Neoprene surgical gloves were used and all latex products eliminated from the anaesthetic equipment. Latex contact was strictly avoided during drug preparation and administration. This time the intra-operative course was uneventful.

Control of airborne latex by use of powder-free latex gloves

Objective: Our objective was to assess airborne latex allergen exposure in the workplace of a hospital laboratory technician with occupational latex sensitization and repeated anaphylactic episodes from this. Her allergic manifestations had cleared only when coworkers changed to powder-free latex gloves. Therefore a laboratory still using powdered latex gloves was selected for comparative airborne latex sampling. Design: The design was a survey. Setting: We used a hospital hematology laboratory, and a biochemistry laboratory was used for comparison. Participants: The index case with latex allergy is described. An average of 10 employees worked on the day shift in the same laboratory, and 10 employees worked in the biochemistry laboratory studied. Main outcome measure: Airborne latex allergen levels obtained by high airflow area sampling were compared in the laboratory using powder-free latex gloves and in the laboratory using powdered latex gloves. Results: Levels were below the level of detection (<0.02 ng/m 3 of latex allergen) in the laboratory using powder-free latex gloves but ranged from 39 to 311 ng/m 3 in the laboratory using powdered gloves. Conclusions: Airborne latex allergen is produced with use of powdered latex gloves. Such usage by coworkers may provoke respiratory and anaphylactic response to latex in sensitized subjects. Use of powder-free gloves by coworkers may enable such patients to continue work in their trained profession and may prevent measurable airborne latex exposure. Affected patients, however, still need to avoid direct latex contact. (J A LLERGY C LIN I MMUNOL 1994;93:985-9.)

Latex Allergy: Recognition and Management of a Modern Problem

Within the past decade, anaphylaxis from latex products has been a recognized clinical crisis. Immediately after contact with latex, the patient can experience urticaria, nasorhinitis, conjunctivitis, asthma, hypotension, and shock. Health care workers, children with spina bifida, patients with a history of urogenital procedures, and employees of rubber manufacturing plants have the highest incidence. The most common denominators include frequent contact with latex and a history of allergies, although cases without these components have been reported. The increased incidence is linked to the increase of glove and condom use in preventing the spread of the HIV virus. Sensitization to the natural rubber protein is the allergen, although the specific protein has not been isolated. A thorough medical and surgical history and a history of previous allergies and allergic events should be collected on all patients with complaints of any latex contact symptoms. Latex-sensitive patients should wear a Medic Alert bracelet and carry an epinephrine autoinjector kit. Health care providers must be alert for the possible occurrence of latex sensitivities in their patients.

Basophil histamine release and lymphocyte proliferation tests in latex contact urticaria

Basophil histamine release and lymphocyte proliferation tests were examined with latex allergen prepared from surgical gloves in 15 patients with latex contact urticaria. The basophil histamine release test (BHRT) yielded positive results in 13/14 (93%) patients, whereas commercial latex RAST was positive in only 9/15 (60%) patients. Lymphocyte proliferation test (LPT) was positive in 3/15 (20%) patients, suggesting that cell-mediated immune reactions may also occur in latex allergy. However, patch tests to latex were negative and neither were epidermal Langerhans cells able to present latex antigen to T lymphocytes in vitro.