Postal questionnaire study of disability associated with latex allergy among health care workers in Finland.

In this study, the association between natural rubber latex (NRL) sensitization and work ability index (WAI) among health care workers was investigated. Furthermore, the diagnostic sensitivity and specificity of a postal questionnaire as a screening device of NRL allergy was evaluated. The study population consisted of 32 female health care workers with an occupational latex allergy, and 51 control subjects who were individually matched for age and occupation. A self-administered two-part questionnaire, including seven items of a work ability index (WAI), as well as questions on glove-related symptoms, was mailed to the subjects. The median age for NRL allergic subjects was 40 years (range 23-62), and the diagnosis of occupational latex allergy had been made six years (range 2-16) before the present study. The WAI scores were on average lower among the sensitized subjects as compared with their nonsensitized controls. Even after removing the contribution of the presence of allergic eczema, diagnosed by a physician, from the original WAI score, the proportion of NRL allergic subjects and the control subjects in the good work ability category were 34% and 53%, respectively. Ten health care workers (31%) had changed occupation and one early retirement had occurred after sensitization to NRL. The sensitivity and specificity of the present self-administered questionnaire as an indicator for latex allergy was 84% and 98%, respectively. In conclusion, there is a clear association between NRL allergy and a decrease in the WAI among health care workers, which cannot be explained by age, gender, profession, or history of atopy.

Glove-related rhinopathy among hospital personnel.

Hypersensitivity to natural rubber latex (NRL) in health care personnel exposed to powdered latex gloves appears as conjunctivitis, rhinitis, nasal congestion, cough, dyspnea, or bronchial asthma in approximately 30% of all cases with latex allergy while most of the patients have contact urticaria. The purpose of the present study was to determine the prevalence of latex-induced allergic rhinitis in health care workers using NRL gloves on a daily basis. Clinical examination accompanied by skin prick test (SPT) with latex glove extracts and common aeroallergens, measurements of specific IgE to NRL, and lung function tests were performed in 25 symptomatic workers and 11 latex-exposed asymptomatic controls. Sensitization to NRL was detected using SPT in one (4%) of 25 symptomatic workers but not in any of the asymptomatic controls. Positive SPT to aeroallergens was demonstrated in 8/25 symptomatic workers and 6/11 controls. Measurements of forced vital capacity, forced expiratory volume in I sec, and bronchial methacholine challenge did not show any significant differences between the study groups. In conclusion, NRL-aeroallergen-induced occupational rhinitis may occur among physicians and nurses who have a frequent use of latex gloves on a daily basis at hospital work. However, a relatively low prevalence of NRL-induced occupational rhinitis is associated with profuse consumption of no-powder sterile gloves.

Glove-induced dermal and respiratory symptoms among health care workers in one Finnish hospital.

To evaluate the prevalence of skin and respiratory symptoms associated with the use of protective gloves in health care workers, an inquiry study was carried out on 534 hospital employees who used protective latex or vinyl gloves on a daily basis at work. The prevalence of skin disorders related to the usage of gloves was 56%. Rhinorrhea or nasal congestion was present in 13% of the workers who used powdered disposable gloves. The prevalence of both skin and respiratory symptoms was significantly higher among the workers who used gloves > 2 hours a day (p < 0.001). The skin disorders were more common in young employees. The findings indicate that most of the symptoms were caused by irritation or an immediate, IgE-mediated allergy. We conclude that there is a positive correlation between the duration of daily glove usage at work and the skin and respiratory symptoms. In order to reduce skin disorders associated with the daily use of gloves, it is necessary to develop safer materials in the glove manufacturing process.

Detection of airborne natural rubber latex by immunoelectrophoresis, RAST inhibition, and immunospot method.

Occupational dermal and respiratory allergies caused by natural rubber latex (NRL) have been encountered with increasing frequency in health care workers. In order to measure the amount of airborne NRL, area and personal air sampling was performed in three hospital laboratories where workers used latex gloves. The total dust levels in laboratory air samples were lower than 0.17 mg/m3. RAST inhibition suggested that NRL antigens may exist both in the area and personal samples. Immunospot measurements, rocket immunoelectroporesis, and rocket radioimmunoelectrophoresis did not show any NRL activities in laboratory airsamples, although they were able to detect immunoactive material in positive control filter specimens. We conclude that the airborne NRL concentration was undetectable in daily hospital laboratory environment where workers used disposable NRL gloves. Airborne NRL, however, can be measured by using immunological assays.

Cold-induced responses in the upper respiratory tract.

Recent investigations have shown that the prevalence of bronchial asthma is higher among skiers exposed to cold and dry air than among nonskiers. The upper airway passages are responsible for warming and humidifying the inhaled air. During exercise in cold and dry air, warming and humidifying of the inhaled air continues in the bronchial tree. Under these conditions both nasal and bronchial mucosa are cooled by inspiratory air and remain cooled throughout the respiratory cycle. The air which reaches the bronchoalveolar air space is at body temperature and fully saturated in all conditions. In this article we briefly review the studies carried out regarding the effects of cold air inhalation on the upper respiratory tract.

Pigeon-serum-induced hypersensitivity pneumonitis in the dog.

Pigeon serum (PS) is one of the most common causes of hypersensitivity pneumonitis (HP). PS-induced HP was examined in a dog model. The dogs (n = 6) were immunized by i.m. injections of PS, followed by insufflation with aerosolized PS, while all control dogs (n = 3) received saline only. All animals insufflated with PS developed tachypnea 2-4 h after PS inhalation. After PS insufflation, a significant decrease in arterial oxygen tension (PaO2) was detected in sensitized dogs. No change in PaO2 was detected in sensitized dogs after saline or in the controls after PS insufflation. In intradermal skin tests with PS antigen, a positive skin reaction was found in 3/6 dogs in 30 min, and in 5/6 dogs in 6 and 48 h after the PS injections. Sensitized dogs showed a significant increase in PS-specific IgG in serum and lavage fluid (LF). In LF of sensitized dogs, an increase in the percentage of lymphocytes, eosinophils, and neutrophils was detected. Sensitized dogs developed chronic interstitial inflammation with lymphocytes, macrophages, plasma cells, and eosinophils in lungs. Granulomas with lymphocytes, histiocytes, and giant cells were detected in both the interstitium and the bronchiolar wall in the lungs of sensitized dogs. PaO2 was lowest in dogs showing the most severe interstitial inflammation in the lungs. The results indicate that dogs can be successfully used in immunologic and physiologic studies of PS-induced HP.

Latex-induced dermal and pulmonary hypersensitivity in rabbits.

BACKGROUND: Natural rubber latex (NRL) causes immediate, IgE-mast cell-mediated reactions in sensitized individuals, especially among health care workers and children with spina bifida. The immunopathogenesis of the reaction is obscure. METHODS: To study the immunologic mechanisms of NRL allergy, rabbits were sensitized with two nonammoniated and one ammoniated NRL antigens. Subcutaneous and intratracheal injections were used to immunize rabbits. Intradermal skin tests, IgG antibodies against NRL in serum and lung lavage fluid, and pulmonary histologic features were evaluated. RESULTS: One of nine sensitized rabbits died of anaphylaxis immediately after the third intratracheal injection with nonammoniated NRL. All sensitized rabbits, but not the controls, showed an immediate wheal and flare reaction in intradermal skin testing with NRL antigens. A positive skin reaction was detected 6 and 48 hours after the intradermal injections in four of five sensitized rabbits. A significant increase in NRL-specific IgG antibodies was detected in serum and lung lavage fluid of immunized rabbits. Lung histologic evaluation of NRL-sensitized rabbits showed a granulomatous interstitial and bronchial inflammation with a predominance of eosinophils and histiocytes in both intratracheally and subcutaneously sensitized rabbits. Vasculitis, hypertrophia, and contraction of pulmonary arteries could be detected in sensitized animals. CONCLUSION: The results of the first NRL rabbit model study indicate that eosinophils and IgE antibodies play a major role in the immunopathogenesis of NRL-induced allergy and anaphylaxis. A wide range of inflammatory responses detected in rabbits injected by subcutaneous route without intratracheal exposure suggests that NRL exposure may pose a risk for a subsequent systemic reaction.

The diagnosis of natural rubber latex allergy.

Allergy to latex is a rapidly emerging public health problem. Because our knowledge of the major allergens involved is incomplete, standardized in vivo and in vitro tests have not been available. Because of systemic reactions to skin prick testing, this method should be used only after results of other tests have been inconclusive. Risks and benefits of the test need to be explained to the patient, and until standard extracts of latex are available, skin tests should be performed under a research protocol. We anticipate that with greater knowledge of the relevant allergens, purification of these allergens with affinity chromatography, high-performance liquid chromatography, and monoclonal antibodies, a safe and reliable extract will be available in the near future for skin testing. Until then, the above guidelines can serve clinicians in their daily practice in the diagnosis of latex allergy.

Two bacteria causing farmer's lung: fine structure of Thermoactinomyces vulgaris and Saccharopolyspora rectivirgula.

The fine structure of Thermoactinomyces vulgaris and Saccharopolyspora rectivirgula is described by transmission electron microscopy. These two bacteria are the most common microbes causing farmer's lung. The fine structure of hyphae, germination of endospores and the details of conidial wall layers of T. vulgaris, as well as the fine structure of septate hypha and globose, polygonal conidia of S. rectivirgula are described. The conidial wall of T. vulgaris consisted of an inner multilayered spore coat, intermediate spore coat and outer spore coat. The findings are important for the investigations to find fragments of these bacteria in the lungs of exposed patients and experimental animals.

Monoclonal antibodies bind identically to both spores and hyphae of Aspergillus fumigatus.

Immunoelectron microscopy (IEM) was used to determine the binding of six monoclonal antibodies (MoAbs) produced against Aspergillus fumigatus antigens present on or within the conidia and hyphae of the fungus. Antigen-antibody complexes were demonstrated in EM using labelled colloidal gold particles (15 nm). Three out of 6 MoAbs (C9, F12 and H10) reacted only with the cytoplasmic components of A. fumigatus while the remaining three (B12, F6G5 and D6E6) showed reactivity to both cytoplasm and cell wall of the conidia and hyphae. The results indicate that IEM is of considerable value in determining and selecting monoclonal antibodies having specific reactivity with diverse antigenic components.

Two common fungi associated with farmer's lung: fine structure of Aspergillus fumigatus and Aspergillus umbrosus.

The fine structure of Aspergillus fumigatus and Aspergillus umbrosus by transmission electron microscopy (TEM) is described. The fine structure of the ascosporic and asexual stages of A. umbrosus is described for the first time. Dense, homogenous material and fibers were detected on the outer hyphal cell wall of the Aspergilli. Septal pores were found in the hypha of A. umbrosus. Two wall layers were detected in the cell wall of the conidia of the both Aspergilli. The ascospores of A. umbrosus contained thick cell wall and the surface of which was smoother than that of the conidia.

Ultrastructural demonstration of specific IgG and IgE antibodies binding to Aspergillus fumigatus from patients with aspergillosis.

Aspergillus-induced diseases usually demonstrate elevated circulating antibodies belonging to different isotypes. The antigens currently used to detect antibodies are crude culture filtrate and mycelial extracts of A. fumigatus (Af). Most Af-associated diseases result from the inhalation of the spores of the organisms present in the environment. However, it is not known whether specific circulating antibodies directed only against spore or mycelia of Af exist in the sera of patients with Af-induced diseases. With colloidal gold we have investigated thin sections of spores and hyphae of Af for their reactivity with Af-specific IgG and IgE antibodies. The results indicate that both spores and hyphae reacted identically with IgG and IgE antibodies from patients. None of the sera from normal control subjects reacted in this system, although low levels of antibodies were detected in the sera by ELISA. Sera from both patients with allergic bronchopulmonary aspergillosis or aspergilloma reacted with cell envelope antigens, whereas sera from patients with invasive aspergillosis also bound to cell sap. This method therefore demonstrates localization of antigens binding to different isotypes in the sera from different clinical forms of aspergillosis and may be useful in purifying specific antigens for immunodiagnosis.

Detection of IgG and IgE antibodies to Aspergillus fumigatus in human sera by immunogold assay.

An immunogold assay (IGA) was developed to detect IgG and IgE antibodies to Aspergillus fumigatus. Sixteen sera from patients with allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and normal controls were studied. All sera were also evaluated for antibodies against A. fumigatus by biotin-avidin linked enzyme immunosorbent assay (BALISA) and by agar gel double diffusion method. A. fumigatus specific IgG and IgE antibodies could be detected by IGA in all the patients' sera but not in the sera of normal controls. Both IgG and IgE antibodies to A. fumigatus could be demonstrated in all the sera by BALISA and normal controls showed only low levels of these antibodies. There was a positive correlation between the degree of reactivity detected by IGA, the BALISA titer and the precipitins by agar gel diffusion. It can be concluded that IGA is a reliable, sensitive and simple method capable of detecting both IgG and IgE antibodies against A. fumigatus in patient serum.

Detection of Candida albicans in disseminated candidosis by immunofluorescence staining.

An indirect immunofluorescence (IF) method using rabbit anti-Candida albicans was used to detect C. albicans in blood samples of 12 patients with systemic candidosis defined clinically, histologically and by blood cultures. Positive staining of C. albicans could be detected in all of the patients. The findings suggest that IF-method offers a more rapid method in the diagnosis of disseminated candidosis.