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Latex allergy Jay E. Slater, MD CBER/OVRR/DBPAP Laboratory of Immunobiochemistry Symptoms of latex allergy Urticaria Rhino-conjunctivitis Wheezing Anaphylaxis A systemic, multisystem allergic reaction that may include any and all of the above, plus hypotension Other types of latex allergy Contact urticaria Contact dermatitis Irritant dermatitis IgE-mediated responses Mast cells Initial reports Germany, 1930’s Europe, 1980’s US/Canada, 1989 Items that elicit latex allergic responses gloves condoms catheters cofferdams surgical drains latex stoppers adhesives other Risk groups Meningomyelocele Urogenital abnormalities Health care workers Rubber industry workers Why latex? Why latex? Latex gloves are “dipped” products Hevea latex antigens Hev b 1 (REF) Hev b 2 (?-1,3-glucanase) Hev b 3 (microhelix component) Hev b 4 Hev b 5 Hev b 6 (prohevein) Hev b 7 (patatin analogue) Hev b 8 (profilin) Hev b 9 (enolase) Hev b 10 (Mn-superoxide dismutase) Hev b 11 (class 1 chitinase Hev b 12 (lipid transfer protein) Hev b 13 (esterase) Glove powder adsorbs and disseminated latex protein allergens Diagnosis of latex allergy History Events Risk factors Latex-specific IgE skin test serum Intervention (challenge and/or avoidance) Prevalence of latex allergy Questionnaire Latex-specific IgE skin test serum Predictive value is questionable Skin tests none licensed in US Outside the US: Western Allergy Services (Canada) Stallergenes S.A. (France) Lofarma (Italy) ALK Abello (Denmark) Serum specific IgE tests Available tests (Hamilton, JACI 2002; 110(2 suppl):S47-S56) : Pharmacia CAP (sens 70-80%, spec 90%) Hycor HyTECH (sens 70-80%, spec 90%) DPC AlaSTAT (sens 90%, spec 70%) Specific allergens important Adding Hev b 5 to CAP increases sensitivity by 1-2% (Lundberg, Allergy 2001; 56:794-795) Hev b 2 + 3 + 7 is 100% sensitive for spina bifida (Kurup Clin Exp Allergy 2000; 30:359-369) General population Seroprevalence Reinheimer (1995): 12% Garabrant (2001) : 8-37% Grzybows