Latex allergy within a cohort of not-at-risk subjects with respiratory symptoms: prevalence of latex sensitization and assessment of diagnostic tools.
BACKGROUND
Immunoglobluin E (IgE)-mediated hypersensitivity to natural rubber latex (NRL) is a major problem in allergy practice. Currently, the use of skin prick tests (SPTs) with latex extracts and specific IgE detection for the diagnosis of NRL allergy in suspected patients is directed to identification of risk factors. Many cases of NRL allergy remain undiagnosed due to misreporting of symptoms by the patients or lack of proper questions asked by the physician.


METHODS
A total of 6,126 subjects referred for respiratory symptoms underwent SPTs with NRL. Positive subjects were resurveyed for exposure to NRL, and specific IgE for NRL extracts and recombinant molecules was determined. Immunoblots of NRL extracts were performed to identify IgE patterns.


RESULTS
Forty-six of 3,930 sensitized subjects had a positive SPT with NRL, displaying a prevalence of NRL sensitization of 0.75% for the general and 1.2% for the sensitized population. Eleven out of 46 (23.9%) subjects could be defined as NRL asymptomatic, whereas 35 (76.1%) developed symptoms upon exposure to NRL. Specific IgE to NRL was detected for 22 (75.86%) of 29 tested sera. Seventeen out of 22 (77%) sera displayed specific IgE to recombinant allergens with most reactions to Hev b 5, Hev b 6.01 and Hev b 6.02. Immunoblots of NRL extract fractions with patients' sera showed heterogeneous patterns.


CONCLUSIONS
SPTs with NRL extract should be routinely performed in patients with respiratory symptoms. Hev b 5, Hev b 6.01 and Hev b 6.02 are the most important allergens, but further characterization of NRL extracts is needed to identify novel allergens and to clarify the role of crossreactive carbohydrate determinants.
Mari
Adriano
A
Center of Clinical and Experimental Allergology, IDI-IRCCS, Rome, Italy. a.mari@panservice.it
Scala
Enrico
E
D'Ambrosio
Claudio
C
Breiteneder
Heimo
H
Wagner
Stefan
S
D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology; D052179:Antigens, Plant; D023181:Antimicrobial Cationic Peptides / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015151:Immunoblotting; D007073:Immunoglobulin E / Q000097:blood; D020315:Latex Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D037121:Plant Lectins / Q000276:immunology; D010940:Plant Proteins / Q000276:immunology; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000276:immunology*; D012882:Skin Tests
D000485:Allergens; D052179:Antigens, Plant; D023181:Antimicrobial Cationic Peptides; C097982:Hev b 6.01 protein, Hevea brasiliensis; D037121:Plant Lectins; D010940:Plant Proteins; C101800:allergen Hev b 5; C045875:hevein; D007073:Immunoglobulin E