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Natural  rubber latex hypersensitivity in health care worker
 

Natural rubber latex hypersensitivity in health care worker

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Presented by Theerapan Songnuy, MD.

Presented by Theerapan Songnuy, MD.

November2, 2012

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    Natural  rubber latex hypersensitivity in health care worker Natural rubber latex hypersensitivity in health care worker Presentation Transcript

    • Theerapan Songnuy
    •  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 brasiliensisJohn 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 productsJohn 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 TourniquetsAdapted 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 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
    • 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 powderOccup Environ Med 2001; 58:479-481
    • Clinical and Experimental Allergy 2008;38:898-912
    • 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 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
    • Allergology International 2009;58:347-355
    • Allergology International 2009;58:347-355
    • Allergology International 2009;58:347-355 .
    • Allergology International 2009;58:347-355
    • Allergology International 2009;58:347-355
    • AllergolInternational 2009;58:347-355
    • Allergology International 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 620J Investig Allergol Clin Immunol 2011; 21(6): 459-465
    • J Investig Allergol Clin Immunol 2011; 21(6): 459-4
    • J Investig Allergol Clin Immunol 2011; 21(6): 459-465
    • J Investig Allergol Clin Immunol 2011; 21(6): 459-465
    • J Investig Allergol Clin Immunol 2011; 21(6): 459-465
    • J Investig Allergol Clin Immunol 2011; 21(6): 459-465
    • Allergic to latex (%) Non-Allergic to latex (%) J Investig Allergol Clin Immunol 2011; 21(6): 459-465
    • -The prevalence of latex allergy is 5.9%
    • Mukda Vangveeravong MD, Jintana Sirikul MDTassalapa Daengsuwan MD J Med AssoThai 2011; 94(Suppl. 3): S1-S8
    •  Study the prevalence of latex-related symptoms Study latex-sensitization Study risk factorsJ Med AssoThai 2011; 94(Suppl. 3): S1-S8
    •  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
    • J Med AssoThai 2011; 94(Suppl. 3): S1-S8
    • J Med AssoThai 2011; 94(Suppl. 3): S1-S8
    • J Med AssoThai 2011; 94(Suppl. 3): S1-S8
    • J Med AssoThai 2011; 94(Suppl. 3): S1-S8
    • J Med AssoThai 2011; 94(Suppl. 3): S1-S8
    • J Med AssoThai 2011; 94(Suppl. 3): S1-S8
    • J Med AssoThai 2011; 94(Suppl. 3): S1-S8
    •  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
    • 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 decreasedAnesthesiology 2005 ; 102(5): 897-903Ann Fr Anesth Reanim 2004;23(12):1133-43
    • INJ OCCUP INVIRON HEALTH 2011;17:17-23
    • INJ OCCUP INVIRON HEALTH 2011;17:17-23
    • INJ OCCUP INVIRON HEALTH 2011;17:17-23
    • 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
    •  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/m3Am J Public Health 1999;89: 1024JACI 1998; 101: 24
    • 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
    •  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
    • Environ Med 2006;63:121
    •  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
    • Environ Med 2006;63:121
    • Environ Med 2006;63:121
    • 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
    •  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
    •  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
    • THANK YOU VERY MUCH