Clinical and laboratory-based methods in the diagnosis of natural rubber latex allergy - 10/05/12
Abstract |
The accurate diagnosis of hypersensitivity to natural rubber latex is the initial step in the effective management of individuals with latex allergy and in ensuring the quality of epidemiologic studies. The diagnostic algorithm used in the evaluation of an individual with suspected latex allergy begins with a comprehensive clinical history during which risk factors (atopy, food allergies, hand dermatitis) and temporal relationships between symptoms and natural rubber product exposure are identified. If type IV hypersensitivity is suspected because of the delayed nature (hours to days) and confinement of symptoms to the skin-latex product contact areas, patch testing can be conducted to confirm the presence of activated T cells with specificity for rubber chemicals. If type I hypersensitivity is suspected because of ocular, upper and lower airway, and/or systemic symptoms that have rapid onset (minutes) after a definable latex exposure, a confirmatory skin or blood test for IgE antibody may be conducted to verify a state of sensitization within the individual. The definitive diagnosis would then be made only after consideration of the individual's clinical history and confirmatory in vivo and/or in vitro laboratory test results. If discordance remains between highly convincing latex-associated symptoms as identified in the history and repetitively negative confirmatory IgE antibody test results, then one of several types of in vivo provocation tests may be performed for adjudication. This overview examines the current state of the art in both in vivo and in vitro diagnostic methods for latex-specific IgE antibody detection in skin and blood. The performance, advantages, and limitations of each diagnostic method are compared. (J Allergy Clin Immunol 2002;110:S47-56.)
Le texte complet de cet article est disponible en PDF.Keywords : Natural rubber latex, hypersensitivity, skin tests, latex-specific IgE antibody
Abbreviations : AL, FDA, IDST, NAL, NRL, SPT
Plan
 | Supported by Johns Hopkins University Research Funds. |
| Dr Hamilton is entitled to small royalties derived from the future sale of the Greer latex skin testing material if the reagent is released and licensed by the FDA. He attests that his statements in this report are factual and do not represent a conflict of interest. Dr Peterson has no significant financial interest in the commercial sponsors of this publication. He attests that there is no commercial or personal conflict of interest. Dr Ownby has provided expert advice to legal firms representing Allegiance Healthcare and Safeskin, evaluated or reviewed individual cases related to latex allergy for both defendants and plaintiffs, and has given depositions on behalf of both patients and defendant healh care institutions regarding latex allergy. All fees from such activities have been donated to the Medical College of Georgia Foundation. He has also reviewed data on a candidate latex extract for Greer Laboratories. Dr Ownby has no direct financial interest in any company involved in the production, distribution, or sale of latex products. |
 | Reprint requests: Robert G. Hamilton, PhD, Johns Hopkins Asthma and Allergy Center, Room 1A20, 5501 Hopkins Bayview Circle, Baltimore, MD 21224. |
Vol 110 - N° 2S
P. S47-S56 - août 2002 Retour au numéro
Article précédent
- Protein and allergen assays for natural rubber latex products
- Vesna J. Tomazic-Jezic, Anne D. Lucas
- Allergic and latex-specific sensitization: Route, frequency, and amount of exposure that are required to initiate IgE production
- David N. Weissman, Daniel M. Lewis
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