Prevalencia de alergia al látex en una población de pacientes con diagnóstico de mielomeningocele / Prevalence of latex allergy in a population of patients diagnosed with myelomeningocele

Introducción: La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos. Objetivo: Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados. Pacientes y métodos: Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada. Resultados: Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas. Conclusión: El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones.

Introduction: Latex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce. Objective: To estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors. Population and Methods: Descriptive, crosssectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact withlatex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit. Results: Eighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ? 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures. Conclusion: According to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.

Alergia al látex, puesta al día / Latex allergy, uptodate

El látex o caucho natural es un producto vegetal que se obtiene de la savia de la Hevea brasiliensis. Ampliamente utilizado para la fabricación de productos de uso doméstico (guantes, preservativos, globos, etc.) y del área de la salud, donde se estima que el 50% de los artículos médicos contienen látex. La alergia al látex es un problema de salud mundial. Se estima que la prevalencia de sensibilización al látex en población general es del 1%. Clínicamente, puede generar una reacción de hipersensibilidad tipo I, IgE mediada, en respuesta a las proteínas del látex que se manifiesta como una urticaria hasta la anafilaxia. También se describe dermatitis de contacto irritativa y la dermatitis de contacto alérgica, 12 a 96 horas luego del contacto, por una reacción de hipersensibilidad retardada tipo IV, secundaria a los aditivos del látex. El diagnóstico se basa en la sospecha clínica, confirmado con pruebas cutáneas y medición de IgEs específicas. Realizar una anamnesis que permita sospechar una alergia al látex y si se determina que el paciente tiene riesgo, realizar el estudio complementario para confirmar el diagnóstico. El enfrentamiento se basa en la prevención de la exposición y el tratamiento de la reacción aguda. Es necesario conocer los alérgenos y procesos implicados en la alergia al látex pues de este modo se podrá sospechar e identificar a pacientes o funcionarios que puedan sufrir o estar en riesgo de presentarla, disminuyendo de este modo las posibles complicaciones.

Latex or natural rubber is a vegetable product which is obtained from the sap of the Hevea brasiliensis. It is widely used to manufacture domestic products (gloves, condoms, balloons, etc.) and used in the health area, where it is estimated that 50% of medical articles contain latex. Latex allergy is a global health problem. It is estimated that the prevalence of latex sensitization is 1% in the general population. The clinical presentation can be a type I hypersensitivity reaction, IgE mediated, in response to latex proteins, manifested as a rash or even as an anaphylaxis. Irritant contact dermatitis and allergic contact dermatitis, 12 to 96 hours after contact, is also described, due to a delayed type IV hypersensitivity reaction, secondary to latex additives. The diagnosis of latex allergy is based on clinical suspicion and confirmed with skin tests measuring specific IgEs. Management is based on the exposure prevention and treatment of the acute reaction. A detailed anamnesis must be made to suspect a latex allergy and if the patient is at risk of presenting it, perform additional study to confirm the diagnosis. It is necessary to know the allergens and processes involved in latex allergy, to be able to suspect and identify patients or staff who may suffer or be at risk of presenting it, thus reducing potential complications.

EFFECTS OF TOPICAL TREATMENT WITH EUPHORBIA TIRUCALLI LATEX ON THE SURVIVAL AND INTESTINAL ADHESIONS IN RATS WITH EXPERIMENTAL PERITONITIS / EFEITOS DO TRATAMENTO TÓPICO COM O LÁTEX DA EUPHORBIA TIRUCALLI NA SOBREVIDA E NAS ADERÊNCIAS INTESTINAIS DE RATOS COM PERITONITE EXPERIMENTAL

Background: The use of plants of the family Euphorbiaceae, particularly Euphorbia tirucalli (avelós) has been popularly widespread for treating a variety of diseases of infectious, tumoral, and inflammatory. Aim: To demonstrated antimicrobial and immunomodulatory effects of these extracts, evaluating the effect of a topical treatment with an aqueous solution of avelós latex on the survival and on intestinal adhesions in rats with experimental peritonitis. Methods: Peritonitis was induced in 24 Wistar rats, that were randomized into four groups of six as follows: (1) Control group (n=6), no treatment; (2) Antibiotic group (n=6), treatment with a single intramuscular dose of antibiotic Unasyn; (3) Saline group (n=6), the abdominal cavity was washed with 0.9% saline; and (4) E.tirucalli group (n=6), the abdominal cavity was washed with E. tirucalli at a concentration of 12 mg/ml. The animals that died were necropsied, and the time of death was recorded. The survivors were killed on postoperative day 11, and necropsy was subsequently performed for evaluation of the intestinal adhesions. Results: Significant differences were observed in the control and antibiotic groups (p<0.01) with respect to the survival hours when compared with the saline and E. tirucalli groups. There was no significant difference (p>0.05) in the survival of animals in the saline andE. tirucalli groups; however, one animal died in the saline group. Necropsy of the animals in the saline and E. tirucalligroups showed strong adhesions resistant to manipulation, between the intestinal loops and abdominal wall. The remaining groups did not show any adhesions. Conclusions: Topical treatment with E. tirucalli latex stimulated an increased formation of intestinal adhesions and prevented the death of all animals with peritonitis.

Racional: O uso de plantas da família Euphorbiaceae, principalmente a Euphorbia tirucalli (avelós), tem sido popularmente difundido para o tratamento de uma variedade de doenças de natureza infecciosa, tumoral e inflamatória. Objetivo: Avaliar o efeito do tratamento tópico com a solução aquosa do látex do avelós na sobrevida e nas aderências intestinas de ratos com peritonite experimental. Métodos: Foi induzido peritonite em 24 ratos Wistar e randomizados em quatro grupos de seis, assim distribuídos: 1) Controle - (n=6), nenhum tratamento; 2) Antibiótico - (n=6), tratamento com dose única intramuscular de antibiótico Unasyn (Pfizer - São Paulo); 3) Salina - (n=6), lavagem da cavidade abdominal com solução fisiológica 0,9%; 4) E.Tirucalli - (n=6), lavagem da cavidade abdominal com E. tirucalli na concentração de 12 mg/ml. Os animais que morreram foram submetidos à necropsia e o horário do óbito anotado. Os sobreviventes foram submetidos à eutanásia no 11odia de pós-operatório e, posteriormente, realizou-se a necropsia para avaliação da formação de aderências. Resultados: Os grupos controle e antibiótico obtiveram diferença significativa (p<0,01) com relação às horas de vida entre os grupos salina e E. tirucalli. Não houve diferença significativa (p>0,05) na sobrevida dos animais dos grupos salina e E. tirucalli, no entanto, houve um óbito no grupo salina. A necropsia dos animais dos grupos salina e E. tirucalli mostrou aderências firmes e resistentes à manipulação entre alças intestinais e parede abdominal. Os demais grupos não tiveram formação de aderências. Conclusão: O tratamento tópico com o látex da E. tirucalli estimulou maior formação de aderências intestinais e evitou o óbito de todos animais com peritonite até o período avaliado.

Alergia ao látex: análise da produção científica dos enfermeiros / Latex allergy: review of the scientific production of nures

Trata-se de uma revisão integrativa com objetivo de evidenciar os artigos da temática alergia ao látex publicados por enfermeiros. Para o estudo foram utilizadas as bases de dados Lilacs, Medline, BDENF, Scielo Brasil, Biblioteca Cochrane, Re@Enf, Scopus, Web of Science e Cinahl. Foram selecionados 28 artigos os quais foram submetidos às análises quanti e qualitativas, sendo identificadas as principais idéias contidas em cada estudo em torno dos temas alergia ao látex em profissionais de saúde, alergia ao látex em pacientes e produtos médicos que contêm látex. Evidenciou-se que os enfermeiros estudam mais sobre materiais que contém o látex, principalmente as luvas, verificando-se lacuna sobre o assunto na área dos cuidados de enfermagem, pesquisas de protocolos para a prática, reduzindo riscos inerentes aos pacientes alérgicos.

Role of calcium in enhancing the activity and thermal stability of a new cationic peroxidase purified from euphorbia tirucalli latex

A new cationic peroxidase from Euphorbi and firucalli [pencil cactus] latex was purified to homogeneity using benzene fractionation, gel filtration and cation-exchange chromatography. The purified enzyme was found to be monomeric with a molecular weight of 44 kDa as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis [SDS-PAGE]. The purified enzyme had a broad specificity towards some phenolic substrates in the order of 2,2'-azino-bis [3-ethylbenzothiazoline-6-sulfonicacid] [ABTS] > guaiacol > 0-phenylenediamine > 4-aminoantipyrene, whereas no affinity towards ascorbic acid and o-dianisidine was recorded. The enzyme had pH and temperature optima at 7.0 and 40°C, respectively. Study of kinetic parameters demonstrated that ABTS had the highest affinity towards ELP, where K[m], F[max] and V[ms]/K[m] values were 0.503 mM, 500 U/assay and 994.04 U/mM, respectively. ELP was stable from 10°C up to 60°C and lost about 70% of its activity at 70°C. The thermal inactivation profile of ELP in absence of Ca[2+] is biphasic and characterized by a rapid decline in activity on exposure to heat, followed by a more gradual decrease in activity on continued exposure. However, the purified enzyme exhibited increased thermal stability in the presence of calcium ions. Furthermore, the activity of purified enzyme was enhanced by 550% in the presence of 15 mM CaCl[2], suggesting a pivotal role for Ca[2+] in conferring structural stability to the heme environment and in retaining the active site of ELP. Most of the examined metal ions [except for Ca and Mg] and compounds had differential inhibitory effects on ELP activity. In conclusion, a locally available plant [Euphorbia tirucalli] could be a potential candidate source for peroxidase, the most widely used enzyme in industrial and biomedical applications. In addition, calcium was found to be essential for enhancing enzymatic activity and thermal stability of the purified Euphorbia tirucalli latex peroxidase

Alergia al látex / Latex allergy

La alergia al látex mediada por IgE se describe por primera vez en 1979, pero es a partir de 1989, coincidiendo con elreconocimiento del SIDA que se convierte en una verdadera epidemia con una morbi-mortalidad muy importante. La evitacióndel látex es lo más importante en la prevención, siendo muy difícil en la gran mayoría de los casos. El tratamientocon inmunoterapia no se realiza en la práctica diaria por los frecuentes efectos adversos descripto.

Latex allergy is IgE-mediated first described in 1979, but after 1989, coinciding with the recognition of AIDS becomesan epidemic with major morbidity and mortality. Avoidance of latex is the most important in the prevention, being very difficultin most cases. Immunotherapy treatment is not performed in daily practice by frequent adverse effects described.

Ocular toxicity by latex of Calotropis procera (Sodom apple).

We report the spectrum of ocular toxicity following accidental inoculation of latex of Calotropis procera (Sodom apple) in 29 eyes between January 2003 and December 2006. All patients presented with sudden painless dimness of vision with photophobia. Twenty-five (86%) patients had initial visual acuity of less than 20/60. All eyes had conjunctival congestion and mild to severe corneal edema with Descemet's folds. Three (10%) eyes had an epithelial defect, nine (31%) had iridocyclitis, and seven (24%) had associated secondary glaucoma. After treatment with topical corticosteroids, antiglaucoma agents, cycloplegics, hypertonic saline and tears supplements, 27 (93%) eyes recovered completely within 3-14 days. After three months, 17 (74%) out of 23 eyes showed a significant low endothelial cell count compared to the normal fellow eye ( P 0.001). The latex of Calotropis procera causes significant ocular morbidity which may be preventable by simple health education. The long-term effect on corneal endothelium has to be studied further.

Calotropis procera -induced keratitis.

Calotropis procera produces copious amounts of latex, which has been shown to possess several pharmacological properities. Its local application produces intense inflammatory response. In the 10 cases of Calotropis procera -induced keratitis reported here, the clinical picture showed corneal edema with striate keratopathy without any evidence of intraocular inflammation. The inflammation was reversed by the local application of steroid drops.

Adverse reaction to latex containing materials in health care workers

Latex allergy has become an occupational hazard among healthcare workers. Atopy, intensity and duration of exposure have been recognized as predisposing factors for latex sensitization. Frequency of sensitization varies among countries. So we decided to investigate the prevalence of latex sensitization and potential risk factors among healthcare workers in a general hospital. In a cross sectional study by distributing a questionnaire among 876 employees of a general hospital, we investigated the prevalence of latex allergy and the potential risk factors for latex sensitization. We collected information about occupational history, including specific tasks performed, time of first exposure to latex, number of pairs of gloves used, and duration of weekly exposure. We also investigated the interval between first exposure and onset of symptoms. We asked about pre-existing rhinoconjuctivitis, asthma, atopic and contact dermatitis, hay fever, autoimmune diseases, and food allergies. This survey documented a high prevalence of adverse reaction to all latex containing materials [52.5%]. 37.7% of responder had adverse reaction to latex gloves. The highest prevalence of adverse reaction to all latex containing materials was found in the surgical operating room, followed by emergency unit and internal medicine wards. According to this study, frequency of adverse reaction to latex was high among health care workers. This may be due to relatively low response rate, low quality of latex products in Iran, and the method of measurement. Whenever, the need for implementing prevention program, using latex-free methods and training of employees to reduce adverse reaction to latex is apparent

Condom leukoderma.

Contact dermatitis from natural latex of condom has been reported and is attributed to latex sensitivity. Chemical leukoderma from rubber condom is probably not reported. Here we present a case of chemical leukoderma in a 32-year-old male who developed depigmentation around the shaft of the penis in a circumferential pattern. Since the lesion was solitary and the site corresponded to the point of maximum contact of the condom, a diagnosis of contact leukoderma due to latex condom was thought of. Patch testing was done with mercaptobenzothiazole (MBT), dusting powder present in the condom and condom latex as such. The patient tested positive (3+) with mercaptobenzothiazole and the condom latex. On discontinuation of condom use and with UVB phototherapy, lesions repigmented in eight weeks.

Evaluation of cytotoxic potential of latex of Calotropis procera and Podophyllotoxin in Allum cepa root model

In the present study we have utilized the Allium cepa root tip meristem model to evaluate the cytotoxic and anti-mitotic activities of latex of Calotropis procera (DL) and podophyllotoxin. Standard cyto-toxic drug cyclophosphamide and non-cytotoxic drugs cyproheptadine and aspirin served as controls. Like cyclophosphamide, both DL and podophyllotoxin significantly inhibited the growth of roots and mitotic activity in a dose-dependent manner. However, podophyllotoxin was more potent in this regard and produced root decay. Cyproheptadine and aspirin, on the other hand, showed a marginal effect on the root growth and mitotic activity at much higher concentrations

Glove allergy and sensitization to natural rubber latex among nursing staff at Srinagarind Hospital, Khon Kaen, Thailand.

BACKGROUND: According to studies from different countries, the prevalence of natural rubber latex (NRL) sensitization in healthcare workers ranges from 2.9 to 17%. The incidence and prevalence of sensitization and allergy to NRL in Thailand is limited to two studies. There is no study among the high risk healthcare workers. OBJECTIVES: 1) To estimate the prevalence of natural rubber latex (NRL) glove allergy and NRL sensitization among nurses; 2) To describe its clinical symptoms. MATERIAL AND METHOD: Included in the present study were 412 nursing and medical record staff. A self-administered questionnaire was used to collect personal biodata and individual allergy histories to NRL products. Skin prick tests (SPTs) with the commercial NRL allergens; Stallergènes, S.A, Fresnes, France, and common environmental allergens, were performed. RESULTS: The questionnaire response rate was 88% (412/470), 93% females. The response rate of SPT was 72% (295/412) (95%CI 67.2, 76.0). The prevalence of NRL glove allergic symptoms and NRL sensitization was 24% (95%CI 19.9, 28.1) and 2% (95%CI 0.4, 3.6), respectively. The mostfrequently reported symptoms among the positive SPT to NRL was angioedema. Five of the six NRL sensitised subjects had had high exposure to NRL. CONCLUSION: NRL sensitization among Thai nursing staff is less prevalent than in healthcare workers in Europe.

Experimental model of pulmonary allergic inflammation induced by latex in Balb/c

The prevalence of allergic airway diseases has dramatically increased in recent years all over the world. Murine models of allergic airway inflammation have provided helpful information about treatment and cellular and molecular mechanisms of the disease. Previous published works using murine models to investigate latex allergy did not introduce a complete characteristic eosinophilic allergic airway inflammation. Latex allergy is important due to serious health impacts and widespread use of its products. Thus, the aim of this study was to establish a new mouse model of latex allergic airway inflammation using aerosol inhalation. Initially, four groups of mice were injected intraperitoneally [IP] with 0, 10, 50, or 200 mg of latex extract and their serum anti-latex IgE titers were compared using ELISA to find out the optimum dose for IP injection. In the second stage, a standard protocol of inhalation was designed and three doses of latex extract solutions including 1%, 0.1%, and 0.01% were used to induce allergic airway inflammation. Characteristics of this model were shown by studying different parameters including bronchoalveolar lavage [BAL], cytokines [Interleukin-5 [IL-5] and interleukin-13 [IL-13]] and serum anti-latex IgE and IgG1 titers by ELISA, specific histologic changes in the lung and eosinophilia of the bone marrow, peripheral blood, BAL, and lung inflammatory foci. The aerosol inhalation of 1% latex allergens solution and pre-sensitization with 50 mg of latex in this study resulted in the development of characteristic allergic airway inflammation in BALB/c mice. These features included elevated allergen specific IgE and IgG1, peripheral blood, BAL and bone marrow eosinophilia and characteristic inflammatory response in lung with eosinophil infiltration. Elevated levels of IL-5 and IL-13 can be a sign of this type of inflammation. This paper describes a latex aerosol inhalational challenge model of eosinophilic airway inflammation in latex pre-sensitized BALB/c mice

Alteraciones histopatológicas en lymnaea columella pulmonata lymnaeidae, huesped intermediario de fasciola hepática Linneaeus, 1758 trematoda fasciolidae causadas por euphorbia spendens var. hislopii N.E.B / Histopathologic changes in lymnaea columella Say, 1817 pulmonata lymnaeidae, intermediary host of fasciola hepática Linnaeus, 1758: trematoda fasciolidae, caused for euphorbia splendens var. hislopii N.E.B

El trabajo registra los cambios histopatológicos en Lymnaea columella huésped intermediario de fasciola hepática causados por el látex de Euphorbia splendens. Los caracoles fueron expuestos al látex en períodos diferentes siendo posteriormente procesados através de técnicas tradicionales. Los resultados demostraron necrosis en la glándula digestiva y gónadas ocurriendo pocas horas después del contacto con el producto

Alergia inmediata al látex con reacción cruzada a frutas: a propósito de un caso / Inmediate allergy latex with cross reaction a fruits: a purpose of a case

Se expone un caso de alergia al latex en un paciente con reacción cruzada a frutas

Prevalencia de hipersensibilidad al látex en personal médico / The latex hypersensitivity in medical personal

Con el objeto de determinar la prevalencia de hipersensibilidad al látex en el personal médico residente del Hospital Universitario de Puebla se efectuó un estudio transversal, observacional y descriptivo que incluyó al personal médico de todas las especialidades. La prueba epicutánea se efectuo con antigenos de los laboratorios Alphy a dilución 1:20. Se estudiaron 90 residentes. La edad promedio fue de 30.6 años (SD 3.8). el 68.9 por ciento correspondió al sexo masculino y 31.1 por ciento al femenino. Con respecto al tipo de especialidad 50 por ciento fue del área quirúrgica y el otro 50 por ciento del área médica. La prevalancia global de hipersensibilidad al látex fue del 5 por ciento. Será conveniente efectuar un seguimiento del grupo estudiado con el fin de establecer si las exposiciones repetidas en años posteriores determinaron la reactividad cutánea al látex en la vida profesional del grupo médico actualmente becario