title: Percutaneous reactivity to natural rubber latex proteins persists in health-care workers following avoidance of natural rubber latex.
abstract: BACKGROUND
  Long-term avoidance of natural rubber latex [Hevea brasiliensis (Hev b)] is currently recommended for health-care workers (HCWs) with established natural rubber latex (NRL) allergy. Percutaneous sensitivity to eight Hev b NRL allergens was evaluated in HCWs in 2000. To date, no studies have evaluated the longitudinal effects of NRL avoidance on percutaneous sensitivity to NRL allergens.
  
  
  OBJECTIVE
  The aims of this study were to evaluate changes in percutaneous reactivity to non-ammoniated latex (NAL) and NRL allergens in HCWs 5 years after a recommendation to avoid NRL and to evaluate factors that predict the persistence of in vivo sensitivity to NAL and NRL allergens.
  
  
  METHODS
  Skin prick testing was performed with NAL, seven NRL allergens (Hev b 1, 2, 3, 4, 6.01, 7.01, and 13), and recombinant Hev b 5 (rHev b 5) in 34 HCWs who were initially evaluated in 2000 for occupationally related NRL allergy. Serial 10-fold dilutions of NAL and NRL allergens were employed in skin testing. Sera from the HCWs were assayed for latex and enhanced latex (rHev b 5-enriched allergosorbent)-specific IgE antibodies using the ImmunoCAP assay.
  
  
  RESULTS
  The prevalence of work-related symptoms significantly decreased between 2000 and 2005 with avoidance of NRL (P<0.05). A >/=100-fold reduction in percutaneous sensitivity to Hev b 2 and Hev b 7 was less likely in those with prior history of systemic reactions to NRL (P=0.0053), reported history of reaction to cross-reactive foods (P=0.014), continued local reactions to NRL gloves (P<0.0001), or high NRL glove exposure since the initial study (P=0.0075). The diagnostic sensitivity and specificity of the latex-specific IgE serology was 54% and 87.5%, respectively, in comparison with NAL skin tests. The addition of rHev b 5 to the ImmunoCAP (enhanced latex) allergosorbent altered the diagnostic sensitivity and specificity of the ImmunoCAP to 77% and 75%, respectively.
  
  
  CONCLUSIONS
  While symptoms may resolve quickly with NRL avoidance therapy, detectable IgE indicating continued sensitization remains beyond 5 years, and thus continued avoidance of NRL should be recommended.
authors.affiliation: Department of Internal Medicine, Division of Allergy/Immunology, University of Cincinnati, Cincinnati, OH, USA. sa6@email.uc.edu
authors.forename: A M
authors.initials: AM
authors.lastname: Smith
authors.forename: H S
authors.initials: HS
authors.lastname: Amin
authors.forename: R E
authors.initials: RE
authors.lastname: Biagini
authors.forename: R G
authors.initials: RG
authors.lastname: Hamilton
authors.forename: S A M
authors.initials: SA
authors.lastname: Arif
authors.forename: H Y
authors.initials: HY
authors.lastname: Yeang
authors.forename: D I
authors.initials: DI
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006282:Health Personnel; D028482:Hevea / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007840:Latex / Q000276:immunology*; D020315:Latex Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D011237:Predictive Value of Tests; D015995:Prevalence; D012408:Rubber / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D012882:Skin Tests; D013997:Time Factors
chemical_list: D007840:Latex; D007073:Immunoglobulin E; D012408:Rubber