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Allergy is a broad topic encompassing common clinical allergic diseases, asthma, and complex immunodeficiencies. In this article, the authors discuss the most common allergic diseases and anaphylaxis and briefly review the current knowledge and management of food allergies, allergic rhinitis, otitis media, sinusitis, chronic cough, atopic dermatitis, urticarial and angioedema, contact dermatitis, allergic ophthalmopathy, drug allergy, latex allergy, and insect sting. Because the prevalence of allergic disorders continues to increase, it is increasingly important for physicians to stay up to date on most recent evidence-based diagnosis and management of allergic disorders.

Latex gloves are seen as an indispensable item in the healthcare field because it offers superior protection for both the medical staff and patient against harmful substances. However, latex gloves with high protein concentration have a high possibility to induce latex allergy which in the worst case can lead to a life-threatening condition. To minimize the occurrence of an allergy reaction, the computerized Biocompatibility Morphological Mean (BMM) test for protein detection is proposed. This test initially goes through the chemical process to determine the protein that resides in the glove sample. After that, the sample is electronically converted into a digital image. Finally, the image undergoes color image processing for calculating the color difference values. These values are then plotted on a standard curve. A high correlation coefficient (R2>0.97) of the standard curve gives better accuracies. The proposed method only takes about 40 minutes to complete the test, while existing methods need at least 6 hours.

Allergy to natural rubber latex (NRLA) from Hevea brasiliensis is a relevant public health issue, in particular in healthcare workers and groups at risk. Clinical manifestations of NRLA can range from mild skin disorders to life-threatening systemic reactions. Prevention measures remain the gold-standard treatment for patients suffering from NRLA, but the only etiological therapy able to influence the natural history of NRLA is specific desensitization. This review aims to underline the epidemiological, clinical and diagnostic aspects of NRLA, and carries out a complete and wide-ranging review of the current literature on NRLA management and immunotherapy.

Objective: To evaluate the knowledge levels, sensitivity status, familial latex sensitivity, and attitudes towards the prevention and treatment of latex allergies of healthcare workers (HCWs) at a tertiary hospital. Materials and Methods: The study was carried out cross-sectionally between December 2012 and March 2013. A total of 566 HCWs at a tertiary hospital were included in the study. Results: The data of a total of 566 [333 (58.8%) female and 233 (41.2%) male] HCWs were analyzed. They consisted of 179 (31.6%) physicians, 48 (8.5%) technicians, 238 (42%) nurses, 48 (8.5%) laboratory technicians and 53 (9.4%) patient care workers. The family history of atopy was significantly higher in female HCWs (24.3%) compared to males (17.2%) (p= 0.041). A significant difference was identified between the occupational groups in terms of the rate of allergic symptoms after coming into contact with medical latex products (nurses 59.7%, doctors 17.6%, technicians 5.7%, laboratory technicians 6.9 %, patient care workers 10.1%; p= 0.001). Latexrelated symptoms were significantly more common in atopic HCWs (52.3%) compared to non-atopic ones (19.4%) (p= 0.001). The rate of latex-food syndrome was significantly more frequent in female HCWs (16%) compared to males (8.9%) (p= 0.038). Symptoms that developed after contact with medical and non-medical latex products were significantly more common in female HCWs (79.9% and 80.5%) compared to the male HCWs (21.1% and 19.5%) (p= 0.001). The rate of non-HCW(s) who shared the same house/room with the HCWs after work and who had allergic symptoms while in the same environment with the HCWs was 18%. The rate of these individuals was reported to be highest among the nurses at 53% and there was a statistically significant difference in terms of occupational groups (physicians 25.5%, technicians 9.8%, laboratory technicians 2.9%, patient care workers 7.8%; p= 0.030). Multivariate regression analysis showed that personal history of atopy (OR= 28.657, 95% CI= 6.548-125.411, p= 0.001) and the type of gloves used (latex gloves) (OR= 8.730, 95% CI= 3.490-21.834, p= 0.001) were independent predictors for latex allergy. Conclusion: In conclusion, latex is not only a cause of occupational allergy but is also an allergen that has the potential to cause allergic symptoms in people who share the same environment with HCWs. Questionnaires questioning the symptoms associated with past latex allergy may be an important tool for demonstrating latex sensitization in HCWs and managing latex-related reactions.

Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.

Introduction: IgE-mediated Hevea latex allergy and associated food-allergies constitute a significant health issue with serious consequences of diagnostic error. Hence, there is a need for more reliable confirmatory diagnostics. Areas covered: Here, we summarize the major limitations of conventional tests using native extracts and describe how piecing together the IgE reactivity profile can benefit correct diagnosis in difficult cases in whom conventional tests yield equivocal or negative results. A diagnostic algorithm integrating traditional sIgE and component-resolved diagnosis (CRD) is presented. Expert opinion: Moreover, it is clear that the discoveries in the field of the Hevea latex proteome will contribute to our understandings and accurate approach of sometimes complex cross-reactivity phenomena that extend beyond the ‘latex-fruit syndrome.’

The prevalence of latex allergy among representatives of the Russian medical community is estimated lower (1.9 – 3.8 %) than in the world as a whole (9.7 %), although the incidence of skin, respiratory and other symptoms after contact with latex gloves varies in the range from 18.8 to 35 %. Accurate assessment of differentiated reactions in mediators is hindered by the very rare reference of Russian researchers to the topic of latex allergy. Its prevention is not among the priorities of practical public health, as evidenced by the lack of professional pathology of the skin and upper respiratory tract pathways of latex genesis in the list of occupational diseases, as well as the low level of quality requirements for personal protective equipment for doctors when choosing and purchasing medical gloves. It justifies the need to introduce into practice a number of measures for the prevention and management of latex allergy among health workers: identifying risk groups, verifying diagnosis, providing recommendations on safety management, studying differentiated needs and searching for possible options to meet them.

Background Intimacy-related allergic reactions, including anaphylaxis, are under-reported due to social stigma, lack of awareness, and misdiagnosis. The differential diagnosis for intimacy-related anaphylaxis is extensive and includes systemic human seminal plasma allergy, exercise-induced anaphylaxis, asthma exacerbation, latex allergy, and transference of food or drug allergens through saliva or seminal fluid. Case presentation Two adolescents met on a popular dating phone application. One individual had a long-standing history of asthma and peanut allergy. Although they never kissed, the male with peanut allergy received fellatio, while the other male had eaten peanut butter before they met. During fellatio, the peanut allergic male developed respiratory symptoms, used his bronchodilator, and collapsed. He remained unconscious despite aggressive interventions by emergency personnel called to the site. The clinical history and autopsy results suggested anaphylaxis to peanut allergen exposure from the intimate exposure as the cause of death. Discussion and conclusions To date, nearly all reported cases of intimacy-related anaphylaxis involve symptomatic women. This is the first report of intimacy-related anaphylaxis involving men who have sex with men and the first report of potential allergen transfer from oral mucosa to a patient receiving fellatio. Based on the paucity of published cases, death from intimacy-related anaphylaxis is exceedingly rare. Post-mortem analysis is inherently difficult, as an elevated tryptase level has myriad potential causes; nevertheless, the authors suggest that intimacy-related anaphylaxis due to peanut allergy is the most likely diagnosis. With increasing popularity of relationship applications, especially amongst stigmatized populations, this case highlights the importance of allergy awareness and patient education to decrease risk, particularly in the adolescent population, who are already at increased risk of severe anaphylaxis. Especially amongst those participating in intimate activities, disclosure of one’s allergies warrants discussion, as the outcome can be fatal. Our case demonstrates the crucial need for increased advocacy in food allergy, education around intimacy-related anaphylaxis, and the importance of allergy awareness and prevention across all populations.

not available.

The aim was to analyze systemic and oral aspects of patients with myelomeningocele (MMC), relevant for their dental treatment. Dental treatment of these individuals requires the dentist's extensive knowledge and careful information to determine the dental treatment plan. Thirty participants aged 3 to 16 years were divided into 2 groups: study group (15 MMC individuals) and control group (15 healthy subjects). All patients were evaluated for: systemic conditions, use of medications, sequela of the underlying pathology, oral hygiene, diseases, convulsion, cerebrospinal fluid (CSF), allergy, behavior, learning, and mouth physical examination to assess the oral conditions. The study group presented: higher percentage using drugs (P < 0.05), 40% had convulsions (P < 0.05), 86.67% using CSF shunt, 53.33% presented latex allergies (P < 0.05), 53.33% were classified as anxious and with cognitive deficit (P < 0.05), showed more gingivitis (P < 0.05). The MMC individuals, in the majority, have shown cognitive impairment and anxious behavior, use of controlled drugs, convulsion, CSF shunt use, and latex allergy. The presence of periodontal tissue damage was higher in patients with MMC.

In the healthcare environment, medical latex gloves are a necessary medical item for healthcare workers as it offers excellent hand barrier protection against dangerous microorganism. However, if the healthcare workers repeated exposure to the latex gloves which contain high protein level, it will increase the possibility of the workers to have a risk for latex allergy. Thus, the objective of this project is to develop a color kernel regression (CKR) method for estimating protein level through the analyses of color difference in glove images. Initially, the gloves will go through an uncomplicated chemical test for protein detection. A blue color will appear on the surface of a glove sample that contains protein. After that, the chemical binded sample will be digitally converted into a sample image using the flatbed scanner. The image will then undergo image processing to improve its quality and to calculate the color difference values of the sample. Those calculated values with the pre-defined protein levels will be used to plot a standard graph. A high coefficient of determination with R2 > 98% has been obtained from the experimental graph. This indicates that the proposed CKR method contributes significantly toward the estimation of protein level

The study aimed to develop preventive measures for occupational allergy to latex in health care workers and to elucidate diagnostic specifics of latex sensitization by clinical and immunological parameters. One thousand three hundred forty-six health professionals whose work involves contact with latex-containing products underwent a screening questionnaire survey. One hundred twenty health professionals had an immunoassay done involving the estimation of total and latex-specific IgE. Thirty-six health care workers had a prick skin test done with a standard kit of allergens (home dust mites, epidermal, and pollen allergens). Latex allergy in health care workers is most often characterized by the development of skin manifestations and allergic rhinitis. Latex allergy in health professionals was found to be most common in individuals with the history of allergies, confirmed by increased total IgE values, which should be taken into consideration in occupational fitness assessments on a preliminary medical examination.

The paper describes how a tertiary children's medical center converted its pediatric-dominant operating rooms (ORs) to latex-safe environments without compromise in patient care or incurement of excessive costs. Latex sensitization and allergy continue to be problems especially with at-risk pediatric populations. Even when a latex allergy is identified for a patient, latex supplies still can be used mistakenly. Mayo Clinic used a methodical approach to identify the latex supplies used in the pediatric ORs, selected appropriate latex-free alternatives, and implemented a robust change management program to ensure a latex-safe environment for all pediatric surgical patients. After the change, the use of latex-containing supplies decreased by 93% in the pediatric ORs. This study showed not only that it is possible to convert to a latex-safe environment in a large medical institution but also that more work needs to be done to completely eliminate latex from the surgical environment.

Background Skin diseases account for more than 35% of occupational diseases, affecting 1/1,000 workers annually. Objective To characterize occupational dermatoses affecting hospital workers and identify possible triggers and susceptibility factors. Methods Cross-sectional study in which we analyzed information extracted from electronic medical records of workers who performed periodic examinations in the course of one year. Results About 3.56% of 1,741 included workers had a diagnosis of occupational dermatosis, being mainly women (76.85%). Thirty-four (54.84%) of the affected workers had irritant contact dermatitis, 17 (27.42%) latex allergy, 6 (9.68%) allergic dermatitis, and 5 (8.06%) two concomitant conditions. We found significant difference in prevalence as a function of occupational group (p=0.008), being highest for nursing assistants (5.11%). Prevalence was also higher for employees allocated to surgery departments (8.47%, p=0.001). Main triggers were skin disinfectants, latex, nitrile gloves, and prolonged contact with water (4.84%). Conclusion The quality of the analyzed data depends on the quality of the analyzed medical records. Most subjects were nursing assistants, which fact hinders the generalization of the results. The prevalence of occupational dermatosis was just 3.56%, which might be explained by previously implemented preventive measures. The employees most frequently affected were those allocated to surgery departments and nursing assistants. Skin disinfectants were the most frequent triggers.

Background:It is not well-understood why symptom severity varies between patients with peanut allergy (PA).Objective:To gain insight into the clinical profile of subjects with mild-to-moderate and severe PA, and investigate individual and collective predictive accuracy of clinical background and IgE to peanut extract and components for PA severity.Methods:Data on demographics, patient history and sensitization at extract and component level of 393 patients with probable PA (symptoms ≤ 2 h + IgE sensitization) from 12 EuroPrevall centers were analyzed. Univariable and penalized multivariable regression analyses were used to evaluate risk factors and biomarkers for severity.Results:Female sex, age at onset of PA, symptoms elicited by skin contact with peanut, family atopy, atopic dermatitis, house dust mite and latex allergy were independently associated with severe PA; birch pollen allergy with mild-to-moderate PA. The cross-validated AUC of all clinical background determinants combined (0.74) was significantly larger than the AUC of tests for sensitization to extract (0.63) or peanut components (0.54–0.64). Although larger skin prick test wheal size, and higher IgE to peanut extract, Ara h 1 and Ara h 2/6, were associated with severe PA, and higher IgE to Ara h 8 with mild-to-moderate PA, addition of these measurements of sensitization to the clinical background model did not significantly improve the AUC.Conclusions:Models combining clinical characteristics and IgE sensitization patterns can help establish the risk of severe reactions for peanut allergic patients, but clinical background determinants are most valuable for predicting severity of probable PA in an individual patient.

A 22-year-old man scheduled to undergo bladder augmentation for management of urinary incontinence secondary to neurogenic bladder presented in the preoperative assessment clinic 2 weeks prior to the proposed surgery. His aunt was in attendance. He was born with a meningomyelocele and was largely confined to a wheelchair due to lower limb spasticity. He had undergone multiple surgical procedures as a child and young adult without incident. He had a history of latex allergy.

An estimated 85% of individuals with spina bifida (SB) survive into adulthood, warranting SB-specific transition to adult healthcare guidelines to address the diverse and complex medical, adaptive, and social needs particular to this condition. Latex allergy constitutes one important health concern for this population that requires ongoing and life-long evidence-based management. This article discusses management of latex allergy according to the SB Latex Allergy Healthcare Guidelines from the 2018 Spina Bifida Association’s Fourth Edition of the Guidelines for the Care of People with Spina Bifida, reviews current care models in which such latex allergy guidelines can be implemented, and explores further relevant research topics in SB care relative to latex allergy.

The oral cavity is a complex area to handle with about thirty-two teeth, highly vascular tongue, oral mucosa,and gingival. It becomes challenging for the clinician to handle a single tooth in focus with patients movementof vascular tongue and especially in very apprehensive subjects. Hence rubber dam has proved to be a boonnot only protecting the tongue, mucosa, and gingiva but also increasing the point of focus for the clinician.Secondly, it reduces infected aerosol procedures thus protecting the clinician and the attendee. Sometimesrarely patients do have allergies to latex or rubber dam and they are not aware. Hence the clinician mustask for leading questions to rule out latex allergy. If the subject does have a latex allergy modifications arerequired before the treatment.

Pneumatic tourniquet education and documentation Key words: pneumatic tourniquet, documentation, competency verification, tourniquet cuff. Creating a safe environment for surgical patients with latex allergies or sensitivities Key words: natural rubber latex, latex allergy, latex sensitivity, latex reaction, anaphylaxis. Covering patients' beards Key words: facial hair, surgical site infection (SSI), beard, sterile field. Informed consent requirements Key words: informed consent, witness, legal representative, signature. Promoting well-being through mindfulness Key words: conscious leadership, mindfulness, well-being, work environment, positive focus.

Objectives Occupational skin disease (OSD) arises from work-related activity. However, there is a paucity of literature on OSD in physicians. The aim of the this review was therefore to examine and summarize what types of symptomatic OSD physicians experience. Methods We conducted a systematic literature search on Cochrane Library, Embase, and Pubmed. Results Contact dermatitis from formaldehyde and glutaraldehyde were found in 11.5 and 13.5% of cases, respectively. In total 2.4–14.9% had latex allergy. The reported standardized incidence ratio of squamous cell carcinoma and melanoma was up to 2.15 [95% confidence interval (CI) 1.57–1.95] and 3.2 (95% CI 1.38–6.31). Transmission of human papilloma virus (HPV) particles during carbon dioxide laser wart ablation were found in 70% of samples collected from protective gloves and in 52% of samples from vapors. Conclusions The most frequently reported OSD in physicians is contact dermatitis from allergens in disinfectants and rubber gloves. There is also a risk of cutaneous reactions to latex. The incidence of skin cancer was higher in physicians than in the general population, and the reason for this remains unexplained and potentially biased. There are no reports of transmission of patient HPV to surgeons during wart ablation, possibly because of proper use of protective equipment.

Introduction: During COVID-19 pandemic, the massive use of Personal Protective Equipment could provoke severe adverse reactions in latex allergy patients and could negatively affect their quality of life. Methods: Trough a survey the study aimed: (a) to evaluate the incidence of allergic reactions in patients with latex allergy during the SARS-CoV-2 pandemic; (b) to evaluate the protective role of continuous latex sublingual immunotherapy (SLIT) during this period; and (c) to evaluate quality of life of natural rubber latex allergy (NRLA) patients during the pandemic. Results: 67 patients (9 males and 58 females, mean age of 45.9 ± 11.4 years) suffering from latex allergy were included in the present study. We recorded among our patients 13 cases (34.2%) of urticarial/angioedema (U/A), 9 cases (23.6%) of respiratory symptoms (dyspnoea, shortness of breath and wheezing) and 7 cases (18.4%) of anaphylaxis. In patients who underwent continuous SLIT, we observed less cases of U/A ( p < 0.001), respiratory symptoms ( p < 0.001), anaphylaxis ( p = 0.003), hospitalizations ( p = 0.014) and a lower therapy administration. We compared the results of SF-36 questionnaire in patients who underwent continuous and not-continuous SLIT with a significance differences score between these two groups. Conclusions: Our study is the first that investigated the clinical and quality of life effects of COVID-19 pandemic in NRLA patients.

The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a validated questionnaire used worldwide to assess intolerances to chemicals, foods, and drugs, and has emerged as the gold standard for assessing chemical intolerance (CI). Despite a reported prevalence of 8–33%, epidemiological studies and routine primary care clinics rarely assess CI. To help address this gap, we developed the Brief Environmental Exposure and Sensitivity Inventory (BREESI)—a 3-item CI screening tool. We tested the BREESI’s potential to predict whether an individual is likely to be classified as chemically intolerant if administered the 50-item QEESI. We recruited 293 participants from a university-based primary care clinic and through online participation. The statistical sensitivity, specificity, and positive and negative predictive values of the BREESI were calculated against the validated QEESI. Ninety percent (90%) of participants answering “yes” to all three items on the BREESI fit the QEESI criteria for being very suggestive of CI based upon their chemical intolerance and symptom scores (positive predictive value = 90%). For participants endorsing two items, 93% were classified as either very suggestive (39%) or suggestive (54%) of CI (positive predictive value = 87%). Of those endorsing only one item, 13% were classified as very suggestive of CI, and 70% as suggestive. Of those answering “No” to all of the BREESI items, 95% were classified as not suggestive of CI (i.e., negative predictive value = 95%). The BREESI is a versatile screening tool for assessing potential CI useful for clinical and epidemiological applications, based upon individuals’ past adverse responses in a variety of settings. Just as health care professionals routinely inquire about latex allergy to prevent adverse reactions, the BREESI provides an essential screen for CI. Together, the BREESI and QEESI provide new diagnostic tools that may help predict and prevent future adverse reactions to chemicals, foods, and drugs.

Antecedentes: El síndrome látex-fruta (SLF) se caracteriza por alergia al látex y vegetales. La papaína, quimopapaína, caricaína y las quitinasas clase I son las proteínas más alergénicas de la papaya. La similitud entre epítopos de heveína del látex y las quitinasas clase I de la papaya puede explicar el síndrome látex-papaya (SLP).Objetivo: Describir las características clínicas de pacientes con SLP.Métodos: Estudio transversal, observacional y descriptivo en el que se incluyeron 11 pacientes con diagnóstico por punción cutánea de alergia al látex y diagnóstico clínico de anafilaxia a papaya. Los resultados fueron analizados con estadística descriptiva.Resultados: De 11 pacientes con SLP, 72.7 % fue del sexo femenino (7 a 46 años), todos con antecedente de anafilaxia a papaya, identificada por historia clínica y notas médicas más pruebas cutáneas positivas a látex; 63.3 % presentó anafilaxia en las pruebas cutáneas. Los factores de riesgo fueron múltiples cirugías, otra enfermedad alérgica y ser empleado en el ámbito de la salud; 63.6 % tenía alergia a otros alimentos, 45.4 % a medicamentos, 45.4 % rinitis alérgica y 27.3 % asma.Conclusiones: La hipersensibilidad a la papaya incrementa el riesgo de anafilaxia en individuos con alergia al látex, por tanto, la mortalidad. La clínica es la herramienta principal para el diagnóstico. La educación para el manejo de la anafilaxia con autoadministración de adrenalina es fundamental.

Antecedentes: La prevalencia de la alergia al látex se desconoce en los estudiantes de medicina.Objetivo: Determinar prevalencia y factores asociados con autorreporte de alergia al látex en estudiantes de medicina.Métodos: Estudio transversal de estudiantes con o sin autorreporte de alergia al látex. Mediante cuestionario estructurado se indagó historia personal y familiar de enfermedad alérgica; tiempo y frecuencia de exposición a guantes de látex y síntomas tras la exposición a productos o alimentos relacionados con alergia al látex. Se realizaron modelos de regresión logística.Resultados: De 854 sujetos, 431 (50.5 %) fueron mujeres. La mediana de edad fue de 21 años. La prevalencia global de alergia al látex fue 4.3 % (IC 95 % = 3.1 a 5.9). Los factores de riesgo relacionados fueron edad (RM = 1.37; IC 95 % = 1.05 a 1.79), historia personal de dermatitis atópica (RM = 7.32; IC 95 % = 3.14 a 17.08), uso de guantes ≥ 15/semana (RM = 2.59; IC 95 % = 1.17 a 5.76), uso de productos con látex (RM = 5.76; IC 95 % = 2.15 a 15.49) y alergia a frutas (RM = 3.24; IC 95 % = 1.27 a 8.27).Conclusión: Cuatro de cada 100 estudiantes reportaron alergia al látex. La edad, la historia personal de dermatitis atópica, la mayor frecuencia de exposición a guantes de látex y antecedente de alergia a frutos fueron factores de riesgo.

Myelomeningocele (MMC) is a congenital malformation that occurs in the embryonic period, characterized by failure in closure of the caudal portion of the neural tube during central nervous system formation. Alterations and complications can be associated with this condition, such as hydrocephalus, neurogenic bladder, orthopedic problems, and motor and cognitive impairment. This patients with MMC also have predisposition to develop latex allergy and high caries risk and activity due to deficient oral hygiene, fermentable carbon hydrate-rich diet and prolonged use of sugar-containing oral medications. This paper reports the oral findings and dental treatment in a 15-year-old female patient diagnosed with MMC and describes the strategies used to improve dental treatment conditions and reduce the impact of associated risks to her health. The measures and precautions adopted in this case could be useful to reduce the barriers for patients with the same condition to access oral health care: regular visits to the dentist, initiating as early as possible; frequent reinforcement of oral homecare instructions and diet counseling; minor adaptions to the dental chair and dental office to improve ease of access due to patients' mobility problems; prevention of latex-related allergic reactions; reduction of gag reflex during dental procedures.

Profilin is a protein that is present in all eukaryotic cells and is responsible for cross-reactivity between pollen, latex, and plant foods. It has been classically acknowledged as a minor or nearly irrelevant allergen, although recent data are changing this conception. The objective of this manuscript is to provide a comprehensive review of published data on the role of this ubiquitous allergen in pollen, latex, and plant food allergy. The patterns of recognition of this minor allergen follow a north-south gradient. Although present in all pollens and vegetables, profilin is significantly associated with allergy to grass pollen and to Cucurbitaceae fruits. Heb v 8, the latex profilin, is usually a marker of profilin allergy in plant food-allergic patients, although it has no clinical relevance in latex allergy. Sensitization to profilin jeopardizes the diagnosis of pollen allergy and selection of immunotherapy, and although component-resolved diagnosis can identify its impact, there are no tailored treatments available. In recent years, several new publications have shown how profilin should be taken into account and, under certain circumstances, considered a marker of severity, an allergen capable of inducing respiratory symptoms, and, in its natural purified form, a potential candidate for etiological treatment of food allergy. Current data on profilin strongly support the need for a shift in the previously accepted paradigm for this allergen. More research should be done to assess the real clinical impact of sensitization in specific populations and to develop therapeutic strategies.

Introduction The only etiological and decisive therapy, able to influence the natural history of latex allergy is the specific desensitization. Aim To verify the clinical efficacy and immunological changes determined by latex sublingual immunotherapy in allergic patients who underwent this treatment for at least 3 years. Material and methods We enrolled 76 patients (16 males and 60 females, mean age 34 years old) with evidence of a natural rubber latex allergy. To assess the effectiveness of the immunotherapy we performed a latex skin prick test, specific IgE and IgG4 and challenge tests before and after at least 3 years of desensitization. Results We observed a reduction in the mean diameter of the wheal area at the skin prick test and a decrease in latex specific IgE while no significant changes of latex IgG4 values were found. Moreover a reduction of symptoms and scores at the provocation tests were remarked. Conclusions Although the primary prevention (which still remains the gold standard treatment for patients suffering from the latex allergy) sublingual immunotherapy can be offered with efficacy in addition to symptomatic treatment to selected patients.

Background: In our country, the prevalence of latex allergy in health personnel has rarely been studied. Objective: To determine the prevalence and associated factors to self-reported latex allergy in health care workers. Methods: A cross-sectional study was conducted among 1,292 health care workers of a second level hospital. All workers were included and they were required to answer a structured questionnaire aimed at identifying latex allergy, atopic personal and family history, exposure to latex gloves and surgical background. Odds ratio (OR) and 95 % confidence interval (95 % CI) were estimated using regression logistic to investigate factors associated to latex allergy. Results: The female to male ratio was 2.4:1. The men age 38.4 ± 11.6 years. The prevalence of latex allergy auto-reported was 9.7 %, with a confidence interval of 95 % (95 % CI) 8.1 %-11.3 %. There was no statistical difference by workplace (p = 0.508). Factors associated with latex allergy included female gender (OR = 1.68; 95 % CI, 1.03-2.73, p = 0.037), personal history of atopy (OR = 4.82; 95 % CI, 3.19-7.26, p < 0.0001), family history of atopic dermatitis (OR = 4.33, 95 % CI, 1.20-4.41) and history of allergy to fruits (OR = 4.33; 95 % CI, 2.62-7.14, p < 0.0001). Conclusions: Up to 10 out to 100 health workers may have latex allergy. The main factors associated with latex allergy in this study were: being a female, personal or familiar atopy and allergy to fruits.

International audience; Aims - The prevalence rate of severe fecal incontinence (FI) in adults with spina bifida (SB) is high. The physiological basis of FI in SB has not been clearly established, which contributes to inadequate care. The aim was to better characterize a large cohort of adults with special consideration of anorectal physiology.Methods - A multidisciplinary team from a French referral centre for SB prospectively collected data on patients who had an anorectal manometry. Factors associated with severe FI (Cleveland clinical incontinence score ≥ 9) were assessed in a multivariate analysis model.Results - A total of 132 adults with SB (sex ratio M/F: 55 [41.7%]/77 [58.3%]; mean age of 38.2 [11.6] years old) were assessed. Among these patients, 83/132 (62.9%) suffered from severe FI. Rectal perception was not evaluable among 17 patients who had a latex allergy. Overall, 29/115 (25.2%) had maximal tolerable volume (MTV) > 330 mL or no sensation. The absence of anal canal sensitivity, MVT > 330 mL and the amplitude of the recto-anal inhibitory reflex (RAIR) >75% after a rectal isovolumic inflation of 50 mL were significantly associated with severe FI in the multivariate analysis model. Neither neurological level nor other neurological features were associated with severe FI.Conclusions - This study showed that FI in patients with SB is mainly associated with rectal abnormalities. This should be taken into consideration to improve incontinence management of patients with SB.

Background Allergic reaction to seminal plasma was described decades ago. In USA only tens of thousands women are estimated to be affected. Not only seminal plasma, but also cervico-vaginal fluid contains sex-restricted antigens, yet allergy to cervicovaginal fluid has never been reported in medical literature. We came to a suspicion that because immunologic tests required to prove such a diagnosis, allergy to cervicovaginal fluid has never been reported yet it is not uncommon. Objective The objective of this study was to use an Internet-based questionnaire to characterize the population of men with suspected hypersensitivity to cervico-vaginal fluid. Methods A questionnaire designed to cover localized and systemic symptoms of hypersensitivity reaction was made available via the Internet. Respondents with post-coital adverse reactions were invited to participate. Only respondents who presented with at least two symptoms suggestive to hypersensitivity to seminal plasma or cervicovaginal fluid and were negative for STI and known hypersensitivity reactions such as latex allergy were a subject for further analysis. Board-certified dermatologists were surveyed for seeing bona fide cases of cervicovaginal fluid hypersensitivity. Results We have identified 52 cases of suspected hypersensitivity to CVF. Both localized and systemic types of hypersensitivity were identified. A substantial number of dermatologists admitted to witnessing cases of hypersensitivity to CVF Conclusion Based on data from affected individuals as well as the opinions of dermatologists worldwide we believe that allergic reaction to cervicovaginal fluid is at least as common as seminal plasma allergy. However, remains unreported due to technical difficulties in diagnosis and dermatologists’ disbelief in its actual existence. This article is protected by copyright. All rights reserved.

Introduction The use of natural rubber latex (NRL) products can cause IgE-mediated allergic reactions in exposed people. The aim of this study was to quantify the content of protein and latex allergens of currently available NRL products to estimate the allergenic potential of these products. Methods 14 household articles (pacifiers, baby bottle nipples, condoms, household and disposable gloves, toy balloons, and Band-Aids) as well as 18 NRL examination gloves currently used by healthcare workers were investigated. Extracts of the examination gloves were prepared according to the standard method DIN EN 455-3, which contains requirements and testing for biological evaluation of single use medical gloves. The protein content was determined with a modified Lowry method. Latex allergen content was measured using an IgE-inhibition immunoassay with a mix of serum-sensitized patients as detection antibody sources and the latex ImmunoCAP as solid phase. The allergens Hev b 1, 3, 5, and 6.02 were determined using available immunoassays. Results In 5 out of 18 examination gloves, the protein content was under the detection limit. The other 13 gloves contained protein between 7.1 and 92.3 µg protein/g material. Five glove brands contained protein concentrations above the recommended reference value of 30 µg protein/g material. Latex allergen could be measured in 12 out of 18 NRL gloves. In only 3 gloves could none of the allergens Hev b 1, 3, 5, and 6.02 be detected. Protein and Hev b 1 could be measured in the examined childcare products, while the concentrations of the latex allergens Hev b 3, 5, and 6.02 were mostly under the detection limit. Boiling of childcare products led to a reduction of protein and allergen content. In some of the other daily-used NRL articles, the protein and allergen contents were even higher than in gloves. Conclusion Our study demonstrated that protein, and particularly latex allergens, were detectable in currently available examination gloves as well as in household articles whereby a risk for sensitization and/or induction of allergic symptoms could not be excluded.

Latex allergy is a common occupational disease among healthcare workers who use latex gloves. The aim of the present study was to determine the prevalence of allergy to latex gloves among dental students and the role of exposure duration in latex allergy. In this prospective study, a total of 240 students completed a self-administered questionnaire aiming at providing information about glove, working habits, signs and symptoms related to glove use, precautions taken to minimize it, etc. The challenge and patch tests were performed through latex gloves, and skin prick test with commercial extracts. The questionnaire items and diagnostic tests revealed that one-fourth of subjects were suspicious for latex gloves hypersensitivity. Their mean value for skin reactions like contact urticaria, irritant or allergic dermatitis was between 10% and 14%, while for non-cutaneous symptoms the mean value was under 5%. The average latex exposure (in hours) is estimated to be about 214±71 (SE), with a maximum of 11500 hours. The correlation between studied variables and the time exposure to latex gloves revealed weak to moderate relations with respect to reported latex allergy, eczematous reactions, hand erythema after glove wearing, irritant reactions during wash/washout procedures, concentration oscillations during usage of latex gloves, or dyspnea attack during latex exposure. Due to the relationship between allergic reactions to latex gloves and some medical histories during school practice, it seems to be necessary to undergo pre-matriculation evaluation and periodic health surveillance of dental students.

Background: Allergy is diagnosed from typical symptoms, and tests are performed to incriminate the suspected precipitant. Skin prick tests (SPTs) are commonly performed, inexpensive, and give immediate results. Laboratory tests (ImmunoCAP) for serum allergen-specific IgE antibodies are usually performed more selectively. The immuno-solid phase allergen chip (ISAC) enables testing for specific IgE against multiple allergen components in a multiplex assay. Methods: We retrospectively analysed clinic letters, case notes, and laboratory results of 118 patients attending the National Adult Allergy Service at the University Hospital of Wales who presented diagnostic difficulty, to evaluate which testing strategy (SPT, ImmunoCAP, or ISAC) was the most appropriate to use to confirm the diagnosis in these complex patients, evaluated in a “real-life” clinical service setting. Results: In patients with nut allergy, the detection rates of SPTs (56%) and ISAC (65%) were lower than those of ImmunoCAP (71%). ISAC had a higher detection rate (88%) than ImmunoCAP (69%) or SPT (33%) in the diagnosis of oral allergy syndrome. ImmunoCAP test results identified all 9 patients with anaphylaxis due to wheat allergy (100%), whereas ISAC was positive in only 6 of these 9 (67%). Conclusions: In this difficult diagnostic group, the ImmunoCAP test should be the preferred single test for possible allergy to nuts, wheat, other specific foods, and anaphylaxis of any cause. In these conditions, SPT and ISAC tests give comparable results. The most useful single test for oral allergy syndrome is ISAC, and SPT should be the preferred test for latex allergy.

Latex allergy (LA) is a common occupational issue among health care workers, with a sensitization rate of 5-17% among the exposed. Although the incidence of LA has decreased dramatically in the United States and Europe over the past few years, 150,000-1 million health care workers and more than 15 million people worldwide still suffer from LA.

Background Medical examination gloves and surgical gloves protect the wearer directly and the patient indirectly from the risk of contamination. Because of concerns related to latex allergy, an increasing trend toward the use of synthetic gloves made of materials other than latex is observable. However, currently it is unknown if the physical properties of different materials may influence bacterial passage in case of a glove puncture. Methods We examined 9 different medical examination gloves from various manufacturers made of nitrile (n = 4), latex (n = 3), or neoprene (n = 2). Additionally, 1 latex surgical glove each with and without antibacterial chlorhexidine gluconate coating and 1 synthetic surgical glove made of thermoplastic elastomer were included in the experiments. The studied materials were perforated following a standardized procedure, and direct bacterial passage was measured under dynamic conditions. Glove elasticity at 1 cm up to 2.5 cm elongation was measured following EN 455-2. Results Nitrile gloves demonstrated higher material stiffness compared with latex gloves. Medical examination gloves made of nitrile and neoprene showed a 10-fold higher bacterial passage through a standardized puncture compared with latex gloves. All surgical gloves showed a lower bacterial passage compared with the tested examination gloves. Conclusion Bacterial passage through punctures is correlated with the stiffness or elasticity of the glove material. Therefore, gloves made of latex may have an increased protective effect in case of a glove breach. Whenever gloves are purchased and selected, a risk-benefit assessment should be conducted, balancing the risk of allergy against the degree of required protection in case of a glove puncture.

Background and Objectives: In Thailand, the Colorectal cancer incidence rate is 127.7 per 100,000 for men and 125.5 per 100,000 for women. Twenty percent of these patients have a permanent or temporary colostomy that needs colostomy flange. The colostomy flanges that are available in Thailand are imported and are expensive. Thailand is an agricultural country and is the leading natural rubber producer and exporter. Flange made within the country would cost significantly less than the imported ones. Nevertheless, the safety standard is the main point that we considered. Material and methods: This study is an experimental prospective non-randomized control trial study at Songklanagarind Hospital. The study was approved and monitored by the ethical committee of Songklanagarind Hospital. Thailand Institute of Scientific and Technological Research (TISTR) approved the animal phase. Then, the volunteer phase was performed to conduct the best one of the material formulas for colostomy flange. Result: Fresh latex has 16.66% dermatitis and no anaphylaxis. Block latex and concentrated latex has the same allergic symptoms (13.1% dermatitis) but Block latex show a lower rate of other symptoms including itch and hyperpigmentation. Block latex was selected to produce Deproteinised Natural Rubber (DPNR). Three Deproteinised Natural Rubbers (DPNR) were achieved. Rubber formula 2 causes the lowest allergic symptoms; there is no anaphylaxis and only 0.5% dermatitis. Conclusion: Rubber formula 2 is the lowest prevalence of latex allergy in this study and is a lower prevalence compared to the previous study. It is suggested that Rubber formula 2 is safe to be the material for producing a colostomy flange. However, clinical trial and data must be collected during the patient phase trail.

Background: Over 8% of the US population have detectable Type I hevea latex IgE antibodies and, upon exposure to natural latex and rubber products, are at risk for potentially dangerous reactions, especially in dental settings where these products meet mucosal membranes. Methods: Extractable antigenic protein levels were quantified in dental dams, examination gloves, and various other dental and rubber products. ASTM standards D6499 (antigenic protein) and D5712 (total protein) were used to quantify protein content. Results: In dental dams, extractable protein content ranged from low/non-sensitizing levels (

espanolRESUMEN El sindrome de sensibilidad quimica multiple (SQM), tambien conocido como intolerancia ambiental idiopatica (IAI), entre otros, es un desorden complejo y mal definido que produce diversos sintomas en respuesta a diferentes estimulos. No hay estudios validos que establezcan la patogenesis de este sindrome. El manejo anestesico de estos pacientes es un reto para los anestesiologos, dado que no hay unas pautas de actuacion establecidas. Se presenta un caso de cirugia exitosa en una paciente afecta de SQM realizandose una anestesia total intravenosa (TIVA) convencional a la que se anadio una premedicacion exhaustiva y la aplicacion del protocolo de alergia al latex. EnglishABSTRACT The multiple chemical sensitivity syndrome (MCS), also known as idiopathic environmental intolerance (IAI), among others, is a complex and poorly defined disorder that produces various symptoms in response to various stimuli. There is a lack of valid studies that establish the pathogenesis of this syndrome. The anesthetic management of these patients is a challenge for anesthesiologists, due to the fact that there are no established guidelines. We present a case of successful surgery in a patient that suffers from MCS by performing a conventional TIVA enhanced with a thorough premedication and the latex allergy protocol.

Introduction: Natural rubber latex (NRL) is processed from Hevea brasiliensis trees. Allergic reactions to certain proteins in the latex manifest as immediate hypersensitivity reactions and allergic reactions to chemicals added to latex during processing manifest as allergic contact dermatitis. Healthcare workers (HCWs) are at increased risk of developing latex allergies. As little data is available from India, this study was directed toward identifying the prevalence of latex glove-related dermatoses among nurses and the factors leading to it. Methodology: This cross-sectional study was undertaken among nurses in a private tertiary care hospital. Results: A total of 700 nurses were included in the study. Symptoms of latex allergy were present in 74 (10.6%) of study subjects, out of which 69 (9.9%) had features of contact dermatitis. Patch test was done in 50 subjects and was positive in 12 (24%); among them, patch test antigens were positive in 9 (18%) and a positive result to glove piece was seen in 3 subjects. Conclusions: Latex allergy in India is a significant problem; though lesser compared to western countries, its prevalence necessitates the development of pre-employment protocols to avoid workplace morbidity.

Targeting the IgE pathway is a clinically validated strategy for treating IgE-mediated diseases. Omalizumab, an anti-IgE antibody, which binds to free IgE and prevents the binding of IgE to FcεRI on mast cells and basophils has been approved for severe persistent allergic asthma and chronic spontaneous (idiopathic) urticaria. The therapeutic efficacy of anti-IgE has also been reported in allergic rhinitis, allergic bronchopulmonary aspergillosis, latex allergy, atopic dermatitis, allergic urticaria, anaphylaxis, and others. Anti-CεmX, which binds to membrane-bound IgE (mIgE) on IgE-switched B cells, lyses mIgE-expressing B lymphoblasts and prevents the allergen-induced generation of IgE-producing plasma cells, offers an alternative mechanism of intervening with the IgE inflammatory pathway. Because anti-CεmX does not bind to free IgE, it can modulate the IgE pathway regardless of the serum IgE levels in treated patients. These unique pharmacologic mechanisms potentially enable anti-CεmX to provide different clinical utilities from anti-IgE and serve as a therapeutic and a prophylactic in some IgE-mediated diseases, which are not adequately treated with current medicine.

ANTECEDENTES: la alergia al látex tiene alta prevalencia en grupos de riesgo conocidos, especialmente en pacientes con espina bífida, malformaciones urinarias y ortopédicas con múltiples cirugías. En México no se cuenta con suficientes estudios que reporten la prevalencia y factores de riesgo asociados.OBJETIVO: determinar la prevalencia de sensibilización al látex mediante prueba de prick con extracto de látex en pacientes con malformaciones genitourinarias y más de tres cirugías en la Unidad Médica de Alta Especialidad de Pediatría del Centro Médico Nacional de Occidente, así como los factores asociados.MATERIAL Y MÉTODO: Estudio transversal analítico y descriptivo, que incluyó hombres y mujeres de 1 a 16 años, con malformaciones genitourinarias y más de tres cirugías. Se aplicó una encuesta para conocer factores de riesgo asociados y se realizó prueba cutánea por punción con extracto de látex, control positivo y negativo, se midieron niveles séricos de IgE total y eosinófilos en sangre periférica.RESULTADOS: la prevalencia encontrada fue de 30.7% y los factores de riesgo asociados: atopia personal (p=0.047), antecedente de reacción previa con productos con látex (p=0.003), específicamente con globos (p=0.000) y guantes (p=0.002). No hubo asociación entre el número de cirugías e intervenciones quirúrgicas a edades tempranas, tampoco con concentraciones elevadas de IgE sérica total. Tuvieron reacción cruzada a frutas-látex 25% de los pacientes, los alimentos asociados fueron: aguacate, papaya, fresa y kiwi.CONCLUSIÓN: la prevalencia de sensibilización al látex es alta en los grupos de riesgo, sobre todo con antecedente de atopia, por lo que es importante que el personal de salud identifique a estos pacientes a fin de implementar oportunamente las medidas de prevención primaria y secundaria; evitar efectos severos potencialmente mortales, como la anafilaxia, para disminuir la morbilidad y la mortalidad y los costos sanitarios.

Objectives This article aims to review the current prevalence rate of latex allergy among healthcare workers, susceptible patients, and the general public, and to investigate why latex is still a ubiquitous occupational health hazard. Methods Scientific publications on PubMed, particularly those published within the last five years, and current regulations from agencies such as Food and Drug Administration (FDA) were reviewed. Consumer and commercial products that may contain latex were also surveyed. Results Approximately 12 million tons of natural rubber latex is produced annually and is widely used to manufacture millions of consumer and commercial products. Only limited number of latex-derived products have been approved and regulated by government agencies, such as FDA, whereas the majority of finished products do not label whether they contain latex. Owing to millions of unidentifiable products containing latex and many routes for exposure to latex, preventing contact with latex allergens and reducing the prevalence of latex allergy are more difficult than expected. Reported data suggest that the average prevalence of latex allergy worldwide remains 9.7%, 7.2%, and 4.3% among healthcare workers, susceptible patients, and general population, respectively. Conclusions Latex-derived products are ubiquitous, and latex allergy remains a highly prevalent health risk in many occupations and to the general population. Developing alternative materials and increasing the ability to identify and label latex-derived products will be practicable approaches to effectively control the health risks associated with latex.

The present study aimed at developing a natural compound with anti-allergic effect and stability under latex glove manufacturing conditions and investigating whether its anti-allergic effect is maintained after its addition into the latex. The effects of nine natural compounds on growth of the RBL-2H3 cells and mouse primary spleen lymphocytes were determined using MTT assay. The compounds included glycyrrhizin, osthole, tetrandrine, tea polyphenol, catechin, arctigenin, oleanolic acid, baicalin and oxymatrine. An ELISA assay was used for the in vitro anti-type I/IV allergy screening; in this process β-hexosaminidase, histamine, and IL-4 released from RBL-2H3 cell lines and IFN-γ and IL-2 released from mouse primary spleen lymphocytes were taken as screening indices. The physical stability of eight natural compounds and the dissolubility of arctigenin, selected based on the in vitro pharnacodynamaic screening and the stability evaluation, were detected by HPLC. The in vivo pharmacodynamic confirmation of arctigenin and final latex product was evaluated with a passive cutaneous anaphylaxis (PCA) model and an allergen-specific skin response model. Nine natural compounds showed minor growth inhibition on RBL-2H3 cells and mouse primary spleen lymphocytes. Baicalin and arctigenin had the best anti-type I and IV allergic effects among the natural compounds based on the in vitro pharmacodynamic screening. Arctigenin and catechin had the best physical stability under different manufacturing conditions. Arctigenin was the selected for further evaluation and proven to have anti-type I and IV allergic effects in vivo in a dose-dependent manner. The final product of the arctigenin-containing latex glove had anti-type I and IV allergic effects in vivo which were mainly attributed to arctigenin as proved from the dissolubility results. Arctigenin showed anti-type I and IV allergic effects in vitro and in vivo, with a good stability under latex glove manufacturing conditions, and a persistent anti-allergic effect after being added into the latex to prevent latex allergy.