Different in vivo reactivity profile in health care workers and patients with spina bifida to internal and external latex glove surface-derived allergen extracts

Abstract

SummaryBackground Allergy to natural rubber latex is a well-recognized health problem, especially among health care workers and patients with spina bifida. Despite latex sensitization being acquired in health institutions in both health care workers and patients with spina bifida, differences in allergen sensitization profiles have been described between these two risk groups. Objective To investigate the in vivo reactivity of health care workers and patients with spina bifida to extracts of internal and external surfaces of latex gloves and also to specific extracts enriched in major allergens for these risk groups. Methods Gloves from different manufacturers were used for protein extraction, and salt precipitation and hydrophobic interaction chromatography (HIC) were applied to obtain the enriched latex extracts. The major latex allergens were quantified by an enzyme immunoassay. The extracts obtained were tested in 14 volunteers using skin prick tests (SPT). Results Latex glove extracts enriched in the hydrophobic allergens that are most often seen in patients with spina bifida were obtained by selective precipitation, whereas HIC produced extracts enriched in the hydrophilic allergens commonly found in health care workers. The health care workers had positive SPTs to glove extracts from internal surfaces and to the hydrophilic allergen-enriched extracts. By contrast, patients with spina bifida had larger skin reactions both to external glove extracts and to the extracts enriched with the hydrophobic major allergens for this risk group. Despite the protein concentration of these extracts being less than half the concentration of the commercial extract, the weal-and-flare reactions were of similar magnitude. Conclusion Using novel latex extracts, our study showed a different in vivo reactivity pattern in health care workers and in patients with spina bifida to extracts of the internal and external surfaces of gloves, which suggests that sensitization may occur by different routes of exposure, and that this influences the allergen reactivity profiles of these risk groups.

Recent research on natural rubber latex (NRL) allergy

“…Furthermore, the authors found different in vivo reactivity patterns in healthcare workers and in patients with spina bifida to extracts of the internal and external surfaces of gloves, which indeed suggests that sensitisation and clinical reactions may occur by different routes of exposure (Peixinho et al, 2008(Peixinho et al, , 2012Marchetti-Deschmann and Allmaier, 2009). Furthermore, this new information may turn out to be helpful in designing and considering possible new manufacturing processes.…”

Sensibilização ao látex em pacientes com mielomeningocele na urologia do HC-FMUSP: prevalência e fatores associados

“…Outro grupo de risco é representado por profissionais na área da saúde que utilizam produtos com látex, sendo a maior sensibilização relacionada aos alérgenos Hev b5 e 6.02 27,35,50 . …”

Identificação dos fatores associados à sensibilização e alergia ao látex em pacientes com defeito de fechamento do tubo neural

“…Além disso, pacientes com DFTN tendem a se sensibilizar com os alérgenos Hevb1 e Hevb3, presentes na face externa das luvas de látex. Em contrapartida, os profissionais da área de saúde apresentam maior sensibilização aos alérgenos Hev b5 e 6.02, presentes na face interna das luvas (Peixinho et al, 2008;Peixinho et al, 2011;Bernstein et al, 2003;Wagner et al, 2001;Hochleitner et al, 2001;Fernandes et al, 2006;Fernandes et al, 2007).…”

“…No caso do HLA-DRB4 e HLA-DQB8 a resposta para a produção de IgE específica é para Hevb6 (Szépfalusi et al, 1999). Entretanto, diversos estudos demonstram que os alérgenos principais para pacientes com DFTN são o Hevb1, 3 e 7, enquanto para profissionais da área da saúde são Hevb2, 5, 6.02 e 13 (Gaspar e Faria, 2012;Peixinho et al, 2011;Peixinho et al, 2008;Bernstein et al, 2003;Wagner et al, 2001) . A idade média dos pacientes foi de 7 anos e três meses (variando de 6 meses a 35 anos) e a sensibilização ao látex aumentou de acordo com a idade.…”

“…Em contrapartida, outros estudos não observaram associação entre atopia e alergia a látex em pacientes com DFTN (Cremer et al, 1998;Machado et al, 2004;Bernardini et al, 1999). (Cabañes et al, 2012;Peixinho et al, 2011;Peixinho et al, 2008;Wagner et al, 2001;Bohle at al., 2000;Yeang et al, 1996;Ylitalo et al, 1998) (Itoh et al, 2010;Mousallem et al, 2012;Savilahti et al, 2010;Jones et al, 2009). Da mesma forma que em alergia alimentar, nas crianças com DFTN a exposição ao alérgeno é precoce e mantém-se muitas vezes em doses progressivas e rotineiras do alérgeno, mas nem todas as crianças desenvolvem alergia ao látex.…”