Passive dispersion of latex aeroallergen in a healthcare facility.

BACKGROUND: Prompted by worsening asthma in a dental assistant with latex allergy and occupational asthma while under personal latex precautions, we confirmed continuing latex aeroallergen exposure. OBJECTIVES: To determine the source of latex aeroallergen and ascertain the effects of site-wide substitution of nonpowdered low allergen latex glove in a health care site. METHODS: Using a volumetric sampler, baseline latex aeroallergen levels were measured in rooms where she worked and nearby rooms, as well as shared X-ray, laboratory, and waiting rooms. Allergen levels were measured in upholstery fabric samples, ventilation duct dust, and latex gloves. Alterations in aeroallergen levels following change of glove types were prospectively determined. RESULTS: Baseline latex aeroallergen levels ranged from 6 to 25 ng/m3 in the patient's work areas and in other rooms from 29 to 90 ng/m3 during work hours. Latex antigen was found in three brands of powdered latex gloves (chi = 1,156 microg/g) used in the nearby opertories and the hygiene room, and in upholstery fabric, carpet dust, but not ventilation duct dust. In the absence of any other control measures, airborne latex became undetectable (<5 ng/m3) with exclusive use of nonpowdered latex gloves. DISCUSSION: Latex aeroallergen is primarily generated by active glove use; carpeting and fabric upholstery can serve as important aeroallergen repositories. Site-wide substitution of nonpowdered latex gloves eliminates detectable latex aeroallergen.

Added relief in the treatment of acute recurrent sinusitis with adjunctive mometasone furoate nasal spray. The Nasonex Sinusitis Group.

BACKGROUND: Intranasal glucocorticoids are effective in the treatment of allergic rhinitis. Their effectiveness as an anti-inflammatory adjunct in the treatment of acute recurrent sinusitis has not been adequately established in a controlled clinical study. OBJECTIVE: The purpose of this study was to test the hypothesis that intranasal corticosteroid treatment produces additional relief in the treatment of acute sinusitis with oral antibiotics. METHODS: Patients who were 12 years old and older with a history of recurrent sinusitis were treated while experiencing a new episode of acute sinusitis, which was diagnosed by symptoms and confirmed by computed tomography scan of the paranasal sinuses. Patients were treated for 21 days with amoxicillin clavulanate potassium and randomized to receive concurrent mometasone furoate nasal spray (MFNS; Nasonex [400 microg, twice daily]; n = 200 patients) or placebo spray (twice daily; n = 207 patients). Symptom scores for headache, facial pain, congestion, purulent rhinorrhea, postnasal drip, and cough were recorded at baseline and throughout treatment. RESULTS: Baseline symptom scores showed a moderate level of symptom severity comparable in both groups. Patient-recorded twice daily symptom scores showed that adjunctive treatment with MFNS caused a significantly greater decrease in total symptom score (primary efficacy variable) and in individual scores of inflammatory symptoms associated with the obstruction process (headache, congestion, and facial pain) compared with placebo. Symptoms associated with the secretory processes were improved to a lesser degree. Therapy-related local adverse events were not significantly different between groups. CONCLUSION: The addition of intranasal corticosteroid, MFNS 400 microg twice daily, to antibiotics significantly reduces symptoms of acute sinusitis compared with antibiotic treatment alone.

Hydroxychloroquine improves airflow and lowers circulating IgE levels in subjects with moderate symptomatic asthma.

BACKGROUND: Although antiinflammatory therapy is accepted as the cornerstone of asthma treatment, available systemic immunosuppressive agents are not widely used because of justified concerns over potential toxicity. Hydroxychloroquine (HCQ) is a well-tolerated, safe immunomodulating drug, with proven efficacy in rheumatic diseases and known actions that suggest potential utility in the treatment of asthma. OBJECTIVE: We sought to assess the effectiveness of HCQ in subjects with moderate symptomatic asthma. METHODS: Symptomatic asthmatic subjects receiving stable doses of at least 6 puffs of inhaled corticosteroid per day with daily need for beta2-adrenergic agonists were studied. After baseline run-in, these subjects were randomized to 30 weeks of HCQ (n = 8) or placebo (n = 9). Objective measures included change from baseline mean FEV1, morning and evening peak flows, beta2-agonist use, IgE level, and need for rescue corticosteroids. Subjective symptom scores from bidaily diaries were also obtained. RESULTS: In the treatment group, mean FEV1 at the last 2 visits on therapy increased by 10.8% (P < .05), morning peak flows rose 16.2% (P < .03), evening peak flows rose 14.2% (P < .04), and beta2-agonist use fell 18.6% (P < .03). Mean IgE level declined 48% from 240 to 125 IU/mL. (P < .05). In the placebo group no significant change in these parameters occurred. Comparison of changes in these objective measures between the treatment and placebo groups failed to reach significance in the small population studied. Corticosteroid rescue interventions were required in 4 patients receiving placebo and 2 receiving HCQ. HCQ was well tolerated without notable side effects. CONCLUSIONS: Although the size of our sample population precludes definitive conclusions, these findings extend previous open-label observations. The late improvement in the HCQ group is consistent with its known slow onset of action. Further studies are warranted to confirm the antiasthmatic and antiallergic effects of HCQ and to investigate its potential as a disease-modifying agent.

Occupational latex exposure: characteristics of contact and systemic reactions in 47 workers.

BACKGROUND: Recent reports have noted an apparent increase in the prevalence of natural rubber latex (NRL) allergy among workers with occupational latex exposure (OLE). The risk factors for and the natural history of NRL allergy in this population are not well delineated, and the utility and comparability of immunoassays as confirmatory testing are unclear. METHODS: Serum samples and medical histories were obtained from 47 symptomatic workers with OLE, from nine other individuals with a history consistent with NRL allergy, and from 10 atopic asymptomatic NRL-exposed control subjects. Sera were coded and analyzed in a blinded manner for latex-specific IgE, using a variety of antigen sources, including ammoniated and nonammoniated raw latex preparations and three finished glove preparations. RESULTS: Risk factors for the latex allergy in workers with OLE appear to include a history of atopy or preexisting dermatitis involving the hands. In this population, NRL allergy is commonly preceded by latex glove-associated contact dermatitis. Serologic testing confirmed the suspected diagnosis in 62% of workers (15 of 24) with systemic symptoms but was only positive in 27% of workers (4 of 15) with symptoms limited to contact urticaria. CONCLUSIONS: The appearance of a latex glove-associated contact rash may precede the development of NRL allergy, particularly in atopic persons. Workers at risk should be advised to use alternate types and brands of latex gloves or to switch to nonlatex gloves entirely.

Serologic methods in the laboratory diagnosis of latex rubber allergy: study of nonammoniated, ammoniated latex, and glove (end-product) extracts as allergen reagent sources.

In the absence of approved natural rubber latex skin testing reagents, serologic methods for the detection of latex-specific immunoglobulin E (IgE) antibody are useful in the definitive diagnosis of latex allergy. In this study we examined extracts from two nonammoniated latex (NAL), two ammoniated latex (AL), and three diverse latex rubber gloves as sources of allergen for their utility in solid phase radioimmunoassays (SPRIAs) for latex-specific IgE. Serum samples were collected from 46 healthcare workers (HCWs), one beautician, two clerks, and seven children with spina bifida who exhibited clinical evidence of latex-associated contact dermatitis (CD, n = 8), contact urticaria (CU) with or without CD (n = 15), or systemic reactions involving respiratory symptoms with or without anaphylaxis (n = 33) and from 10 latex-exposed HCW control subjects with no latex allergy symptoms. Serum samples were coded and analyzed in a blinded manner in two laboratories by three particulate and four nonparticulate SPRIAs with different latex extracts on the allergosorbent. Intraassay coefficient of variation as assessed with 44 split, randomized, blinded serum specimens was < 20%. Agreement within a source of latex (e.g., NAL, AL, or gloves) and between laboratories was > 90% concordant for Glove 1/Glove 2 and NAL1/2. Specific IgE antilatex was detected in one of 10 latex-exposed control serum samples by five of the seven SPRIAs, despite a lack of clinical evidence for latex allergy in this otherwise atopic individual. Latex-specific IgE was detected in the serum of 22% of subjects with CU with or without CD, suggesting that IgE antibody may not be the primary factor involved in the induction of these local reactions. Approximately two thirds of the systemic reactor group had detectable latex-specific IgE in their serum, with levels ranging from 0.7 to 338 ng/ml. The predictive characteristics of these assays will await future provocation testing. We conclude that glove extracts contain as complete a repertoire of allergens as the NAL and AL. Of the three source latex materials, NAL and glove extracts provided the most sensitive and greatest consistency of IgE antibody results between laboratories.

Open study of hydroxychloroquine in the treatment of severe symptomatic or corticosteroid-dependent asthma.

To examine the possible usefulness of the immunomodulating antiinflammatory drug, hydroxychloroquine (HCQ), in the treatment of asthma, we studied the response of 11 asthmatics, four severe symptomatic nonsteroid dependent and seven steroid-dependent, in an open label 28 week trial at doses of 300 to 400 mg/d. Evaluation measures included daily symptom diary scores of six symptoms, subjective global evaluation, spirometric flow studies, and cumulative monthly steroid dosages. Baseline plasma theophylline and IgE levels were also obtained and compared with values during treatment. For the group as whole, mean FVC and FEV1 increased 10% and 17% respectively (P less than .01) and the mean of each of six symptom scores declined significantly (P less than .05). Among the nonsteroid-dependent asthmatics, the mean FVC and FEV1 rose 19% and 32% respectively (P less than .05) and mean symptom scores for five of six symptoms declined from baseline (P less than .05). Among the steroid-dependent patients, cumulative mean monthly steroid dosage required decreased 50% from 383 mg at entry to 191 mg at week 28 (P less than .01), mean FVC and FEV1 increased by 7% and 9%, although neither of these changes achieved significance, and two of six symptom scores improved (P less than .05). Comparison of pretreatment IgE levels to levels during treatment in ten patients demonstrated a fall from a mean of 645 to 339 IU/mL (P less than .05). Adverse reactions to HCQ were infrequent and did not require discontinuing therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of cyclosporine on immunization with tetanus and keyhole limpet hemocyanin (KLH) in humans.

Eleven patients with chronic uveitis treated with Cyclosporine were immunized with keyhole limpet hemocyanin (KLH) and tetanus toxoid. Delayed cutaneous hypersensitivity responses, lymphocyte blastogenic responses, and antibody production were compared with those of similarly immunized control individuals. A significant decrease in delayed cutaneous hypersensitivity (P less than 0.001 for KLH and P less than 0.01 for tetanus toxoid) was observed. No significant differences in blastogenic or antibody responses were noted. These findings demonstrate that the majority of the Cyclosporine-treated patients had intact T cell-dependent antigen responses as measured by both proliferative response and antibody production to primary and secondary antigenic challenges but that other immune functions such as delayed cutaneous hypersensitivity are affected by therapeutic doses of systemic Cyclosporine.