DRAFT 11/6/03 njm

Deusch E, Reider N, Marth C. Anaphylactic reaction to latex during
cesarean delivery. Obstet Gynecol. 1996 Oct;88(4 Pt 2):727.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8841273&dopt=Abstract>

Shingai Y, Nakagawa K, Kato T, Fujioka T, Matsumoto T, Kihana T, Noda K,
Mori T. Severe allergy in a pregnant woman after vaginal examination
with a latex glove. Gynecol Obstet Invest. 2002;54(3):183-4.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12571444&dopt=Abstract>

Steiner DJ, Schwager RG. Epidemiology, diagnosis, precautions, and
policies of intraoperative anaphylaxis to latex. J Am Coll Surg. 1995
Jun;180(6):754-61.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7773496>

Sussman GL, Beezhold DH, Kurup VP. Allergens and natural rubber
proteins. J Allergy Clin Immunol. 2002 Aug;110(2 Suppl):S33-9.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12170241&dopt=Abstract>

BACKGROUND: Allergy to natural rubber latex (NRL) results from exposure
to proteins derived from Hevea brasiliensis. Type I latex
hypersensitivity is observed in certain occupational and other high-risk
groups with frequent exposure to NRL products. This includes health care
workers (HCWs), workers in the latex industry, children with spina
bifida, and atopic individuals. OBJECTIVES: Early reliable diagnosis and
avoidance are required for better patient care. Standardized reagents
are not presently available for in vitro and in vivo testing and
treatment of patients with latex allergy. However, a number of allergens
have been isolated and characterized from Hevea latex and NRL products.
Currently, a total of 11 major and minor allergens are designated by the
International Allergen Nomenclature Committee. This article reviews the
structural and functional characteristics of these latex allergenic
proteins. RESULTS: NRL-allergenic proteins include those involved in the
biosynthesis of polyisoprene and coagulation of latex rubber elongation
factor, small rubber particle protein, prohevein, and patatin.
Pathogenesis-related proteins include beta-1,3-glucanases, chitinases,
and hevamine; and the structural proteins include microhelix protein
complex, proline-rich protein, profilins, enolases, and manganese
superoxide dismutase. Recombinant allergens demonstrated skin test
reactivity in patients with latex allergy. The minimal level of skin
test reactivity was about 70 pg/mL for NRL and 1 ng/mL for recombinant
allergens. The use of selected recombinant latex allergens (Hev b 5, Hev
b 6, and Hev b 7) in skin prick tests identified 93% of allergic
individuals, mainly health care workers. CONCLUSIONS: Recombinant latex
allergens are clinically reactive and can be produced in a standardized
manner, which could potentially provide safe and sensitive reagents for
the diagnosis and treatment of type I latex allergy.\
\
Sussman GL; Beezhold DH. Allergy to latex rubber. Ann Intern Med 1995
Jan 1;122(1):43-6.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7985895&dopt=Abstract>

OBJECTIVE: To summarize the clinical symptoms of latex rubber allergy
and provide guidelines for the management of this allergy. DATA SOURCES:
The English-language literature was searched from 1979 through 1994
manually and using MEDLINE. Conference proceedings and reference lists
of relevant articles were reviewed. DATA EXTRACTION: Studies clinically
relevant to latex allergy were selected. RESULTS: The most common
clinical presentation of latex allergy is a nonimmunologic, irritant
dermatitis of the hand. Contact dermatitis (type IV delayed
hypersensitivity reactions to rubber additives) is the most common
immunologic manifestation of latex rubber allergy. Type I allergic
responses are less common and include contact urticaria,
rhinoconjunctivitis, asthma, and anaphylaxis. Seven percent to 10% of
health care workers regularly exposed to latex and 28% to 67% of
children with spina bifida have a positive skin test result to latex
proteins indicating increased blood levels of IgE antibody. About one
third of patients with positive skin test results, however, do not yet
have symptoms of latex allergy. Systemic (life-threatening) anaphylactic
shock can occur intraoperatively in highly sensitive patients because of
mucosal absorption of latex protein allergens from the surgeon\'s
gloves. The present treatment for latex allergy is careful avoidance of
latex materials. In addition, the use of powder-free latex gloves can
eliminate airborne latex exposure and can allow health care workers with
inhalant allergic reactions to return to work. CONCLUSION: Latex allergy
currently affects thousands of people. These persons have IgE-mediated
cutaneous, respiratory, and systemic allergic reactions. A reduction of
the total protein level on latex rubber devices may prevent further
sensitization and eliminate latex allergic reactions.

Anaphylaxis: Diagnosis and Management

<http://www.jcaai.org/Param/Anaphylax.htm>

Anaphylaxis: Diagnosis and Management (Word document)

<http://www.jcaai.org/Param/ParamDocs/ANAPHL.doc>

Anaphylaxis: Initial evaluation

<http://www.jcaai.org/Param/ParamDocs/ANAPHL.doc>

Anaphylaxis: Treatment

<http://www.jcaai.org/Param/Anaphylaxis/Algorithm_Acute_Anaphylaxis.pdf>