title: In vivo and vitro in diagnosis of latex allergy at Groote Schuur Hospital.
abstract: OBJECTIVE
  The aim of this study was to evaluate the diagnostic utility of skin-prick tests, radio-allergosorbent tests (CAP RASTs), basophil histamine release, sulphidoleukotriene release and Western blotting in the diagnosis of latex allergy at Groote Schuur Hospital.
  
  
  METHODS
  Patients with a history suggesting latex hypersensitivity were recruited via staff health and allergy clinics at Groote Schuur Hospital. A clinical assessment was followed by laboratory investigation and skin-prick testing. A control group consisted of laboratory and hospital staff who had regular latex exposure but were asymptomatic.
  
  
  METHODS
  Hospital-based cohort at Groote Schuur Hospital.
  
  
  METHODS
  Twenty-three patients with suspected latex allergy; 10 control subjects exposed to, but not clinically sensitive to, latex.
  
  
  RESULTS
  Skin-prick testing was more sensitive than in vitro diagnostic tests for the diagnosis of latex allergy.
  
  
  RESULTS
  Eighteen of 21 (85.7%) of the patients tested had a positive skin-prick test with a commercial latex solution (Allerbioprick) and 17/21 (80%) tested skin-prick-positive with an in-house glove extract. CAP RASTs were positive in 13/23 patients (56.5%), sulphidoleukotriene release was positive in 10/23 (43%), histamine release assay was positive in 10/23 (45%) and Western blots were positive in 8/23 (34.7%). All patients with only urticaria were Western blot-negative and CAP RAST-negative, suggesting that they have very little circulating latex-specific IgE. Although patients who were Western blot-positive tended to have multi-organ involvement, both patients with anaphylaxis were Western blot-negative.
  
  
  CONCLUSIONS
  Latex allergy is a significant clinical problem at Groote Schuur Hospital. Titrated skin-prick testing performed in a controlled environment can safely and reliably confirm the diagnosis in patients who do not give a history of anaphylaxis. The CAP RAST was the most sensitive in vitro test for latex allergy locally available, but lacks sensitivity in patients presenting with urticaria only.
authors.affiliation: Department of Immunology, Groote Schuur Hospital, Cape Town.
authors.forename: G I
authors.initials: GI
authors.lastname: Marais
authors.forename: J M
authors.initials: JM
authors.lastname: Fletcher
authors.forename: P C
authors.initials: PC
authors.lastname: Potter
mesh_terms: D000328:Adult; D001491:Basophils / Q000378:metabolism; D015153:Blotting, Western; D016022:Case-Control Studies; D003877:Dermatitis, Contact / Q000175:diagnosis* / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006636:Histamine Release; D006801:Humans; D007428:Intradermal Tests; D015289:Leukotrienes / Q000097:blood; D008297:Male; D008875:Middle Aged; D012408:Rubber / Q000009:adverse effects*; D013438:Sulfhydryl Compounds / Q000097:blood
chemical_list: D015289:Leukotrienes; D013438:Sulfhydryl Compounds; D012408:Rubber