Br J Dermatol. 2012 Mar;166(3):518-24.

Different in vivo reactivity profile in health care workers and patients with spina bifida to internal and external latex glove surface-derived allergen extracts.

C. M. Peixinho*, P. Tavares-Ratado*,§,, M. F. Gabriel*, A. M. Romeira, C. Lozoya-Ibanez, L. Taborda-Barata*,§,#, C. T.Tomaz*

* CICS-UBI – Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal

§ Department of Health Sciences, University of Beira Interior, Covilhã, Portugal

Laboratory of Clinical Pathology, Sousa Martins Hospital, ULS Guarda, Portugal

† Department of Allergy & Clinical Immunology, Dona Estefânia Hospital, Lisbon, Portugal

‡ Department of Allergy & Clinical Immunology, Amato Lusitano Hospital, Castelo Branco, Portugal

# Department of Allergy & Clinical Immunology, Cova da Beira Hospital, Covilhã, Portugal

 

Corresponding author:

Prof. CândidaTomaz, Ph.D.

CICS – Health Sciences Research Centre, University of Beira Interior

6201-001 Covilhã, Portugal

E-mail: ctomaz@ubi.pt

Fax: +351 275 329 099

 

Abstract

BACKGROUND: Allergy to natural rubber latex is a well-recognized health problem, especially among health care workers and patients with spina bifida. Despite latex sensitization being acquired in health institutions in both health care workers and patients with spina bifida, differences in allergen sensitization profiles have been described between these two risk groups.

OBJECTIVE: To investigate the in vivo reactivity of health care workers and patients with spina bifida to extracts of internal and external surfaces of latex gloves and also to specific extracts enriched in major allergens for these risk groups.

METHODS: Gloves from different manufacturers were used for protein extraction, and salt precipitation and hydrophobic interaction chromatography (HIC) were applied to obtain the enriched latex extracts. The major latex allergens were quantified by an enzyme immunoassay. The extracts obtained were tested in 14 volunteers using skin prick tests (SPT).

RESULTS: Latex glove extracts enriched in the hydrophobic allergens that are most often seen in patients with spina bifida were obtained by selective precipitation, whereas HIC produced extracts enriched in the hydrophilic allergens commonly found in health care workers. The health care workers had positive SPTs to glove extracts from internal surfaces and to the hydrophilic allergen-enriched extracts. By contrast, patients with spina bifida had larger skin reactions both to external glove extracts and to the extracts enriched with the hydrophobic major allergens for this risk group. Despite the protein concentration of these extracts being less than half the concentration of the commercial extract, the weal-and-flare reactions were of similar magnitude.

CONCLUSION: Using novel latex extracts, our study showed a different in vivo reactivity pattern in health care workers and in patients with spina bifida to extracts of the internal and external surfaces of gloves, which suggests that sensitization may occur by different routes of exposure, and that this influences the allergen reactivity profiles of these risk groups.

© 2011 The Authors. BJD © 2011 British Association of Dermatologists 2011.

PMID: 21967293

 

SUPPLEMENTARY

Allergy to natural rubber latex (NRL) is a significant medical and occupational public health problem, especially for health care workers (HCWs) and spina bifida patients (SBPs), possibly due to the drastic increase in glove usage in response to concerns about AIDS and other infectious diseases.1

Although latex sensitisations are mainly acquired at health institutions for both SBPs and HCWs, these risk groups can have different sensitisation profiles to latex allergens. In fact, the major allergens for SBPs are hydrophobic (Hev b 1 and Hev b 3), whereas the major allergens for HCWs are hydrophilic (Hev b 2, Hev b 5, Hev b 6.01 and Hev b 13)2. We have previously shown that there are substantial differences in the composition of latex allergen profiles between the internal and external surfaces of natural rubber latex gloves. Concentrations of major allergens for SBPs, Hev b 1 and Hev b 3, were found significantly higher on external surfaces, while internal surfaces had higher allergen levels of health care workers major allergens, Hev b 5 and Hev b 6.02.3 In this context, the different reactivity profiles observed between HCWs and SBPs may be in part due to the exposure to different direct environmental exposure, namely in terms of the differential allergen composition of internal and external surfaces of the latex gloves.3-4

It is known that HCWs contact directly with the internal surface of latex gloves and with aerosolized glove powder. By contrast, the main route of sensitisation of SBPs is the direct contact with external surfaces of latex gloves during surgical procedures. To investigate in vivo reactivity of HCWs and SBPs to internal and external latex glove extracts and also to specific extracts enriched in major allergens for these risk groups, we hypothesized that HCWs might showed higher skin prick test (SPT) reactivity to allergens from internal surfaces of latex gloves, whereas SBPs might showed stronger positive skin reactions to allergens from external surfaces.

As it turns out, our hypothesis was correct. In general, HCWs had positive SPT to internal glove extracts and to HCW allergen-enriched glove extract. By contrast, SBPs had larger skin reactions both to external glove extracts and to extracts enriched with major allergens for this risk group (Table 1). SPT results also showed that our extracts exhibit good allergenic capacity and good specificity for in vivo diagnosis, even though they contain less than half of the protein concentration in latex commercial extract (Table 1). This is very important since we were able to detect sensitization to latex allergens in all volunteers that had latex-related symptoms, which suggests that our extracts are sensitive enough for diagnosis and decrease exposure of different risk groups to allergens that are less relevant for the risk group oriented-diagnosis (e.g. HCWs can be sufficiently diagnosed as latex sensitive using only the extracts from the inner glove surface thereby avoiding unnecessary exposure to extracts from the outer surface).

The importance of this work is two-fold. First, it brings novel data on differential in vivo reactivity pattern in HCWs and SBPs to internal and external glove extracts, which suggests that sensitization by different routes of exposure may clearly influence the reactivity profiles in these risk groups.

Second, it showed the importance of diagnosis extracts in latex allergy by leading interesting and novel preparations of latex-glove enriched extracts with major allergens for the latex risk groups, using selective precipitation and HIC. Based upon the differential latex-sensitization profiles in both HCWs and SBPs, specific latex glove extracts could represent an alternative approach not only to a more targeted and effective diagnosis of latex allergy but also to a more reliable and possibly safer assessment than with conventional latex extracts.

References

  1. Bousquet J, Flahault A, Vandenplas O et al.  Natural rubber latex allergy among health care workers: A systemic review of the evidence. J Allergy Clin Immunol 2006; 118: 447-454.
  2. Bernstein DI, Biagini RE, Karnani R et al.  In vivo sensitization to purified Hevea brasiliensis proteins in health care workers sensitized to natural rubber latex. J Allergy Clin Immunol 2003; 111: 610-616.
  3. Peixinho C, Tavares P, Tomás MR et al. Differential expression of allergens on the internal and external surfaces of latex surgical gloves. Allergol Immunopathol 2006; 34: 206-211.
  4. Peixinho C, Tavares-Ratado P, Tomás MR et al. Latex allergy: new insights to explain different sensitization profiles in different risk groups. Br J Dermatol 2008; 159: 132-136.

 

Table 1. SPT results of fourteen patients using a commercial extract and specific prepared latex glove extracts (internal, external and enriched in HCWs and SBPs major allergens).

 Patients

Internal

Glove

Extract

External

Glove

Extract

pHCW

(Enriched

with HCW

majorallergens)

(400 mg/ml)

pSBP

(Enriched

with SB major   allergens)

(400 mg/ml)

 

Commercial extract

(1000 mg/ml)

 

Positive

Control

Negative control

1

(HCW)

+

+

+

+

2

(HCW)

+++

+

+++

++

+++

+

3

(HCW)

+

+

+

4

(HCW)

+

+

+

+

5

(HCW)

+

+

+

+

6

(HCW)

+

++

+

+

+

7

(HCW)

+

++

+

+

+

8

(SBP)

+

+

++

+

+

9

(SBP)

+

++

+

+++

+

+

10

(SBP)

+

+

++

++

+

11

(SBP)

++

+

++

+

+

12

(SBP)

+

++

++

++

+

13

(SBP)

+

14

(SBP)

+

+ = Positive   reaction: wheal diameter ³ 3 mm; ++ = positive reaction: wheal diameter ³ 5 mm; +++ = highly positive reaction: wheal diameter > 15 mm; – =   negative reaction: wheal diameter < 2 mm

 

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