Grand rounds: latex-induced occupational asthma in a surgical pathologist.
BACKGROUND
Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice.


METHODS
A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time.


CONCLUSIONS
The patient's presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work.


CONCLUSIONS
The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.
University of Pennsylvania Medical Center, Division of Occupational and Environmental Medicine, Philadelphia, Pennsylvania 19104-4283, USA. jmckenzi@mail.med.upenn.edu
Judith
J
Green-McKenzie
Debra
D
Hudes
D001249:Asthma / Q000139:chemically induced* / Q000175:diagnosis; D005932:Gloves, Surgical; D006801:Humans; D020315:Latex Hypersensitivity / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis; D016273:Occupational Exposure; D010340:Pathology, Surgical; D010366:Peak Expiratory Flow Rate; D010820:Physicians; D013147:Spirometry