Tailored Sublingual Immunotherapy in a Monosensitized Child with Natural Rubber Latex Allergy.

Adverse reactions to natural rubber latex (NRL) represent a group of clinical manifestations that include non-allergic reactions and immediate-type or delayed-type allergic reactions. NRL sublingual immunotherapy (SLIT) has been demonstrated to be an effective and safe practice for latex clinical manifestations with good patient tolerance. A pediatric case of NRL allergy managed with an effective tailored SLIT is described. This case is compelling because the girl, who did not have an atopic background, suffered from NRL allergy with high reactivity and unique monosensitization. To the best of our knowledge, this is the first case with this characteristic described to date. Moreover, the SLIT follow-up time reported was unusually long, extending from childhood to adulthood. The case described highlights several problems of real-life management, and it demonstrates how the pediatric allergist plays a key role in the management of all these issues in order to succeed in guiding the patient through the immunotherapy process with a personalized approach, in line with the precision medicine principles. However, further long-term clinical studies are needed to better define the natural history of NRL allergy and find new potential biomarkers of response to NRL immunotherapy.

Misleading Allergens in the Diagnosis of Latex Allergy: Profilin and Cross-Reactive Carbohydrate Determinants.

BACKGROUND: It has been suggested that latex-specific IgE analysis may lead to false-positive results, especially in patients with pollen allergy. In the present study, the reasons underlying clinically irrelevant latex-specific IgE positivity were investigated. METHODS: Thirty patients with latex allergy (group 1), 89 patients sensitised to aeroallergens (group 2a), and 98 healthy individuals without allergy (group 2b) were enrolled. Participants from all 3 groups were subjected to skin prick tests with aeroallergens including latex, latex-specific IgE analysis (ImmunoCAP), and nasal provocation test with latex. All cases demonstrating positive latex-specific IgE also underwent specific IgE tests (ImmunoCAP) with latex profilin, birch pollen profilin, peach lipid transfer protein, and pineapple bromelain as cross-reactive carbohydrate determinants. RESULTS: Comparison of the atopic and healthy control groups showed that the rate of positive latex-specific IgE was significantly higher in group 2a. Latex profilin-, birch pollen profilin-, and bromelain-specific IgE were remarkably higher in group 2a. CONCLUSION: False positivity to latex-specific IgE in ImmunoCAP analysis may be observed in approximately 19% of patients with pollen allergy. Profilins and bromelain are the main contributors to clinically irrelevant positive latex-specific IgE.

[Anaphylactic shock lasting 4 days]. / Shock anafiláctico prolongado de 4 días de duración.

We present a case of a 62 year-old male scheduled for radical cystectomy, who, ten minutes into the surgery, presented with severe hypotension, tachycardia and increased airway pressure. There was no response to the administration of vasoactive drugs such as, ephedrine, phenylephrine, dopamine and norepinephrine. After ruling out several causes, we evaluated the possibility of an anaphylactic reaction. Adrenaline was given, and the patient stabilized. An adrenaline infusion and mechanical ventilation was required for four days in the critical care unit.

Novel allergens from ancient foods: Man e 5 from manioc (Manihot esculenta Crantz) cross reacts with Hev b 5 from latex.

SCOPE: Manioc (Manihot esculenta) is a tuber mainly consumed in the Southern Hemisphere and used worldwide by food and chemistry industry. We aimed to recombinantly produce and characterize the first manioc allergen and evaluate its IgE reactivity in sera of Brazilian and Italian patients. METHODS AND RESULTS: The molecule, termed Man e5, was expressed in E. coli, characterized by amino acid analysis, mass spectrometry, circular dichroism, HPLC, and dynamic light scattering. A tertiary structural model of the protein was produced using bioinformatics and susceptibility to pepsin digestion was analyzed in vitro. Based on its high content of charged residues, heat stability, flexibility and lack of secondary structure elements, the allergen was determined a member of the intrinsically disordered protein family. Brazilian patients were selected based on manioc allergy and Italians based on latex allergy and sensitization to Hev b 5.71% of Brazilians and 40% of Italians were in vitro IgE positive to Man e5. Cross-inhibition assays suggest a possible involvement of this allergen in the latex-fruit syndrome. CONCLUSION: Man e5, the first purified allergen from manioc demonstrates IgE cross-reactivity with Hev b 5. Data suggest Hev b 5 might act as primary sensitizer and could therefore lead to allergic manifestations upon manioc consumption without prior exposition.

Latex-fruit syndrome in Italian children and adolescents with natural rubber latex allergy.

Approximately 30-50 percent of individuals with natural rubber latex (NRL) allergy show an associated hypersensitivity to particular plant-derived foods, which has been defined "latex-fruit syndrome" (LFS). In our population of 22 patients with IgE-mediated NRL allergy we found a relevant prevalence (36 percent) of LFS, which resulted significantly higher in the group of patients with more severe clinical manifestations of NRL allergy than in patients with contact symptoms due to NRL (78 percent vs 8 percent; less than 0.005).

Molecular allergens in the diagnosis of latex allergy.

BACKGROUND: Molecular allergens enable the definition of sensitization profiles in allergic patients. AIM: To validate the most helpful allergens for the diagnosis of latex allergy in different clinical situations. METHODS: 130 patients suspected to be allergic to latex with positive IgE against natural rubber latex (NRL) have been studied: 97 were confirmed as latex allergic (among which 55 professionally exposed to latex and 35 with a peranaesthetic anaphylactic shock) and 33 were only sensitized to latex without clinical allergy. Each serum was tested for IgE against 9 recombinant latex allergens and bromelain using Phadia ImmunoCAP 250. RESULTS: rHev b 6.01, 6.02, 2 and 5 were the major allergens in the allergic population. An excellent correlation (94%) was observed between IgE against rHev b 6.01 and latex prick test positivities. IgE against rHev b 1, 3 and 5 were more frequent and their levels significantly higher in patients with peranaesthetic anaphylactic shock. Among the asymptomatic patients (29/33 allergic to pollen), NRL IgE positivity is explained by the presence of anti-rHev b 8 and/or anti-carbohydrate IgE. CONCLUSIONS: rHev b 6.01 and rHev b 5 specific IgE are of major interest to confirm latex allergy diagnosis. rHev b 5 is particularly useful in case of monosensitization where clinical symptoms and latex skin prick tests may be discordant, rHev b1 and rHev b 3 are interesting to document multi-operated and peranaesthetic latex allergy. Finally, rHev b 8 is a helpful marker to highlight latex/pollen cross-reactivity which improves the specificity of the serological tests.

Sensibilidade ao Látex e Dosagem de Anticorpos Específicos em Profissionais da Área da Saúde / Sensitivity to latex and the dosage of specific antibodies in professionals in the area of health

O objetivo deste estudo foi verificar a ocorrência da reação de sensibilidade ao látex e realizar dosagem de anticorpos antilátex em profissionais dos cursos de odontologia, medicina e enfermagem da Universidade Federal do Espírito Santo (UFES), Vitória-ES, Brasil. Estudo observacional, transversal. A amostra intencional foi composta por 295 profissionais. A sensibilidade foi avaliada por meio de questionário estruturado e validado, e a presença de IgE-látex por meio da coleta de 10ml de sangue submetido a análise com emprego do sistema Immunocap-Pharmacia®. Os valores IgE-látex foram distribuídos em diferentes classes. Resultados: 22,4, por cento (n=66) apresentaram sensibilidade ao látex, classe V IgE latex (17,6-42 KUA/L); 77,6 por cento (n=229) sem sensibilidade, classe 0 IgE-látex (<0,35KUA/L). O teste de Fisher mostrou correlação estatística significativa (p<0,05) em relação às seguintes variáveis: gênero; atopia; eczema nas mãos; alergia a medicamento; doença crônica; uso de anti-inflamatório; cirurgias anteriores. Conclusão: Observou-se valores positivos de IgE-látex nos profissionais com sensibilidade ao látex, sugerindo a necessidade de adoção de medidas profiláticas para a prevenção e ou adequação do ambiente de trabalho, preservando a saúde destes trabalhadores.

The scope of this study was to verify the occurrence of sensitivity to latex and conduct dosage of anti-latex antibodies in health professionals of the Dental, Medical and Nursing Schools of the Federal University of Espírito Santo (UFES), Vitoria, ES, Brazil. This was a cross-sectional observational study. The intentional sample was composed of 295 professionals. Sensitivity was evaluated by means of a structured and validated questionnaire and the presence of IgE-latex by means of collection of 10 ml of blood submitted to analysis using the Immunocap-pharmacia® system. The IgE-latex values were categorized in different groups. Results: 22.4 percent (n=66) showed latex sensitivity, class V of the IgE latex (17.5-42 KUA/L); 77.6 percent (n=229) showed no sensitivity, class 0 or 1 of the IgE-latex (<0.35KUA/L-8,6KUA/L). Fisher's test showed a significant correlation statistic (p<0.05) in relation to the following variables: gender; atopy; eczema of the hands; allergy to medicination; chronic illness; use of anti-inflammatory; prior surgeries. Conclusion: Positive values of IgE were observed in the professionals with sensitivity, suggesting the adoption of prophylactic measures for the prevention and or adaptation of the work environment, preserving the health of these workers.

[Sensitivity to latex and the dosage of specific antibodies in professionals in the area of health]. / Sensibilidade ao Látex e Dosagem de Anticorpos Específicos em Profissionais da Área da Saúde.

UNLABELLED: The scope of this study was to verify the occurrence of sensitivity to latex and conduct dosage of anti-latex antibodies in health professionals of the Dental, Medical and Nursing Schools of the Federal University of Espírito Santo (UFES), Vitoria, ES, Brazil. This was a cross-sectional observational study. The intentional sample was composed of 295 professionals. Sensitivity was evaluated by means of a structured and validated questionnaire and the presence of IgE-latex by means of collection of 10 ml of blood submitted to analysis using the Immunocap-pharmacia® system. The IgE-latex values were categorized in different groups. RESULTS: 22.4% (n=66) showed latex sensitivity, class V of the IgE latex (17.5-42 KUA\L); 77.6 % (n=229) showed no sensitivity, class 0 or 1 of the IgE-latex (<0.35KUA\L-8,6KUA\L). Fisher's test showed a significant correlation statistic (p<0.05) in relation to the following variables: gender; atopy; eczema of the hands; allergy to medicination; chronic illness; use of anti-inflammatory; prior surgeries. CONCLUSION: Positive values of IgE were observed in the professionals with sensitivity, suggesting the adoption of prophylactic measures for the prevention and or adaptation of the work environment, preserving the health of these workers.

[Latex allergy among medical staff].

The article covers results of study revealing incidence and clinical features of latex allergy in medical staffers, to further specifying essential approaches ot early diagnosis and prevention of this disorder.

Identification of clinically relevant cross-sensitization between Soliadgo virgaurea (goldenrod) and Hevea brasiliensis (natural rubber latex).

BACKGROUND: Solidago virgaurea (goldenrod) is a perennial weed from which no allergens have been identified. A high latex content in its leaves has been reported. Although not an airborne allergen, it may be an important occupational sensitizer. OBJECTIVE: To identify allergenic proteins in goldenrod and to determine whether they cross-react with Hevea brasiliensis latex. METHODS: Potential cross-reactive allergens in latex and goldenrod were investigated by immunoblot inhibition and ImmunoCAP inhibition analyses using serum from patients with clinically evident goldenrod and/or latex allergy. Cross reactivity between latex allergens and goldenrod proteins was studied using recombinant Hev b 1, 3, 4, 5, 6.01, 6.02, 8, 9, or 11 in ImmunoCAP inhibition analyses. RESULTS: Immunoglobulin (Ig) E antibodies from individuals with goldenrod allergy bound extracted goldenrod proteins ranging from 20 kDa to 130 kDa in Western blots. Evidence for latex and goldenrod cross reactivity was identified by ImmunoCAP and immunoblot inhibition experiments using serum from patients with strongly positive concomitant latex and goldenrod-specific IgE antibody responses. Observed latex-goldenrod cross reactivity could not be ascribed to any of the recombinant major latex allergens evaluated. CONCLUSIONS: H brasiliensis latex and goldenrod contain cross-reactive and unique allergenic proteins. Exposure to goldenrod may sensitize patients to latex and vice versa.

Hev B 6.02 is the most important allergen in health care workers sensitized occupationally by natural rubber latex gloves.

BACKGROUND: Natural rubber latex (NRL) allergy is a common occupational disease in health care workers (HCW). However, few reports have compared the major allergen of HCWs to those in gloves that are routinely used in the hospital. The aim of this study was to evaluate the major NRL allergens in gloves used by HCWs. METHODS: We studied 20 HCWs who were suspected to have latex allergy (LA). We performed a skin prick test (SPT) using NRL allergens. Serological testing was performed using the ImmunoCAPTM. The total amount of protein and the antigenic protein concentrations extracted from NRL gloves were measured. Four different types of FITkitTM were used to measure the concentrations of Hev b 1, 3, 5, and 6.02 in the gloves. RESULTS: A SPT using NRL extract identified 14 cases with positive reactions. The sensitivity and specificity of the SPT scores to the NRL glove extract were 100%. The sensitivity of latex specific IgE was 100% but the specificity was 14.2%. The sensitivity and specificity of rHev b 6.02 specific IgE were 100% in the LA group. The total amounts of protein from the medical gloves for surgery and examination were 265 microg/g and 95 microg/g, respectively. The antigenic protein concentrations in the gloves were 24.9 microg/g and 1.0 microg/g, respectively. The total amounts of the specific four allergens in the NRL gloves were 2.18 microg/g and 0.45 microg/g, respectively. CONCLUSIONS: We concluded that the main allergen of HCWs who have been sensitized occupationally by NRL gloves was Hev b 6.02.

Hydrophobic allergens from the bottom fraction membrane of Hevea brasiliensis.

Several proteins of rubber latex have been recognized as allergens causing immediate hypersensitivity in humans. In this study, a bottom fraction membrane (BFM) protein preparation from Hevea brasiliensis trees grown in southern Thailand was used to detect specific IgE in four groups of serum samples. The first group included 170 samples of latex glove factory workers (LGWs); group 2 consisted of the sera of 35 health care workers (HCWs) who were repeatedly exposed to powdered latex gloves; groups 3 and 4 were 31 positive and 22 negative sera, respectively, obtained from Johns Hopkins University School of Medicine, Baltimore, USA, tested for IgE to latex allergen. It was found that 56/170 (33%), 5/35 (14%), 11/31 (35.5%) and 1/22 (4.5%) samples of the LGWs, HCWs, CAP+ and CAP- groups had significant IgE to the BFM proteins, respectively. However, of all subjects only one subject of group 1 had experienced allergic morbidity consisting of eczema, conjunctivitis and asthma. The IgE of this subject bound to a 55 kDa component in the rubber latex BFM preparation. Thus, this protein may be regarded as a novel, although minor, latex allergen. Further investigation is needed to characterize the component and to pinpoint its allergenic role.