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Latex Allergy

Background

Allergy to natural rubber latex is increasingly
common and serious in children and adults.

Latex is the milky fluid derived from the
lactiferous cells of the rubber tree, Hevea
brasiliensis.

It is composed primarily of cis -1,4-polyisoprene, a
benign organic polymer that confers most of the
strength and elasticity of latex.

It also contains a large variety of sugars, lipids,
nucleic acids, and highly allergenic proteins.


More than 200 polypeptides have been isolated
from latex. Latex proteins vary in their allergenic
potential.

Protein content varies with harvest location and
manufacturing process.

Basic knowledge of the manufacturing processes
aids in understanding the medical problems related
to latex exposure.[1]

Freshly harvested latex from Malaysia, Indonesia,
Thailand, and South America is treated with
ammonia and other preservatives to prevent
deterioration during transport to factories.

Latex is treated with antioxidants and accelerators
including thiurams, carbamates, and
mercaptobenzothiazoles.

It is then shaped into the desired object and
vulcanized to produce disulfide cross-linking of
latex molecules.

After being dried and rinsed to reduce proteins and
impurities, the product frequently is dry-lubricated
with cornstarch or talc powder.


Powder particles rapidly adsorb residual latex
proteins; other proteins remain in soluble form on
the surface of finished products.

Alergia la latex
Fundal

Alergia la latex natural este tot mai frecvente i
grave la copii si adulti.

Latexul este lichid lptos derivate din celulele din
lapte de arborele de cauciuc, Hevea brasiliensis.

Se compune n principal din cis -1,4-poliizopren,
un polimer organic benigne care confer cea mai
mare parte puterea i elasticitatea latexului.


Acesta conine, de asemenea, o mare varietate de
zaharuri, lipide, acizi nucleici, proteine i extrem de
alergene.

Mai mult de 200 de polipeptide au fost izolate din
latex.

Proteine latex variaz n potenialul lor alergene.
Coninutul de proteine variaz n funcie de locaie
recoltare i procesul de fabricaie.

Cunotine de baz de procesele de fabricaie SIDA
n nelegerea problemelor medicale legate de
expunerea la latex. [1]

Latex proaspt recoltat din Malaezia, Indonezia,
Thailanda, i America de Sud este tratat cu
amoniac i ali conservani pentru a preveni
deteriorarea n timpul transportului la fabrici.

Latex este tratat cu antioxidani i acceleratori,
inclusiv thiurams, carbamai, i
mercaptobenzothiazoles.

Acesta este apoi modelat n obiectul dorit i
vulcanizat a produce disulfura de reticulare de
molecule latex.

Dup ce a fost uscat i splat pentru a reduce
proteinelor i a impuritilor, produsul frecvent este
uscat-lubrifiate cu amidon de porumb sau pudr de
talc.

Particulele de praf rapid absorb proteinele din latex
rezidual; alte proteine rmne n form solubil pe
suprafaa de produse finite.

Latex is ubiquitous in modern society and
particularly in health care.

William Halstead first used latex surgical gloves in
1890.

Latex has been used in a myriad of medical
devices for decades.

In the late 1980s, however, its use skyrocketed as
latex gloves were widely recommended to prevent
transmission of blood-borne pathogens, including
the human immunodeficiency virus (HIV).


Billions of pairs of medical gloves are imported to
the United States in annually, often as powdered,
nonsterile examination gloves.

In the 1980s and 1990s, heightened demand for
latex to manufacture gloves and other objects
resulted in hundreds of new, poorly regulated latex
factories in tropical countries.

The incidence of minor and serious allergic
reactions to latex began to rise rapidly among
patients and health care workers (HCWs).[2, 3, 4]
Latex sensitization can occur after skin or mucosal
contact, after peritoneal contact during surgery, and
possibly after inhalation of aerosolized particles
with latex on their surfaces.

For related information, see Medscape's Allergy &
Immunology Resource Center.

Pathophysiology
Latex exposure is associated with 3 clinical
syndromes.

The first syndrome is irritant dermatitis.

It is a result of mechanical disruption of the skin
due to the rubbing of gloves and accounts for the
majority of latex-induced local skin rashes.


It is not immune mediated, is not associated with
allergic complications, and is not the subject of this
article. It may be confused with Type IV
hypersensitivity.

Latexul este omniprezent n societatea modern i
n special n domeniul ngrijirii sntii.

William Halstead primul folosit manusi
chirurgicale latex n 1890.

Latex a fost folosit ntr-o multitudine de
dispozitive medicale pentru zeci de ani.

La sfritul anilor 1980, cu toate acestea, utilizarea
sa a crescut foarte mult ca mnui de latex au fost
foarte recomandat pentru a preveni transmiterea de
sange agentii patogeni, inclusiv virusul
imunodeficientei umane (HIV).

Miliarde de perechi de manusi medicale sunt
importate n Statele Unite, n fiecare an, de multe
ori ca, mnuilor pudrate examinare nesterile.

n anii 1980 i 1990, cererea sporita de latex pentru
fabricarea de mnui i alte obiecte a dus la sute de
noi, slab reglementate fabrici de latex n rile
tropicale.

Incidena reaciilor alergice minore i grave la latex
a nceput s creasc rapid n rndul pacienilor i a
lucrtorilor de ingrijire a sanatatii (HCWs). [2, 3, 4]
sensibilizare la latex pot aprea dup pielea sau
mucoasele, dup contactul peritoneala in timpul
interventiei chirurgicale, i, eventual, dup
inhalarea de particule de aerosoli cu latex pe
suprafata lor.

Pentru informaii legate, consultai Medscape de
alergie si Imunologie Centrul de Resurse.

Fiziopatologie
Expunerea latex este asociat cu 3 sindroame
clinice.

Primul sindrom este dermatita iritant.

Este un rezultat de perturbare mecanice a pielii din
cauza frecarea de mnui i conturile pentru
majoritatea latex induse de erupii cutanate locale.

Acesta nu este mediat imun, nu este asociat cu
complicaii alergice, i nu face obiectul acestui
articol. Acesta poate fi confundat cu tip IV
hipersensibilitate.

Any chronic hand dermatitis in HCWs raises the
risk of nosocomial infections, including blood-
borne pathogens.

The second syndrome is a delayed (type IV)
hypersensitivity reaction, resulting in a typical
contact dermatitis.

Symptoms usually develop within 24-48 hours of
cutaneous or mucous membrane exposure to latex
in a sensitized person.

The primary allergens are residual accelerators and
antioxidants left from the original manufacturing
process.

Langerhans cells process the antigens and present
them to cutaneous T cells.

Multiple objects can cause sensitization, but the
most common sources in this country are probably
examination gloves for adults and shoe soles for
children.

Type IV hypersensitivity is more common in atopic
individuals.

The dermatitis may predispose patients to further
sensitizations or infections.

The third, most serious, and least common
syndrome is immediate (type I) hypersensitivity.

It is mediated by an immunoglobulin E (IgE)
response specific for latex proteins.

As noted, latex proteins are highly allergenic, and
they are variable between lots from different
plantations, factories, and manufacturers.

Cross-linking of IgE molecules on mast cell and
basophil cell membranes by latex protein allergens
triggers the release of histamine and other
mediators of the systemic allergic cascade in
sensitized individuals.[5]

Exposure can occur following skin, mucous
membrane, or visceral/peritoneal contact.

It also can follow inhalation of latex-laden
particles or bloodstream exposure to soluble latex
Orice dermatita de mana cronica in HCWs creste
riscul de infectii nosocomiale, inclusiv ageni
patogeni prin snge.

Doilea sindrom este o ntrziere (tip IV) reacii de
hipersensibilitate, rezultnd ntr-o dermatita de
contact tipic.

Simptomele apar de obicei n termen de 24-48 de
ore de la expunere membranei cutanate sau
mucoase la latex ntr-o persoan sensibilizat.

Alergeni primare sunt acceleratoare reziduale si
antioxidanti plecat din procesul de fabricaie
original.

Celulele Langerhans procesarea antigenelor i s le
prezinte celulelor T cutanate.

Obiecte multiple poate provoca sensibilizare, dar
cele mai comune surse din aceast ar sunt,
probabil, mnui de examinare pentru aduli i tlpi
de pantofi pentru copii.

Tip IV hipersensibilitate este mai frecventa la
persoanele atopice.

Dermatita poate predispune pacienii la
sensibilizarile sau alte infectii.

Sindromul a treia, cea mai grav, i cel comun este
imediat (de tip I) hipersensibilitate.

Acesta este mediat de un E imunoglobulin (IgE)
aciune specific pentru proteinele din latex.

Dup cum sa menionat, proteinele din latex sunt
extrem de alergene, i ei sunt variabile ntre o
mulime de plantaii diferite, fabrici, i productori.

Reticulare de molecule de IgE pe celule catarg i
membranele celulare bazofili de alergeni proteine
latex declanseaza eliberarea de histamina si alte
mediatori ale cascadei alergice sistemice la
persoanele sensibilizate. [5]

Expunerea poate s apar dup pielii, mucoaselor,
sau contactul visceral / peritoneal.

De asemenea, putei urmri inhalarea de particule
de latex-Laden sau cu expunere fluxul sanguin la
proteins following intravascular access procedures.


Powdered latex examination gloves have been the
most frequent source of sensitization in adults,
causing cutaneous and inhalational exposures.

(Fortunately, their use is decreasing as many
hospitals move toward powder-free, "low-
allergen," or nonlatex glove products.)[6]

Sensitization is more common in atopic
individuals.

Symptoms generally begin within minutes of
exposure.

The spectrum of clinical manifestations includes
localized or generalized urticaria, rhinitis,
conjunctivitis, bronchospasm, laryngospasm,
hypotension, and full-blown anaphylaxis.

Type I allergy has been implicated clearly in
intraoperative and intraprocedure anaphylaxis, and
it can be fatal without emergent treatment.[7]

Epidemiology
Frequency
United States

Latex allergy is present in 1-5% of the general
population, with an increased prevalence in atopic
individuals.

Latex allergy is increased in populations with
chronic occupational exposure to latex.[8] It is
found in 2-17% of HCWs and in at least 10% of
rubber industry workers.

Symptoms of latex allergy have been described in
14% of a group of EMS providers and in 54% of a
pediatric ED staff.[9, 10, 11] Atopy raises the risk
of occupational sensitization.

The highest prevalence of latex allergy (20-68%) is
found in patients with spina bifida or congenital
urogenital abnormalities.

Sensitization in these patients apparently follows
multiple urinary tract, rectal, and thecal procedures,
as well as multiple surgeries during early
proteinele din latex solubile n urma procedurilor
de acces intravascular.

Praf latex mnui de examinare au fost cele mai
frecvente surse de sensibilizare la adulti, cauznd
expuneri cutanate i prin inhal

are. (Din fericire, utilizarea lor este n scdere, ca
multe spitale se indrepte spre pulbere-free, "low-
alergen," sau produse nonlatex mnu.) [6]

Sensibilizare este mai frecventa la persoanele
atopice.

Simptomele ncepe n general n termen de minute
de expunere.

Spectrul manifestrilor clinice include urticarie
localizate sau generalizate, rinita, conjunctivita,
bronhospasm, laringospasm, hipotensiune arterial
i anafilaxie n plin floare.

Tipul I de alergie a fost implicat n mod clar n
intraoperator i intraprocedure anafilaxie, i poate
fi fatal, fara tratament emergente. [7]

Epidemiologie
Frecven
Statele Unite

Alergie la latex este prezent n 1-5% din populaia
general, cu o prevalenta crescuta la persoanele
atopice.

Alergie la latex este crescut in randul populatiilor
cu expunere cronica la latex. [8] Se gaseste in 2-
17% din HCWs i n cel puin 10% din lucrtorii
din industria de cauciuc.

Simptomele de alergie la latex, au fost descrise n
14% dintr-un grup de furnizorii de EMS i n 54%
de personal ED pediatru. [9, 10, 11] Atopia creste
riscul de sensibilizare profesionale.

Cea mai mare prevalen de alergie la latex (20-
68%) se gaseste la pacientii cu spina bifida sau
anomalii urogenitale congenitale.

Sensibilizare la acesti pacienti aparent urmeaz
tractului urinar multiple, procedurile rectale, i
dural, precum i mai multe interventii chirurgicale
childhood. Patients with spina bifida also may have
a genetic predisposition for latex sensitization

. Patients with spina bifida and human leukocyte
antigen (HLA) alleles DRB and DQB1 were more
likely to have a specific IgE response to a common
latex antigen.


Again, within this risk group, atopic children are at
increased risk.

Other patients with a history of multiple surgeries
or other latex-exposing procedures are also at
increased risk relative to the general population.

Patients with cerebral palsy, mental retardation, or
quadriplegia also appear to have increased risk of
latex allergy, probably because of repeated medical
exposures.

Finally, the prevalence of latex allergy is increased
in persons with allergies to avocado, banana,
chestnut, kiwi, papaya, peach, or nectarine.

Cross-reacting antigens have been found between
these tropical fruits and latex.

International
The risk patterns described above are similar in
other developed countries.

One study from Germany suggests that the
incidence of type I latex allergy has risen faster
recently among HCWs than Type IV
hypersensitivity, possibly due to recent
manufacturing changes that lessen exposure to
accelerators but not to latex proteins.

A recent meta-analysis of the French literature
confirmed that HCWs have an increased risk of
sensitization and allergic symptoms to latex.

Workers with occupational exposure during
harvesting and/or processing latex in developing
countries where H brasiliensis is grown have an
increased risk relative to the general populations.[8,
12]

Mortality/Morbidity
Patients with type I hypersensitivity are at risk of
in timpul copilariei timpurii. Pacientii cu spina
bifida, de asemenea, poate avea o predispoziie
genetic de sensibilizare la latex.

Pacientii cu spina bifida i antigen leucocitar uman
(HLA) alele DRB si DQB1 au mai multe sanse de a
avea un rspuns specific IgE la un antigen comun
latex.

Din nou, n acest grup de risc, copiii atopic sunt la
risc crescut.

Alte pacienii cu antecedente de mai multe
interventii chirurgicale sau alte proceduri latex-
expunerea sunt, de asemenea, un risc crescut n
raport cu populatia generala.

Pacienii cu paralizie cerebrala, retard mintal, sau
tetraplegie par, de asemenea, s aib risc crescut de
alergie la latex, probabil din cauza expunerilor
medicale repetate.

n cele din urm, prevalenta de alergie la latex este
crescut la persoanele cu alergii la avocado, banane,
castan, kiwi, papaya, piersici, nectarine sau.

Antigene cross-reactive au fost gsite ntre aceste
fructe tropicale i latex.

Internaional
Modelele de risc descrise mai sus sunt similare n
alte ri dezvoltate.

Un studiu din Germania, sugereaza ca incidenta de
tip I alergie la latex, a crescut mai repede recent
printre Lucratorii dect de tip IV hipersensibilitate,
probabil din cauza schimbrilor recente de
producie care reduc expunerea la acceleratoare,
dar nu la proteinele din latex.

O meta-analiza recenta a literaturii franceze au
confirmat c Lucratorii au un risc crescut de
sensibilizare i simptome alergice la latex.

Lucrtorii cu expunere n timpul recoltrii i / sau
de prelucrare latex n rile n curs de dezvoltare n
care H brasiliensis este crescut au un risc crescut n
raport cu populaia general [8, 12].

Mortalitatea / Morbiditatea
Pacienii cu hipersensibilitate de tip I sunt la riscul
developing anaphylaxis and/or respiratory
obstruction, which can be fatal.

Deaths have been reported following the
intraoperative use of latex rectal catheters.

Latex anaphylaxis has occurred after childbirth,
instrumentation, intravenous injection, balloon
blowing, and condom use.[7]

Although most patients can be treated effectively
for type IV and type I reactions without clinical
sequelae, major allergy may prevent them from
pursuing certain careers, using many household and
workplace objects, and seeking timely medical care
due to justified fear of latex exposure.


Sex
Incidence in males and females is equal.

Age
Latex allergy probably is more common in children
and in younger working adults because of the
increased medical and/or occupational exposure
over the past two decades.
de a dezvolta anafilaxie i / sau obstrucie
respiratorie, care pot fi fatale.

Decese au fost raportate n urma utilizrii
intraoperatorie de latex rectale catetere.

Latex anafilaxie a avut loc dup natere,
instrumente, injecie intravenoas, balon suflare, i
folosirea prezervativului. [7]

Dei majoritatea pacienilor pot fi tratate eficient
pentru tipul IV i de tip I, reacii, fr sechele
clinice, alergie majore le poate mpiedica urmrirea
anumite cariere, cu multe obiecte de uz casnic i de
la locul de munc, i caut ngrijire medical n
timp util din cauza fricii justificat de expunere
latex.

Sex
Inciden la brbai i femei este egal.

Vrst
Alergie la latex, probabil, este mai frecventa la
copii i la adulii tineri de lucru, din cauza
expunerii prelungite medicale i / sau profesionale
n ultimele dou decenii.