Latex Intolerance

by Chowdhury; Mahbub M. U.

• ISBN13: 9780849316708
• ISBN10: 0849316707
• Format: Hardcover
• Copyright: 2004-09-29
• Publisher: CRC Press

Summary

Latex intolerance has become an increasingly common diagnosis. As experimental techniques and theoretical concepts emerge, it is important for physicians to stay on the cutting edge of new methodologies in skin research.Latex Intolerance: Basic Science, Epidemiology, and Clinical Management covers all aspects of latex allergy. Each chapter presents the latest research in latex intolerance, exploring issues such as skin irritation, allergic contact dermatitis, and contact urticaria. The well-illustrated textbook also discusses the basic science and clinically relevant practical issues, including the epidemiology, prognosis, and management of latex intolerance. Sections on hand dermatitis, barrier creams, and medical glove regulations enhance understanding of the condition.Experts with a special interest in this area from the United Kingdom, Europe, and the USA provide a balanced international perspective to this first major book dedicated to latex intolerance. Dermatologists and other medical professionals involved in the treatment of latex intolerance will benefit from this valuable resource.

Table of Contents

Epidemiology of Latex Allergy	1	(14)
Barry N. Statham
Introduction	1	(1)
Epidemiological Study Determinants	2	(2)
Latex Allergy versus Hypersensitivity	2	(1)
Recruitment of the Study Population	2	(1)
Allergy Prevalence in ``Normal Population''	2	(1)
Identification of Latex-Related Symptoms	3	(1)
Strengths and Weaknesses of Diagnostic Tests	3	(1)
Risk Factors and Latex Allergy	4	(4)
Atopic Diathesis	5	(1)
Hand Dermatitis	5	(1)
Multiple Operations and/or Indwelling Latex	6	(1)
Latex Glove Exposure	7	(1)
Latex and Food Allergy	7	(1)
Prevalence in Occupational Subgroups	8	(1)
Incidence of Latex Sensitization or Allergy	8	(1)
Changing Trends of Latex Sensitivity after Latex Exposure Alteration	8	(2)
Conclusions	10	(5)
References	11	(4)
Allergenic Proteins	15	(12)
Harri Alenius
Timo Palosuo
Introduction	15	(1)
Allergenic NRL Proteins	16	(5)
Hev b 1 (Rubber Elongation Factor)	16	(1)
Hev b 2 (1,3-β-glucanase)	16	(2)
Hev b 3 (22-27 kD rubber particle protein)	18	(1)
Hev b 4 (50-57 kD microhelix protein complex)	18	(1)
Hev b 5 (acidic NRL protein; 16 kD pI 3.5)	18	(1)
Hev b 6.01 (prohevein), Hev b 6.02 (hevein), and Hev b 6.03 (prohevein C-domain)	19	(1)
Hev b 7 (46 kD patatin-like protein)	19	(1)
Hev b 8 (profilin)	19	(1)
Hev b 9 (enolase)	20	(1)
Hev b 10 (manganese superoxide dismutase; MnSOD)	20	(1)
Hev b 11 (Class 1 chitinase)	20	(1)
Hev b 12	20	(1)
Hev b 13	20	(1)
Other NRL Allergens	21	(1)
IgE-Binding Epitopes of NRL Allergens	21	(1)
T-Cell Epitopes of NRL Allergens	22	(1)
Allergens in NRL Products	23	(1)
Future Aspects	24	(3)
References	24	(3)
Chemical Additives	27	(30)
Curtis P. Hamann
Pamela A. Rodgers
Kim Sullivan
Introduction	28	(1)
Manufacture of Rubber	28	(12)
History of Rubber Manufacturing	28	(1)
Manufacturing Processes	29	(1)
Harvesting and Processing of Natural Rubber	30	(1)
Centrifugation	30	(1)
Compounding	31	(1)
Dipping Technology	31	(1)
Vulcanization and Prevulcanization	32	(1)
Leaching	33	(1)
Drying	33	(1)
Chlorination	33	(1)
Surface Coatings	34	(1)
Rubber and Rubberlike Elastomers	34	(2)
Natural Rubber Polyisoprene	36	(1)
Nitrile	37	(1)
Neoprene	37	(1)
Polyvinyl Chloride	38	(1)
Polyurethanes	38	(1)
Styrene-Based Elastomers	39	(1)
Synthetic Polyisoprene	39	(1)
Other Rubberlike Elastomers	40	(1)
Rubber Compounding	40	(10)
Chemical Additives	41	(1)
Vulcanizing Agents and Accelerators	41	(3)
Antidegradants	44	(2)
Pigments, Fragrances, and Flavorants	46	(1)
Processing Aids	47	(1)
Releasing Agents and Lubricants	47	(1)
Allergenicity of Rubber Additives	47	(1)
Vulcanization Agents and Accelerators	48	(1)
Antidegradants	49	(1)
Other Additives	49	(1)
Release Agents and Lubricants	50	(1)
Conclusions and Future Developments	50	(7)
References	51	(6)
Natural Rubber Latex Allergy: Clinical Manifestations	57	(10)
Ignatius C. Chua
Alison J. Owen
Paul E. Williams
Introduction	57	(1)
Systemic Manifestations of Allergy	58	(2)
IgE Mediated Immediate Hypersensitivity Reactions	59	(1)
Sensitization to NRL and Development of Symptoms	59	(1)
Patients with Spina Bifida	60	(1)
Surgical and Medical Procedures	60	(1)
Fatal Anaphylaxis	61	(1)
Occupational Exposure to NRL	61	(1)
Everyday Exposure to NRL	62	(1)
Case History	62	(1)
Conclusions	63	(4)
References	63	(4)
Natural Rubber Latex Allergy and Allergens: In Vitro Testing	67	(20)
Vesna J. Tomazic-Jezic
Introduction	67	(1)
Basis and Principles of Test Development	68	(1)
In Vitro Diagnosis of NRL Allergy	69	(2)
Development of In Vitro Tests for NRL Sensitivity	69	(1)
Performance of Commercial In Vitro Diagnostic Tests	70	(1)
Significance of In Vitro Tests in Diagnosing NRL Sensitivity	71	(1)
Evaluating the Allergenic Potential of NRL Products	71	(9)
Methods for Measurement of Total NRL Protein	72	(1)
Methods for Quantification of Antigenic NRL Proteins	73	(1)
Quantification of NRL Allergens	74	(1)
Measurement of the Individual NRL Allergens	75	(1)
Relative Performance of Total Protein, Antigen, and Allergen Tests	76	(4)
Future Trends and Goals	80	(7)
References	81	(6)
New Developments in Measuring Allergens in Natural Rubber Latex Products	87	(10)
Katja Frisk
Tytti Karkkainen
Hely Reinikka-Railo
Timo Palosuo
Introduction	87	(1)
NRL Allergens in the Source Material and in Manufactured Products	88	(1)
Methods for Measuring Natural Rubber Latex Allergens	89	(5)
Qualitative Methods	89	(1)
IgE-Immunoblotting Analysis (Western Blotting)	89	(1)
IgE-Immunoblotting after Isoelectric Focusing and Electrophoresis (Two-Dimensional Immunoblotting)	90	(1)
Semiquantitative Methods	90	(1)
Skin Prick Testing in Voluntary Latex-Allergic Subjects	90	(1)
RAST Inhibition and IgE-ELISA Inhibition Assay	90	(1)
Quantitative Methods	91	(1)
Capture Enzyme Immunoassays (EIA) for NRL Allergen Quantification	91	(3)
Conclusions	94	(3)
References	95	(2)
Contact Urticaria: Clinical Manifestations	97	(10)
Sarah H. Wakelin
Introduction	97	(1)
Classification	98	(2)
Nonimmunological Contact Urticaria	98	(1)
Immunological Contact Urticaria	98	(2)
Contact Urticaria with Undetermined Mechanisms	100	(1)
Clinical Features of NRL Contact Urticaria	100	(3)
Conclusions	103	(4)
References	103	(4)
Contact Urticaria Syndrome: Predictive Testing	107	(6)
Antti I. Lauerma
Howard I. Maibach
Introduction	107	(1)
Immunologic Contact Urticaria (ICU)	108	(2)
Mechanisms	108	(1)
Respiratory Chemical Allergy as an Animal Model for ICU	108	(1)
Contact Chemical Allergy as an Animal Model for ICU	109	(1)
Protein Allergy as an Animal Model for ICU	109	(1)
Nonimmunologic Contact Urticaria	110	(1)
Mechanisms	110	(1)
Animal Models for NICU	110	(1)
Predictive Testing: Perspectives	110	(1)
Predictive Testing for Agents Causing ICU or NICU	110	(1)
Predictive Testing for Medicaments for ICU or NICU	111	(1)
Conclusions	111	(2)
References	111	(2)
Contact Urticaria Syndrome: Prognosis	113	(6)
Sarah H. Wakelin
Introduction	113	(1)
Follow-up Studies of Adults with Occupational NRL Allergy	113	(2)
Primary Prevention	115	(1)
Patients with Spina Bifida	116	(1)
Conclusions	117	(2)
References	117	(2)
Allergic Contact Dermatitis: Clinical Manifestations	119	(8)
Natalie M. Stone
Introduction	119	(1)
Sites Involved	120	(1)
Eczematous Variants	121	(1)
Rubber Purpura	121	(1)
Rubber Depigmentation	121	(1)
Unusual Delayed-Type Reactions	122	(1)
Allergic Contact Dermatitis to Natural Rubber Latex	122	(5)
References	123	(4)
Allergic Contact Dermatitis: Tests	127	(6)
Natalie M. Stone
Introduction	127	(1)
Investigation of Allergic Contact Dermatitis to Rubber Additives	127	(1)
Rubber Mixes	128	(2)
Other Rubber Additives	130	(1)
Patch Testing with Natural Rubber Latex	130	(3)
References	131	(2)
Allergic Contact Dermatitis: Prognosis	133	(2)
Natalie M. Stone
Prognosis for Allergic Contact Dermatitis	133	(2)
References	134	(1)
Latex-Fruit Syndrome	135	(6)
Tanya D. Wright
Introduction	135	(1)
Latex-Fruit Syndrome	136	(2)
Symptoms	136	(1)
Latex Proteins and Latex-Fruit Syndrome	136	(1)
Hev b 8 (profilin)	136	(1)
Hev b 6.02 (hevein)	137	(1)
Hev b 7 (patatin-like protein)	137	(1)
Hev b 2 (1,3-β-glucanase)	137	(1)
Class 1 chitinases	137	(1)
Foods Cross-Reacting with Latex	137	(1)
Conclusions	138	(3)
References	138	(3)
Irritant Dermatitis Due to Occlusive Gloves: Clinical Manifestations	141	(6)
Priyanka Singh
Mayanka Singh
Mahbub M. U. Chowdhury
Howard I. Maibach
Introduction	141	(1)
Symptoms	142	(1)
Occlusion	142	(3)
Long-Term Study	143	(1)
Group A	143	(1)
Group B	143	(1)
Short-Term Study	143	(1)
Group A	143	(1)
Group B	143	(2)
Conclusions	145	(2)
References	145	(2)
Irritation Dermatitis Due to Occlusive Gloves: Predictive Testing	147	(4)
Mayanka Singh
Priyanka Singh
Mahbub M. U. Chowdhury
Howard I. Maibach
Introduction	147	(1)
Methods	147	(2)
Testing Paradigm for Predictive Testing	149	(1)
21-Day Cumulative Irritation Assay	149	(1)
Exaggerated Use Studies	149	(1)
Conclusions	149	(2)
References	149	(2)
Management of Hand Dermatitis	151	(14)
Graham A. Johnston
Nicolas Nicolaou
Mahbub M.U. Chowdhury
Introduction	151	(1)
Important Issues in the Management of Hand Dermatitis	152	(5)
Hand Protection with Gloves	152	(1)
Use of Soap Substitutes and Moisturizers	153	(2)
Avoidance of Irritants	155	(1)
Prognosis and Ongoing Management	156	(1)
Treatment of Hand Dermatitis	157	(8)
Emollients	157	(1)
Corticosteroids	158	(1)
Topical Corticosteroids	158	(1)
Intralesional Steroids	159	(1)
Systemic Corticosteroids	159	(1)
Topical and Systemic Antibiotics	159	(1)
Photochemotherapy	159	(1)
Systemic Immunosuppressives	160	(1)
Cyclosporin	160	(1)
Azathioprine	160	(1)
Topical Immunosuppressives	160	(1)
Other Modalities	160	(1)
References	160	(3)
Appendix 16.1: Information Sheet for Patients with Hand Dermatitis	163	(2)
Barrier Creams/Moisturizers	165	(12)
Hongbo Zhai
Mahbub M. U. Chowdhury
Howard I. Maibach
Introduction	165	(1)
Barrier Creams (BC)	166	(1)
Definition and Terms	166	(1)
Reasons to Use Barrier Creams	166	(1)
Mechanism of Action and Duration	166	(1)
Application Methods and Efficacy	167	(1)
U.S. Food and Drug Administration Monograph Skin Protectants	167	(1)
Moisturizers	167	(4)
Definition and Terms	167	(1)
Effect of Moisturizers on Skin	168	(1)
Moisturizers in Preventing Irritant Contact Dermatitis	168	(3)
Conclusions	171	(6)
References	173	(4)
Occlusive Effects: Man vs. Animal	177	(12)
Hongbo Zhai
Mahbub M. U. Chowdhury
Howard I. Maibach
Introduction	177	(1)
Skin Barrier Function	178	(1)
Effects of Occlusion on Barrier Function	178	(1)
Evaluating Methods	179	(4)
Animal Models	179	(2)
Human Models	181	(2)
Conclusions	183	(6)
References	185	(4)
Medical Glove Regulation: History and Future of Safety	189	(16)
Deborah D. Davis
Introduction	190	(1)
Glove Regulations	190	(3)
Minimum Performance and Physical Requirements	192	(1)
Length	192	(1)
Size	192	(1)
Thickness or Gauge	192	(1)
Acceptable Quality Level (AQL)	192	(1)
Tensile Strength	193	(1)
Ultimate Elongation	193	(1)
Stress at 500% Elongation	193	(1)
Donning Lubricants	193	(1)
Powdered and Powder-Free	193	(1)
Coatings Technologies	193	(1)
Protein and Allergen Levels	194	(1)
Labeling	194	(1)
Assay Methods	194	(1)
Allergen-Specific Assays	194	(1)
Storage Stability and Expiration Dating	195	(1)
Synthetic Medical Gloves	196	(1)
Polymers	196	(1)
Nitrile	196	(1)
Vinyl	196	(1)
Neoprene	196	(1)
Polyisoprene	197	(1)
Material-Specific Requirements	197	(1)
Chemical Resistance	197	(2)
Appropriate Use of Gloves	199	(2)
Glove Hydration and Conductivity	201	(1)
Glove Manufacturers	201	(1)
Conclusions	202	(3)
References	203	(2)
Occupational Health Management of Latex Allergy	205	(6)
Anil Adisesh
Introduction	205	(1)
Occupational Prevalence of Latex Allergy	205	(2)
Recognition of Cases	207	(1)
Case Management	207	(2)
Exposure Reduction	208	(1)
Advice to the Organization	209	(1)
Conclusions	210	(1)
References	210	(1)
Management of Rubber-Based Allergies in Dentistry	211	(38)
Curtis P. Hamann
Pamela A. Rodgers
Kim Sullivan
Introduction	212	(1)
Diagnosis and Symptom Assessment	213	(4)
Health History and Risk Assessment	213	(1)
Symptom Assessment	214	(1)
Diagnostic Testing for Rubber-Based Allergies	214	(1)
Diagnostic Testing for Type I NRL Hypersensitivity	215	(1)
Diagnostic Testing for Type IV Hypersensitivity to Rubber Chemicals	216	(1)
Education of Allergic Dental Professionals	217	(1)
Allergens in Natural and Synthetic Rubber	218	(9)
NRL Extractable Total Protein Content	221	(1)
NRL Extractable Allergenic Protein Content	222	(1)
Glove Powder and NRL Protein Allergens	222	(1)
Allergenic Rubber Chemicals	223	(2)
Exposure Routes and Thresholds for Rubber-Based Allergens	225	(1)
Other Dental Allergens	226	(1)
Mitigating Rubber Allergen Exposure	227	(9)
Administrative Controls	228	(1)
Dental Operatory Cleaning and NRL Remediation	228	(1)
NRL Product Substitution	229	(1)
Guidelines and Glove Standards	229	(2)
Product Substitutions for Type I NRL Hypersensitivity	231	(2)
Product Substitutions for Type IV Rubber Chemical Hypersensitivity	233	(1)
Considerations for the Dental Patient with Rubber-Based Allergies	234	(1)
Procedures Requiring Local Anesthesia	234	(1)
Endodontic Procedures	235	(1)
Emergency Preparedness	236	(1)
Psychological Issues	236	(1)
Examples of Successful Management of Rubber-Based Allergies	236	(1)
Summary and Recommendations	237	(12)
References	238	(11)
Management of Latex Allergy: Allergist's Perspective	249	(12)
Ignatius C. Chua
Alison J. Owen
Paul E. Williams
Introduction	249	(1)
Management of NRL Allergy	250	(6)
Principles Underlying Drug Management	250	(1)
Increasing Patient Awareness of NRL allergy	250	(1)
Treatment of Local Symptoms	251	(1)
Treatment of Systemic Symptoms	252	(1)
Emergency Rescue Medication for Patient Self-Medication	252	(2)
Training Patients to Deal with Severe Allergic Reactions	254	(2)
Planned Clinical Management of NRL Allergic Patients	256	(1)
Spina Bifida Patients	256	(1)
Patients with Symptoms/Confirmatory Evidence of NRL Allergy	256	(1)
NRL-Free Environments	256	(1)
Latex Immunotherapy	256	(1)
Prognosis	257	(1)
Useful Addresses	258	(3)
References	258	(3)
Index	261