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Latex-associated allergies and anaphylactic reactions

Profile image of Benjamin FisherBenjamin Fisher

1992, Clinical Immunology and Immunopathology

https://doi.org/10.1016/0090-1229(92)90185-Q
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Abstract

The recent reports of severe anaphylactic reactions and several fatalities caused by contact with latex-containing products raised concerns in the medical community. Although hypersensitivity to natural rubber has been widely reported in the literature, the prevalence and severity of reactions have rapidly increased in the last few years. Latex proteins, constituents of natural latex, appear to be responsible for the sensitization. Many investigators, including our laboratory, are focused on the identification of proteins in raw latex and latex products, specifically those responsible for the elicitation of allergic responses. This paper summarizes available information on the mechanism and epidemiology of latex sensitivity and reviews research efforts toward the identification of the antigen(s) responsible for the reactions. The questions of proper diagnosis and testing, heightening awareness, and prevention of reactions are also addressed.

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Summary of appropriate measures to prevent natural rubber latex allergy
Xaver Baur

Allergology International, 1999

This paper presents a short overview of the diagnostics and background of type I allergy to natural rubber latex proteins and makes recommendations for preventing corresponding allergic diseases in the future. These recommendations and prevention strategies are based on the current knowledge of latex allergy presented in the literature and are addressed to legislative bodies; manufacturers; directors of hospitals; those working at nursing facilities and physicians' and dentists' practices; as well as to other health service employees. Primary prevention is the focus but advice is also given on secondary prevention. The major preventive aim is the elimination of causative protein allergens in all latex devices and thus, the minimization of latex-related health problems.

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Allergen concentration in natural rubber latex
Hoong-Yeet Yeang

Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 2006

Background Hevea brasiliensis latex serum is commonly used as the in vivo and in vitro reference antigen for latex allergy diagnosis as it contains the full complement of latex allergens. Objective This study quantifies the concentrations of the significant allergens in latex serum and examines its suitability as an antigen source in latex allergy diagnosis and immunotherapy. Methods The serum phase was extracted from centrifuged latex that was repeatedly freezethawed or glycerinated. Quantitation of latex allergens was performed by two-site immunoenzymetric assays. The abundance of RNA transcripts of the latex allergens was estimated from the number of their clones in an Expressed Sequence Tags library. Results The latex allergens, Hev b 1, 2, 3, 4, 5, 6, 7 and 13, were detected in freeze-thawed and glycerinated latex serum at levels ranging from 75 (Hev b 6) to 0.06 nmol/mg total proteins (Hev b 4). Hev b 6 content in the latex was up to a thousand times higher than the other seven latex allergens, depending on source and/or preparation procedure. Allergen concentration was reflected in the abundance of mRNA transcripts. When used as the antigen, latex serum may bias the outcome of latex allergy diagnostic tests towards sensitization to Hev b 6. Tests that make use of latex serum may fail to detect latex-specific IgE reactivity in subjects who are sensitized only to allergens that are present at low concentrations. Conclusion Latex allergy diagnostics and immunotherapy that use whole latex serum as the antigen source may not be optimal because of the marked imbalance of its constituent allergens.

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Prospective study of risk factors in natural rubber latex hypersensitivity
Denise-anne Moneret-vautrin

Journal of Allergy and Clinical Immunology, 1993

Five hundred sixty-nine subjects routinely underwent skin prick tests for latent sensitization to latex The study of risk factors included skin tests to inhalant allergens, to diagnose atopy, and a questionnaire aimed at revealing frequent exposure to latex such as the wearing of gloves, multiple surgical procedures, or urinary catheterization. The subjects were categorized into five groups: group I, subjects with no risk factor (n = 272); group II, nonatopic subjects exposed to later (n = 73); group III, atopic subjects not exposed (n = 180); group w exposed atopic subjects (n = 44); and group v subjects with a histoly of intraoperative anaphylactic shock caused by latex (n = 13). Twenty-Jive subjects had spina bifida and were in either group II (14 subjects) or group IV (11 subjects). The questionnaire identified a probable allergy to latex in 18 subjects: 16 cases were confirmed by skin test, but responses were not informative in 23 patients who were sensitive to latex. Positive prick tests to latex were obtained in 0.37% of group I, 6.85% of group II, 9.44% of group III, and 36.36% of group n/ Of the children with spina bifida, 32% had positive skin test results. As risk factors, atopy and exposure were synergistic. We recommend predictive prick tests not on& in children with spina bifida but also in any atopic subject or in any patient with a history of frequent aposure to latex. Latex could be considered a habitual allergen. The use of latex urinary catheters should be avoided in patients who are cathetetied on a daily basis. (J ALLERGY CLIN IMMUNOL 1993;92:668-77.)

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Journal of athletic training, 2003

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Lymphocyte proliferation response to extracts from different latex materials and to the purified latex allergen Hev b 1 (rubber elongation factor)☆, ☆☆, ★, ★★
Xaver Baur

Journal of Allergy and Clinical Immunology, 1996

Background: Type I allet?gy to latex is a growing plvblem, especially among health care workers. A detailed study of the peripheral blood cell responses to latex allergens has not been reported. Methods: Peripheral blood mononuclear cells of patients and healthy subjects were isolated and stimulated with protein extracts from latex sap and latex gloves and the purified latex allergen Hey b 1 (rubber elongation facto 0 at different concentrations to determine the anngen-specific plvliferation response. The examined patients were sensitized to latex by occupational exposure tn = 23) and had rhinitis, conjunctivitis, contact umcaria, and~or asthma. Two control groups of nonsensitized subJects were studied: one occupationally exposed to latex (n -8), and the second, not exposed to latex tn = 8). Results: In general, only latex-exposed subjects responded to the different latex antigen preparanons. Lymphocyte proliferation responses to latex sap extract were found in 65% of latexsensitized subjects and in 37.5% of the latex-exposed healthy subjects. Latex glove extract induced a significant proliferative response in 47.8% of latex-sensitized patients and in 25% of latexexposed individuals. Hev b 1 induced lymphocyte proliferation responses in 52% of the latexsensitized patients' and in 25% of the latex-exposed subjects, indicating that Hev b 1 is relevant antigen in these latex-sensitized and latex-exposed groups. Peripheral blood mononuclear cells of 39.1% of the latex-sensitized subjects responded to all three allergen preparations (latex sap and latex glove extract, as well as Hey b 1). We could find no correlation between latex-specific IgE level and latex-induced lymphocyte proliferation response. Conclusion: Our data indicate that the 14 kd protein Hey b 1 is a relevant allergen in health care workers. It can be detected by specific IgE antibodies to Hey b 1. as well as in lymphocyte proliferation assay. In addition, our study suggests that antigen-specific proliferation response to latex is associated with exposure to latex, but not with the level of specific latex IgE. This may be useful for the evaluation and prediction of latex hypersensitivity development. (J Allergy Clin Immunol 1996.'98.'640-51. j

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Latex-specific proteins causing immediate-type cutaneous, nasal, bronchial, and systemic reactions
Xaver Baur

Journal of Allergy and Clinical Immunology, 1992

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AORN Journal, 2000

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Prevention of latex allergy among health care workers and in the general population: latex protein content in devices commonly used in hospitals and general practice
Lorenzo Mace

International Archives of Occupational and Environmental Health, 2006

Background: In this study the latex protein content in devices commonly used in hospitals and general practice were investigated. The main aim was to acquire information for preventing latex allergy in health care workers and in the general population. Methods: About 22 different types of medical devices and 23 devices commonly used in general practice were examined evaluating the total allergenic potency by a modified RAST-inhibition assay and quantitative determination of single allergens (Hev b1, Hev b5 and Hev b6.02) by using commercial ELISA kit. Results: A high level of inhibition was found in medical devices, such as elastic bandage (81.57%), tourniquet (74.09%), Foley urinary catheter (68.35%), Penrose drainage (67.25%) and taping (39.6%), and in common devices, such as rubber inner-sole (84.20%), toy balloon (78.62%), latex mattress (74.27%), household rubber gloves (49.10%), working gloves (38.25%), inflatable floating mattress (32.10%). Concentrations of latex extractable proteins and Hev b1, Hev b5 and Hev b6.02 antigens were high in some medical and general devices. Conclusions: Latex exposure sources were found in hospitals and the home. These findings, though only preliminary and far from conclusive, could enable sensitized persons to avoid risky exposures and prevent allergic reactions. From the point of view of prevention, the time may come when every natural rubber object could be systematically labelled as “containing latex” together with the warning that “this item may cause allergic reactions in sensitized subjects.”

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Clinical and laboratory-based methods in the diagnosis of natural rubber latex allergy
eva hamilton

Journal of Allergy and Clinical Immunology, 2002

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Natural rubber latex allergens: new developments
Hoong-Yeet Yeang

Current Opinion in Allergy and Clinical Immunology, 2004

Purpose of review New allergenic latex proteins have been identified, whereas further information on known latex allergens has emerged in recent years. Although prevalence figures for sensitization to the various latex allergens have been published in several studies in the past, the data have not been collated to facilitate crosscomparison. Recent findings Salient characteristics of the three most recently identified latex allergens, Hev b 11, 12 and 13 are described, whereas new findings on some of the previously recognized allergens are examined. Hev b 2 is viewed from the standpoint of allergenicity and protein glycosylation, Hev b 4 in relation to its biochemical identity and molecular cloning, Hev b 5 with respect to its recombinant form, and Hev b 6 in connection with conformational IgE epitopes. Reports on sensitization or allergic reaction to purified latex allergens from recent and past work are summarized. The use of latex allergens in latex allergy diagnostics is reviewed and discussed. Summary Thirteen latex allergens have been recognized by the International Union of Immunological Societies. Based on the results of published studies, native Hev b 2, recombinant Hev b 5, native or recombinant Hev b 6, native Hev b 13, and possibly native Hev b 4 are the major allergens relevant to latexsensitized adults. Although there is an increasing tendency to identify and characterize latex allergens largely on the basis of their recombinant forms, not all such recombinant proteins have been fully validated against their native counterparts with respect to clinical significance.

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Latex allergy diagnosis: in vivo and in vitro standardization of a natural rubber latex extract
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Natural rubber latex (hereafter referred as latex) allergy, an IgE-mediated hypersensitivity reaction to constituent proteins retained in finished latex products (e.g., surgical gloves), has recently been identified as an international public health problem.lm6 Latex allergy has been prevalent in patients with spina bifida, health care workers exposed frequently to latex at work, atopic patients, individuals who require frequent surgery, and workers in the latex industry.7-' However, a number of patients with severe reactions, including fatal anaphylaxis associated with latex, have not been included in these groups, suggesting that other groups of individuals are at high risk.3 A wide spectrum of clinical manifestations ranging from contact urticaria, rhinoconjunctivitis, and asthma to severe anaphylaxis including death, has been associated with latex hypersensitivity.l-' Direct mucosal contact, inhalation, and parenteral exposure to latex proteins may lead to life-threaten:ing reactions. Cutaneous exposure usually causes local reactions limited to the

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Immediate-type hypersensitivity to latex is a growing problem, especially among health care workers (HCWs) and patients requiring long-term catheterization and multiple operations. The responsible allergens are latex proteins, which are found in raw latex, as well as in various latex-containing products. More than 200 polypeptides can be discerned in latex sap and of these, 60 proteins showed reactivity with IgE antibodies from patients with latex allergy. Several of these proteins have been characterized at the molecular level and their role in latex allergy has been elucidated. Latex allergy is often associated with hypersensitivity to certain fruits and vegetables like avocado, kiwi, banana, sweet pepper, and tomato. Several case reports demonstrate a potential for serious allergic reactions to foods in latex allergic patients. Nevertheless, comprehensive studies on the clinical significance and relevance of this co-sensitization are missing. Although some of the latex allergens are ubiquitous plant proteins or share structural features with plant proteins, the molecular bases of these cross-reactivities have not yet been clarified. © 1997 Elsevier Science B.V.

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