Natural rubber latex hypersensitivity in health care worker

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Presented by Theerapan Songnuy, MD.

November2, 2012

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Natural rubber latex hypersensitivity in health care worker

  1. 1. Theerapan Songnuy
  2. 2.  Background Common Antigens in Latex Epidemiology Clinical Manifestations Diagnosis Management
  3. 3.  Natural Rubber : a processed plant product derived from the “cytosol”, or latex of rubber tree Hevea brasiliensisJohn W Yunginger. Natural Rubber Latex Allergy. In Middleton’s 7th Ed : 1019-1026 .
  4. 4.  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 productsJohn W Yunginger. Natural Rubber Latex Allergy. In Middleton’s 7th Ed : 1019-1026
  5. 5.  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
  6. 6. Balloon Bandages ( adhesive) Blood pressure cuffs Condoms Dental dam Diaphragms Elastic Gloves Pacifiers TourniquetsAdapted from American Latex Allergy Association .http://www.latexallergyresources.org/topics/. Accessed on Oct 28,2012
  7. 7.  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 allergyTeylor JS, Erek E. Latex allergy: diagnosis and management. Dermatol Ther. 2004; 17(4):289-301Wakelin SH, White IR. Natural rubber latex allergy. Clin Exp Dermatol. 1999; 24(4):245-248
  8. 8. Adapted from American Latex Allergy Association .http://www.latexallergyresources.org/topics/.Accessed on Oct 28,2012
  9. 9.  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 powderOccup Environ Med 2001; 58:479-481
  10. 10. Clinical and Experimental Allergy 2008;38:898-912
  11. 11. Clinical and Experimental Allergy 2008;38:898-912
  12. 12. 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 phosphatebuffer saline Ph 7.2- Measure allergen by ASTM D 5712-95 method- FITkit used to calculate individual allergen Allergology International 2009;58:347-355
  13. 13. Allergology International 2009;58:347-355
  14. 14. Allergology International 2009;58:347-355
  15. 15. Allergology International 2009;58:347-355 .
  16. 16. Allergology International 2009;58:347-355
  17. 17. Allergology International 2009;58:347-355
  18. 18. AllergolInternational 2009;58:347-355
  19. 19. Allergology International 2009;58:347-355
  20. 20.  Hev b 6.02 is the most common allergen among HCWs sensitized occupationally
  21. 21.  To analyze the prevalence of latex allergy To describe characteristics of health care worker who has latex allergy
  22. 22.  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
  23. 23. Total workers 620J Investig Allergol Clin Immunol 2011; 21(6): 459-465
  24. 24. J Investig Allergol Clin Immunol 2011; 21(6): 459-4
  25. 25. J Investig Allergol Clin Immunol 2011; 21(6): 459-465
  26. 26. J Investig Allergol Clin Immunol 2011; 21(6): 459-465
  27. 27. J Investig Allergol Clin Immunol 2011; 21(6): 459-465
  28. 28. J Investig Allergol Clin Immunol 2011; 21(6): 459-465
  29. 29. Allergic to latex (%) Non-Allergic to latex (%) J Investig Allergol Clin Immunol 2011; 21(6): 459-465
  30. 30. -The prevalence of latex allergy is 5.9%
  31. 31. Mukda Vangveeravong MD, Jintana Sirikul MDTassalapa Daengsuwan MD J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  32. 32.  Study the prevalence of latex-related symptoms Study latex-sensitization Study risk factorsJ Med AssoThai 2011; 94(Suppl. 3): S1-S8
  33. 33.  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) J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  34. 34. J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  35. 35. J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  36. 36. J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  37. 37. J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  38. 38. J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  39. 39. J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  40. 40. J Med AssoThai 2011; 94(Suppl. 3): S1-S8
  41. 41.  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 consideredJ Med AssoThai 2011; 94(Suppl. 3): S1-S8
  42. 42. Am Fam Physician 2009; 80(12): 1413-1418
  43. 43.  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 decreasedAnesthesiology 2005 ; 102(5): 897-903Ann Fr Anesth Reanim 2004;23(12):1133-43
  44. 44. INJ OCCUP INVIRON HEALTH 2011;17:17-23
  45. 45. INJ OCCUP INVIRON HEALTH 2011;17:17-23
  46. 46. INJ OCCUP INVIRON HEALTH 2011;17:17-23
  47. 47. Skin : 2.4% urticaria 4.8% rash within 1 hr 3% rash beyond contacted areaUpper respiratory tract : 5.4% coryza 3.8% sneezing spellsLower respiratory tract : 1.5% cough 1.5% wheezing 1.4% shortness of breathAnaphylaxis 15 ( 0.3% )INJ OCCUP INVIRON HEALTH 2011;17:17-23
  48. 48.  Skin testing - commercial extracts - extracts of rubber products
  49. 49.  Latex specific IgE antibodies - strong /weak point - sensitivity - specificity - improved sensitivity by using recombinant latex protein
  50. 50.  Challenge Studies - Nasal & bronchial inhalation - “ Use test”
  51. 51.  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/m3Am J Public Health 1999;89: 1024JACI 1998; 101: 24
  52. 52. Filon FL, Radman G. Environ Med 2006;63:121Objectives: To evaluate incidence/prevalence of latex related symptoms & latex sensitization between pre & post implementation of powder-free gloves with low latex release
  53. 53.  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
  54. 54. Environ Med 2006;63:121
  55. 55.  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
  56. 56. Environ Med 2006;63:121
  57. 57. Environ Med 2006;63:121
  58. 58. Avoidance of unnecessary glove utilityNon-powder latex glove in all workersNon-latex glove in sensitization workers Stop worsening latex symptom Prevent new case of sensitization
  59. 59.  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: 96Euv Ann Allergy Clin Immunol 2008;40(4):142-147
  60. 60.  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 testingOptimal management includes education & avoidance of latex products
  61. 61. THANK YOU VERY MUCH

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