Tolerance and effects on skin reactivity to latex of sublingual rush immunotherapy with a latex extract.
BACKGROUND
Specific immunotherapy could be a therapeutic tool for the increasing problem of sensitisation to Natural Rubber Latex (NRL).


OBJECTIVE
To investigate the tolerability of SLIT for Latex and its effects on skin reactivity.


METHODS
Twenty-six patients (mean age 35.5 years) with an average history of 7.5 years of cutaneous symptoms plus respiratory symptoms (23/26) due to NRL were studied. All underwent rush sublingual therapy (4 days) with a standardized NRL extract followed by a 9-week maintenance treatment. Local and systemic adverse reactions were monitored throughout the treatment. Skin reactivity to NRL extract was evaluated before, during and at the end of the treatment by latex glove-use test, rubbing test and skin prick test.


RESULTS
All patients reached the maintenance dose. Out of 1044 administered doses, 257 (24.6%) produced adverse reactions from which 21.4% were local. Only 10.1% of cases required treatment, mainly with antihistamines alone (5.8%), with 2-agonists alone (0.8%) or associated to antihistamines and/or corticosteroids (2.7%). One patient was precautionary treated twice with adrenaline but completed the treatment without further problems. The glove-use test improved significantly after 5 days and 10 weeks of treatment (p = 0.003, p = 0.0004 respectively), whereas the rubbing test improved significantly only after 10 weeks of treatment. Doctor's assessments confirmed the results obtained with the glove-use test (p = 0.003 after 5 days, and p = 0.004 after 10 weeks) but not those obtained with the rubbing test. No change was detected for SPTs.


CONCLUSIONS
SLIT for NRL allergy is able to modify skin reactivity to NRL in days as assessed with methods reproducing HCWs normal exposure to the allergen. Tolerance of SLIT is better than tolerance reported for injective therapy with NRL, but the build up phase should be administered under medical surveillance until sufficient experience has been accumulated. The long-term effect of the treatment deserves further investigation.
Cisteró Bahima
A
A
Institut Universitari Dexeus, Barcelona, Spain.
Sastre
J
J
Enrique
E
E
Fernández
M
M
Alonso
R
R
Quirce
S
S
Gandarias
B
B
Parmiani
S
S
Rico
P
P
D000286:Administration, Sublingual; D000328:Adult; D017449:Dermatitis, Allergic Contact / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017575:Gloves, Protective; D006801:Humans; D007114:Immunization / Q000379:methods*; D007167:Immunotherapy / Q000379:methods*; D007840:Latex / Q000008:administration & dosage* / Q000009:adverse effects; D020315:Latex Hypersensitivity / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D011336:Probability; D018570:Risk Assessment; D012408:Rubber / Q000009:adverse effects; D012494:Sampling Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D007840:Latex; D012408:Rubber