Characteristics of the dysarthria of multiple system atrophy

Allergy to latex has become an increasing and clinically important problem during last years. Natural rubber latex (NRL) allergy has been acknowledged as a major occupation problem among health-care workers. More recently, NRL allergy also occurs in children with spina bifida and in atopic children. Even patients allergic to various fruits, such as banana and avocado may experience allergic reaction from NRL and vice versa. Different latex allergens have been characterized at the molecular level using varied techniques and heterogeneous latex materials. Little is known about prevalence and clinical relevance of latex sensitization and allergy in the general population although the incidence is increasing in children. The wide spectrum of symptoms of NRL allergy range from mild contact urticaria to asthma and anaphylactic reactions. History is an integral part to identify latex allergy. Different tests (skin prick tests, RAST, Pricking, Use test) have been used to objectively supplement the history. Latex allergy must be prevented by the standardization of medical gloves including the labeling of latex content and allergenicity; furthermore the industrial strategies may also develop new methods of less allergenic gloves and other NRL products.     

Delayed and immediate orofacial reactions following contact with rubber gloves during dental treatment

Allergic reactions during or after dental examination are uncommon. However, such reactions may be serious and distressing. Allergy to local anaesthetics and dental materials may be considered, but reactions to rubber in gloves worn by the dentist should be remembered. Two patients are reported who experienced symptoms following contact with rubber gloves worn by their dentists, with skin tests subsequently showing an allergic reaction to glove constituents, and in one case latex. With the increasing use of rubber gloves by dental and medical personnel, reactions in sensitised patients are likely to become more common. In patients with a history of symptoms related to dental work, it is important to remember delayed and immediate reactions to rubber.     

Protein affinity map of chemical space

Natural latex from the rubber tree Hevea brasiliensis is an allergen in persons with significant cumulative latex exposure, such as those in the health care and rubber industries, as well as those undergoing repeated surgeries, especially if they undergo surgeries early in life. Symptoms of latex allergy may progress rapidly and unpredictably to anaphylaxis. The prevalence of latex allergy has increased as the use of rubber gloves in health care settings has increased. Airborne latex particles that adhere to the cornstarch used to powder gloves are a significant cause of respiratory symptoms and a source of sensitization. Once an individual has become sensitized, he or she may experience allergic symptoms when exposed to any product containing latex. Diagnosis is made initially by the history. Latex-specific IgE testing and skin prick testing may confirm the suspicion. The most effective strategy in the treatment of latex allergy is avoidance; however, there is a large group of sensitized people who have not been identified and who do not recognize that their symptoms are caused by latex allergy. Physicians caring for latex-sensitive persons must act as their advocates in building awareness of the problem and developing protocols for their safe care. Latex-sensitized persons should be educated about the latex content of common objects.     

Sensitivity to latex and other rubber substances--an important occupational risk for health personnel (case report)

Sensitization to latex and rubber additives has been acknowledged during the last 10 years as a major occupational health problem among health-care workers. In sensitized persons, respiratory and/or skin symptoms may be present. Pathophysiologic mechanisms of senzitisation involve allergic reactions types I and IV (Coombs and Gell). In this case report we described a female health-care worker with sensitization to latex and rubber additives simultaneously present on the skin and in the respiratory system, caused by wearing protective rubber gloves. The complex diagnostic procedure involved in determination of occupational allergic diseases is discussed.     

Practitioner and student latex exposure and allergy

Greater application of universal precautions has increased practitioner exposure to chemicals present in personal protective equipment. Of prime concern is the latex present in examination and surgical gloves. A survey concerning latex exposure, allergies, and handwashing was administered to three advanced classes of dental students and was sent to 300 private practitioners in Central Indiana. Results indicate that adverse skin reactions to latex start while in dental school. Problems due to latex gloves were reported by 18.6 percent of the students. Student handwashing materials and methods were adequate, except for inadequate washing time. Adverse skin reactions were reported by 24.1 percent of practitioners wearing latex gloves. Two handwashing problems were noted--inadequate washing time and the common use of water instead of an antimicrobial soap after glove removal. Both students and practitioners reported relatively high levels of personal and family histories of allergy to a variety of sources.     

The blood coagulation aspects of acute infectious myocarditis]

With the increase in infectious disease epidemics and the need to protect health-care workers, the use of rubber gloves has increased twofold. Recent reports have noted an increase also in the prevalence of natural rubber latex allergy among some of these workers. A newly emerging problem, the allergy has potentially life-threatening consequences for those affected, a fact which has far-reaching ramifications for all those working in contact with latex, critical care nurses in particular. Indeed, the allergy has had a major impact on one such nurse, to the extent that she has had to relinquish her career and make significant changes to her lifestyle. Latex allergy was first recognised in 1927 but has become more prevalent in the last few years. There are two types of reactions, type I and type IV, with symptoms varying from a mild itch to anaphylaxis. Diagnosis is made via a blood or skin test, as well as a patient history. Treatment is to medicate for symptoms, while avoidance is the only way to prevent occurrences. The case study which follows reveals the impact that this allergy can have on a critical care nurse.     

Management of latex reactions in the occupational setting

1. The increased use of natural rubber latex barrier protection to prevent exposure to bloodborne pathogens has led to an increase in latex related health reactions, particularly associated with glove use. 2. The three types of reactions to latex in order of frequency include irritant contact dermatitis, allergic contact dermatitis, and immediate systemic/anaphylaxis reactions. 3. The management goal for all reactions is to avoid unnecessary restriction from the appropriate use of latex (gloves) which provides the best barrier protection, while protecting individual workers from exposure that results in sensitization or causes sensitized individuals to have serious reactions. 4. Choose non-latex gloves when barrier protection from bloodborne pathogens is not an issue. When selecting a latex glove, choose a glove that is low in proteins and powder free to control airborne latex exposure.     

Latex allergens: review of current knowledge

Both health care workers and spina bifida patients are at risk to develop type I latex allergy since allergenic proteins of natural rubber latex are present in a variety of latex products. Natural latex contains more than 250 polypeptides and approximately 60 of them show IgE-binding characteristics. A multitude of these latex allergens has been identified, and their sensitization potency for both risk groups has been determined. While hevein (Hev b 6.02) is the major allergen in latex-allergic health care workers, 80% of latex sensitized-spina bifida children have IgE antibodies to the "rubber elongation factor" (Hev b 1). Almost all relevant latex allergens have been identified in natural latex products: however, no data on the allergen profiles of individual latex products exist. The knowledge of the major latex allergens enables improved diagnosis and to monitor the success of prevention strategies for decreasing the high prevalence of latex allergies.     

Setting standards for product selection: allergy prevention

It is axiomatic to state that if products made of natural rubber latex were not used in health care settings then there would be no problems of acquired hypersensitivity from such products. Although synthetic materials are available they do not currently possess the same technical qualities of elasticity and comfort, nor do they deliver the desired degree of protection against biological agents as gloves made out of natural rubber latex. Selection of gloves either for non-sterile procedures or sterile surgical use should be based on this understanding, and gloves with minimal levels of extractable latex proteins should be used.     

Latex allergens in tire dust and airborne particles

The prevalence and severity of latex allergy has increased dramatically in the last 15 years due to exposure to natural rubber products. Although historically this health risk has been elevated in hospital personnel and patients, a recent survey has indicated a significant potential risk for the general population. To obtain a wide-spread source for latex exposure, we have considered tire debris. We have searched for the presence of latex allergens in passenger car and truck tire tread, in debris deposited from the atmosphere near a freeway, and in airborne particulate matter samples representative of the entire year 1993 at two sites in the Los Angeles basin (California). After extraction of the samples with phosphate buffered saline, a modified-ELISA inhibition assay was used to measure relative allergen potency and Western blot analyses were used to identify latex allergens. The inhibition studies with the human IgE latex assay revealed inhibition by the tire tread source samples and ambient freeway dust, as well as by control latex sap and latex glove extracts. Levels of extractable latex allergen per unit of protein extracted were about two orders of magnitude lower for tire tread as compared to latex gloves. Western blot analyses using binding of human IgE from latex-sensitive patients showed a band at 34-36 kDa in all tire and ambient samples. Long Beach and Los Angeles, California, air samples showed four additional bands between 50 and 135 kDa. Alternative Western blot analyses using rabbit IgG raised against latex proteins showed a broad band at 30-50 kDa in all samples, with additional bands in the urban air samples similar to the IgE results. A latex cross-reactive material was identified in mountain cedar. In conclusion, the latex allergens or latex cross-reactive material present in sedimented and airborne particulate material, derived from tire debris, and generated by heavy urban vehicle traffic could be important factors in producing latex allergy and asthma symptoms associated with air pollution particles.     

Latex allergy

During the last 10-15 years allergic reaction to Natural rubber latex (NLR) has become an increasing occupational problem among health-care workers. The allergy is caused by allergenic proteins in the NRL. The diagnosis is achieved through a relevant history, skin prick tests with aquous NRL glove extracts and blood tests. History and prick tests are most important. The most frequent cross-reaction is to banana. Careful instruction on prevention is a must.     

Up- and down-regulation of calpain inhibitor polypeptide, calpastatin, in postischemic hippocampus

A dental student developed swelling of the lips and peri-oral urticaria, immediately after placement of a dental rubber dam during a chairside demonstration of clinical dentistry. A provisional diagnosis of a Type I hypersensitivity reaction to natural rubber latex was made and an appointment organised for specialist investigations. The student reported an atopic history and allergy to peanuts. A Radioallergosorbent Test (RAST), to measure Ig-E antibodies to latex, was positive. The dental student was given advice concerning the avoidance of natural rubber latex. Dental staff must be aware of potentially serious reactions to natural rubber latex in the dental surgery.     

Transverse laparotomy closed with continuous absorbable loop sutures

The use of latex gloves in the health care setting dates back to the 1800s, when these products were introduced as a means of preventing the passage of microorganisms to operating room patients. Today, fear of human immunodeficiency virus transmission and other blood-borne diseases has led to implementation of standardized guidelines for glove use for health care professionals. Because of the unique combination of strength, flexibility, and elasticity of natural rubber, latex is typically the material of choice for a variety of medical products, including examination gloves. Unfortunately, routine use of latex in the health care setting may be detrimental to patients and caregivers with a history of natural rubber latex hypersensitivity reactions.     

Occupational asthma due to latex in health care workers

Immediate hypersensitivity reactions ranging from mild urticaria to life threatening anaphylaxis after exposure to natural rubber latex have been reported frequently in health care workers while occupational asthma due to latex exposure is less well studied. The results of specific challenge tests and immunological tests in four health care workers with work related respiratory and skin disorders induced by the use of latex gloves are described. Occupational asthma was confirmed in three subjects by specific challenge tests. All had a positive skin test reaction to the latex extract; specific IgE antibodies were detected in only one subject. The fourth subject had a negative specific inhalation and skin test reaction to the latex extract. Peak expiratory flow monitoring at work and away from work showed a pattern consistent with work related asthma. These findings confirm that latex is a cause of occupational asthma in health care workers.     

Psychopathological disorders and coronary diseases

BACKGROUND: Endotoxin is an inflammatory made by gram negative bacteria that can irritate the skin, induce respiratory problems, fever, and shock. It is an adjuvant for both delayed hypersensitivity and IgE production and has been shown to magnify antigen specific mediator release. Since many of the clinical problems associated with natural latex products involve similar clinical sequelae, we investigated the possibility that latex gloves might be contaminated with endotoxin. OBJECTIVE: To measure the endotoxin content of a variety of natural latex gloves, investigate the its distribution and origin, associated with latex proteins, and determine the particle sizes associated with its release. METHODS: Endotoxin, protein, and allergen were measured using a quantitative kinetic Limulus assay, modified Lowry, and RAST inhibition, respectively. Particle size and density were determined using an Anderson multistage air sampler and CsCl2 gradient. RESULTS: Endotoxin was found to be a highly significant contaminant of some latex gloves. Levels ranged from 0.09 ng to 2.8 micrograms/g of glove. Protein levels ranged from < 25 to 1150 micrograms/g of glove while allergen levels ranged from < 1 to 837 micrograms/g of glove. Endotoxin and protein eluted rapidly from the interior of the gloves tested. Greater than 70% of the endotoxin was found to be associated with particles in the < 7 microns aerodynamic diameter range. The highest levels of endotoxin were found in nonsterile examination gloves with a tendency towards powdered gloves containing more endotoxin and protein. A slurry containing cross-linked dextran through which gloves were dipped revealed very high endotoxin contamination (64 micrograms/mL) while unused cross-linked dextran has very little associated endotoxin. CONCLUSIONS: These data demonstrate that some natural rubber latex gloves, particularly nonsterile examination gloves, are contaminated with high amounts of endotoxin and proteins. These were found mostly on the inside of gloves and were released as very small respirable particles that were not physically associated with the powder. These findings support the hypothesis that endotoxin may be responsible for some of the tissue irritation associated with latex glove use. In addition, this material may be responsible for the enhancement of delayed and immediate hypersensitivity reactions to chemicals and proteins found in these products and offers a possible explanation for the disproportionate severity of these reactions.     

Examination gloves as barriers to hand contamination in clinical practice

OBJECTIVE: To test the effectiveness of vinyl and latex gloves as barriers to hand contamination with gram-negative organisms and enterococci during routine hospital procedures. DESIGN AND INTERVENTIONS: We studied 137 procedures during which a health care worker's gloved hand contacted a patient's mucous membrane and was thus potentially contaminated with gram-negative rods or enterococci. Quantitative hand cultures were obtained from each health care worker before and after the gloved contact using a modified glove juice method, and the exterior glove surface was also quantitatively cultured after patient contact. Used gloves were then tested for leaks using the American Society for Testing and Materials' watertight test. SETTING: Harborview Medical Center, a 330-bed city-county hospital and level I regional trauma and burn center, is both a teaching facility affiliated with the University of Washington and the major provider of care to indigent and uninsured persons in Seattle-King County, Washington. PATIENTS AND OTHER PARTICIPANTS: Respiratory therapists performing endotracheal tube care on intubated intensive care unit patients, registered nurses performing digital rectal stimulation for bowel training on patients with spinal cord injury in the rehabilitation ward, and dentists performing routine dental examinations and procedures on healthy outpatients in the dental clinic. MAIN OUTCOME MEASURE AND RESULTS: Eighty-six of the 135 gloves cultured had gram-negative rods or enterococci on the external surface after use and were thus sources of potential hand contamination. Microbial contamination of the health care worker's hands occurred in 11 (13%; 95% confidence interval, 6% to 20%) of these 86 events, and was more frequent with vinyl (10 of 42) than latex (one of 44) gloves (P < .01). After use, glove leaks were also more frequent in vinyl gloves (26 of 61) than with latex gloves (six of 70) (P < .001). Even when leaks were present, gloves prevented hand contamination in 77% of instances and quantitative counts of microorganisms contaminating hands were 2 to 4 logs less than counts on external glove surfaces. Health care workers reported awareness of the presence of glove leaks in only seven (22%) of the 32 events in which leaks were subsequently demonstrated. CONCLUSIONS: Under conditions of routine use, gloves effectively function as a protective barrier even when leaks are present. Latex gloves were less frequently associated with leaks and hand contamination. Since hand contamination occurred after 13% of exposures and cannot be readily identified by health care workers, routine hand washing should be done after each patient contact.     

Dental findings in an adult with Lowe's syndrome

This paper describes the dental findings and care of a Chinese adult affected with oculo-cerebro-renal syndrome--Lowe's syndrome--a rare, X-linked recessive disorder, whose clinical manifestations include cataracts, mental retardation, and renal tubular dysfunction. Approximately 150 cases have been reported in the last 45 years. Little has been reported in the dental literature. This patient is described with particular reference to the dental findings, which include gross periodontal disease with severe bone loss, impaction of teeth in the permanent dentition, taurodontism, and underdevelopment of the maxilla and mandible. Dental treatment was aimed at arresting the periodontal disease and preserving the remaining dentition.     

Type I allergies to latex and the aeroallergenic problem

Between 1989 and 1995, a 12-fold increase in latex allergy was documented amongst our patients. Similar findings have been noted elsewhere. Increase in type I allergies to latex has become an international problem. The issues associated with latex allergy are described, including those posed by the ubiquitous nature of latex in medical equipment, and in commonplace domestic objects. The potential for allergic patients to cross react to a variety of fruits or plants is an added problem for sensitized patients. This paper concludes that the universal introduction of powder-free surgical gloves with low protein content would be a very important measure in the prevention of acquired latex allergy.     

Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases

In May 1993, the US Food and Drug Administration (FDA) granted product approval for the first female condom made of polyurethane. It provides some protection against sexually transmitted diseases (STDs), but the data are limited on the effectiveness of the Reality Vaginal Pouch against STDs. Female condom users have a relatively high pregnancy rate. FDA requires the label for Reality to stress that latex condoms for men are most effective against STDs and HIV/AIDS. Men who are sensitive to rubber can use condoms made of sheep intestine or cecum (brand names: Fourex and Lambskin). These nonrubber male condoms prevent pregnancy, but do not prevent HIV transmission. A specialist in contact dermatitis suggests that rubber sensitive men use a nonrubber condom directly over the penis and then cover that condom with a rubber condom to protect against HIV transmission. A nonlatex thermoplastic elastomer has been used to make male condoms since the early 1990s, but FDA has yet to approve it. A recent article suggests that a thermoplastic elastomer may be the only choice for rubber sensitive males. FDA approval will increase the availability of a nonlatex thermoplastic elastomer condom. The contact dermatitis specialist reviews and follows up on other articles he has written over the last 20 years. Topics include ethylene oxide burns in hospitalized patients, paraben paradox, benzocaine as a contaminant in sunscreens containing glyceryl PABA, sensitivity to nickel, misuse of a patch test to detect hypersensitivity to mercury amalgam dental fillings, permanent destruction of the fingernails due to an allergic reaction to an acrylic nail preparation, and dermatitis due to visual display units.     

The prevalence of atopy and hypersensitivity to latex in medical laboratory technologists

Members of the Alberta Society of Medical Laboratory Technologists were invited to take part in a study of sensitivity to latex gloves. A total of 230 persons volunteered; 108 (47%) had no problems with gloves, and 122 (53%) reacted to latex gloves. A history was obtained regarding atopy, smoking, years in laboratory medicine, and the nature of the problem with latex gloves. Serum was assayed for the total IgE level and the presence of IgE with specificity to common inhalant allergens and to latex. The affected group had an increased population of subjects with an atopic history and a higher incidence of a raised IgE level and a positive screen for inhalant allergens. In the affected group, there was no relationship between the total IgE level and severity of skin reaction. However, smoking was related to severity of reaction and was more common in the groups with a more severe reaction. Three subjects were positive for IgE specific for latex; there were no other data distinguishing them from latex-negative subjects.