Latex Intolerance

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ISBN: 9780849316708 | 0849316707
Cover: Hardcover
Copyright: 9/29/2004

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Latex intolerance has become an increasingly common diagnosis. As experimental techniques and theoretical concepts emerge, it is important for physicians to stay on the cutting edge of new methodologies in skin research.Latex Intolerance: Basic Science, Epidemiology, and Clinical Management covers all aspects of latex allergy. Each chapter presents the latest research in latex intolerance, exploring issues such as skin irritation, allergic contact dermatitis, and contact urticaria. The well-illustrated textbook also discusses the basic science and clinically relevant practical issues, including the epidemiology, prognosis, and management of latex intolerance. Sections on hand dermatitis, barrier creams, and medical glove regulations enhance understanding of the condition.Experts with a special interest in this area from the United Kingdom, Europe, and the USA provide a balanced international perspective to this first major book dedicated to latex intolerance. Dermatologists and other medical professionals involved in the treatment of latex intolerance will benefit from this valuable resource.

Epidemiology of Latex Allergy

(14)

Barry N. Statham

Introduction

(1)

Epidemiological Study Determinants

(2)

Latex Allergy versus Hypersensitivity

(1)

Recruitment of the Study Population

(1)

Allergy Prevalence in ``Normal Population''

(1)

Identification of Latex-Related Symptoms

(1)

Strengths and Weaknesses of Diagnostic Tests

(1)

Risk Factors and Latex Allergy

(4)

Atopic Diathesis

(1)

Hand Dermatitis

(1)

Multiple Operations and/or Indwelling Latex

(1)

Latex Glove Exposure

(1)

Latex and Food Allergy

(1)

Prevalence in Occupational Subgroups

(1)

Incidence of Latex Sensitization or Allergy

(1)

Changing Trends of Latex Sensitivity after Latex Exposure Alteration

(2)

Conclusions

(5)

References

(4)

Allergenic Proteins

(12)

Harri Alenius

Timo Palosuo

Introduction

(1)

Allergenic NRL Proteins

(5)

Hev b 1 (Rubber Elongation Factor)

(1)

Hev b 2 (1,3-β-glucanase)

(2)

Hev b 3 (22-27 kD rubber particle protein)

(1)

Hev b 4 (50-57 kD microhelix protein complex)

(1)

Hev b 5 (acidic NRL protein; 16 kD pI 3.5)

(1)

Hev b 6.01 (prohevein), Hev b 6.02 (hevein), and Hev b 6.03 (prohevein C-domain)

(1)

Hev b 7 (46 kD patatin-like protein)

(1)

Hev b 8 (profilin)

(1)

Hev b 9 (enolase)

(1)

Hev b 10 (manganese superoxide dismutase; MnSOD)

(1)

Hev b 11 (Class 1 chitinase)

(1)

Hev b 12

(1)

Hev b 13

(1)

Other NRL Allergens

(1)

IgE-Binding Epitopes of NRL Allergens

(1)

T-Cell Epitopes of NRL Allergens

(1)

Allergens in NRL Products

(1)

Future Aspects

(3)

References

(3)

Chemical Additives

(30)

Curtis P. Hamann

Pamela A. Rodgers

Kim Sullivan

Introduction

(1)

Manufacture of Rubber

(12)

History of Rubber Manufacturing

(1)

Manufacturing Processes

(1)

Harvesting and Processing of Natural Rubber

(1)

Centrifugation

(1)

Compounding

(1)

Dipping Technology

(1)

Vulcanization and Prevulcanization

(1)

Leaching

(1)

Drying

(1)

Chlorination

(1)

Surface Coatings

(1)

Rubber and Rubberlike Elastomers

(2)

Natural Rubber Polyisoprene

(1)

Nitrile

(1)

Neoprene

(1)

Polyvinyl Chloride

(1)

Polyurethanes

(1)

Styrene-Based Elastomers

(1)

Synthetic Polyisoprene

(1)

Other Rubberlike Elastomers

(1)

Rubber Compounding

(10)

Chemical Additives

(1)

Vulcanizing Agents and Accelerators

(3)

Antidegradants

(2)

Pigments, Fragrances, and Flavorants

(1)

Processing Aids

(1)

Releasing Agents and Lubricants

(1)

Allergenicity of Rubber Additives

(1)

Vulcanization Agents and Accelerators

(1)

Antidegradants

(1)

Other Additives

(1)

Release Agents and Lubricants

(1)

Conclusions and Future Developments

(7)

References

(6)

Natural Rubber Latex Allergy: Clinical Manifestations

(10)

Ignatius C. Chua

Alison J. Owen

Paul E. Williams

Introduction

(1)

Systemic Manifestations of Allergy

(2)

IgE Mediated Immediate Hypersensitivity Reactions

(1)

Sensitization to NRL and Development of Symptoms

(1)

Patients with Spina Bifida

(1)

Surgical and Medical Procedures

(1)

Fatal Anaphylaxis

(1)

Occupational Exposure to NRL

(1)

Everyday Exposure to NRL

(1)

Case History

(1)

Conclusions

(4)

References

(4)

Natural Rubber Latex Allergy and Allergens: In Vitro Testing

(20)

Vesna J. Tomazic-Jezic

Introduction

(1)

Basis and Principles of Test Development

(1)

In Vitro Diagnosis of NRL Allergy

(2)

Development of In Vitro Tests for NRL Sensitivity

(1)

Performance of Commercial In Vitro Diagnostic Tests

(1)

Significance of In Vitro Tests in Diagnosing NRL Sensitivity

(1)

Evaluating the Allergenic Potential of NRL Products

(9)

Methods for Measurement of Total NRL Protein

(1)

Methods for Quantification of Antigenic NRL Proteins

(1)

Quantification of NRL Allergens

(1)

Measurement of the Individual NRL Allergens

(1)

Relative Performance of Total Protein, Antigen, and Allergen Tests

(4)

Future Trends and Goals

(7)

References

(6)

New Developments in Measuring Allergens in Natural Rubber Latex Products

(10)

Katja Frisk

Tytti Karkkainen

Hely Reinikka-Railo

Timo Palosuo

Introduction

(1)

NRL Allergens in the Source Material and in Manufactured Products

(1)

Methods for Measuring Natural Rubber Latex Allergens

(5)

Qualitative Methods

(1)

IgE-Immunoblotting Analysis (Western Blotting)

(1)

IgE-Immunoblotting after Isoelectric Focusing and Electrophoresis (Two-Dimensional Immunoblotting)

(1)

Semiquantitative Methods

(1)

Skin Prick Testing in Voluntary Latex-Allergic Subjects

(1)

RAST Inhibition and IgE-ELISA Inhibition Assay

(1)

Quantitative Methods

(1)

Capture Enzyme Immunoassays (EIA) for NRL Allergen Quantification

(3)

Conclusions

(3)

References

(2)

Contact Urticaria: Clinical Manifestations

(10)

Sarah H. Wakelin

Introduction

(1)

Classification

(2)

Nonimmunological Contact Urticaria

(1)

Immunological Contact Urticaria

(2)

Contact Urticaria with Undetermined Mechanisms

100

(1)

Clinical Features of NRL Contact Urticaria

100

(3)

Conclusions

103

(4)

References

103

(4)

Contact Urticaria Syndrome: Predictive Testing

107

(6)

Antti I. Lauerma

Howard I. Maibach

Introduction

107

(1)

Immunologic Contact Urticaria (ICU)

108

(2)

Mechanisms

108

(1)

Respiratory Chemical Allergy as an Animal Model for ICU

108

(1)

Contact Chemical Allergy as an Animal Model for ICU

109

(1)

Protein Allergy as an Animal Model for ICU

109

(1)

Nonimmunologic Contact Urticaria

110

(1)

Mechanisms

110

(1)

Animal Models for NICU

110

(1)

Predictive Testing: Perspectives

110

(1)

Predictive Testing for Agents Causing ICU or NICU

110

(1)

Predictive Testing for Medicaments for ICU or NICU

111

(1)

Conclusions

111

(2)

References

111

(2)

Contact Urticaria Syndrome: Prognosis

113

(6)

Sarah H. Wakelin

Introduction

113

(1)

Follow-up Studies of Adults with Occupational NRL Allergy

113

(2)

Primary Prevention

115

(1)

Patients with Spina Bifida

116

(1)

Conclusions

117

(2)

References

117

(2)

Allergic Contact Dermatitis: Clinical Manifestations

119

(8)

Natalie M. Stone

Introduction

119

(1)

Sites Involved

120

(1)

Eczematous Variants

121

(1)

Rubber Purpura

121

(1)

Rubber Depigmentation

121

(1)

Unusual Delayed-Type Reactions

122

(1)

Allergic Contact Dermatitis to Natural Rubber Latex

122

(5)

References

123

(4)

Allergic Contact Dermatitis: Tests

127

(6)

Natalie M. Stone

Introduction

127

(1)

Investigation of Allergic Contact Dermatitis to Rubber Additives

127

(1)

Rubber Mixes

128

(2)

Other Rubber Additives

130

(1)

Patch Testing with Natural Rubber Latex

130

(3)

References

131

(2)

Allergic Contact Dermatitis: Prognosis

133

(2)

Natalie M. Stone

Prognosis for Allergic Contact Dermatitis

133

(2)

References

134

(1)

Latex-Fruit Syndrome

135

(6)

Tanya D. Wright

Introduction

135

(1)

Latex-Fruit Syndrome

136

(2)

Symptoms

136

(1)

Latex Proteins and Latex-Fruit Syndrome

136

(1)

Hev b 8 (profilin)

136

(1)

Hev b 6.02 (hevein)

137

(1)

Hev b 7 (patatin-like protein)

137

(1)

Hev b 2 (1,3-β-glucanase)

137

(1)

Class 1 chitinases

137

(1)

Foods Cross-Reacting with Latex

137

(1)

Conclusions

138

(3)

References

138

(3)

Irritant Dermatitis Due to Occlusive Gloves: Clinical Manifestations

141

(6)

Priyanka Singh

Mayanka Singh

Mahbub M. U. Chowdhury

Howard I. Maibach

Introduction

141

(1)

Symptoms

142

(1)

Occlusion

142

(3)

Long-Term Study

143

(1)

Group A

143

(1)

Group B

143

(1)

Short-Term Study

143

(1)

Group A

143

(1)

Group B

143

(2)

Conclusions

145

(2)

References

145

(2)

Irritation Dermatitis Due to Occlusive Gloves: Predictive Testing

147

(4)

Mayanka Singh

Priyanka Singh

Mahbub M. U. Chowdhury

Howard I. Maibach

Introduction

147

(1)

Methods

147

(2)

Testing Paradigm for Predictive Testing

149

(1)

21-Day Cumulative Irritation Assay

149

(1)

Exaggerated Use Studies

149

(1)

Conclusions

149

(2)

References

149

(2)

Management of Hand Dermatitis

151

(14)

Graham A. Johnston

Nicolas Nicolaou

Mahbub M.U. Chowdhury

Introduction

151

(1)

Important Issues in the Management of Hand Dermatitis

152

(5)

Hand Protection with Gloves

152

(1)

Use of Soap Substitutes and Moisturizers

153

(2)

Avoidance of Irritants

155

(1)

Prognosis and Ongoing Management

156

(1)

Treatment of Hand Dermatitis

157

(8)

Emollients

157

(1)

Corticosteroids

158

(1)

Topical Corticosteroids

158

(1)

Intralesional Steroids

159

(1)

Systemic Corticosteroids

159

(1)

Topical and Systemic Antibiotics

159

(1)

Photochemotherapy

159

(1)

Systemic Immunosuppressives

160

(1)

Cyclosporin

160

(1)

Azathioprine

160

(1)

Topical Immunosuppressives

160

(1)

Other Modalities

160

(1)

References

160

(3)

Appendix 16.1: Information Sheet for Patients with Hand Dermatitis

163

(2)

Barrier Creams/Moisturizers

165

(12)

Hongbo Zhai

Mahbub M. U. Chowdhury

Howard I. Maibach

Introduction

165

(1)

Barrier Creams (BC)

166

(1)

Definition and Terms

166

(1)

Reasons to Use Barrier Creams

166

(1)

Mechanism of Action and Duration

166

(1)

Application Methods and Efficacy

167

(1)

U.S. Food and Drug Administration Monograph Skin Protectants

167

(1)

Moisturizers

167

(4)

Definition and Terms

167

(1)

Effect of Moisturizers on Skin

168

(1)

Moisturizers in Preventing Irritant Contact Dermatitis

168

(3)

Conclusions

171

(6)

References

173

(4)

Occlusive Effects: Man vs. Animal

177

(12)

Hongbo Zhai

Mahbub M. U. Chowdhury

Howard I. Maibach

Introduction

177

(1)

Skin Barrier Function

178

(1)

Effects of Occlusion on Barrier Function

178

(1)

Evaluating Methods

179

(4)

Animal Models

179

(2)

Human Models

181

(2)

Conclusions

183

(6)

References

185

(4)

Medical Glove Regulation: History and Future of Safety

189

(16)

Deborah D. Davis

Introduction

190

(1)

Glove Regulations

190

(3)

Minimum Performance and Physical Requirements

192

(1)

Length

192

(1)

Size

192

(1)

Thickness or Gauge

192

(1)

Acceptable Quality Level (AQL)

192

(1)

Tensile Strength

193

(1)

Ultimate Elongation

193

(1)

Stress at 500% Elongation

193

(1)

Donning Lubricants

193

(1)

Powdered and Powder-Free

193

(1)

Coatings Technologies

193

(1)

Protein and Allergen Levels

194

(1)

Labeling

194

(1)

Assay Methods

194

(1)

Allergen-Specific Assays

194

(1)

Storage Stability and Expiration Dating

195

(1)

Synthetic Medical Gloves

196

(1)

Polymers

196

(1)

Nitrile

196

(1)

Vinyl

196

(1)

Neoprene

196

(1)

Polyisoprene

197

(1)

Material-Specific Requirements

197

(1)

Chemical Resistance

197

(2)

Appropriate Use of Gloves

199

(2)

Glove Hydration and Conductivity

201

(1)

Glove Manufacturers

201

(1)

Conclusions

202

(3)

References

203

(2)

Occupational Health Management of Latex Allergy

205

(6)

Anil Adisesh

Introduction

205

(1)

Occupational Prevalence of Latex Allergy

205

(2)

Recognition of Cases

207

(1)

Case Management

207

(2)

Exposure Reduction

208

(1)

Advice to the Organization

209

(1)

Conclusions

210

(1)

References

210

(1)

Management of Rubber-Based Allergies in Dentistry

211

(38)

Curtis P. Hamann

Pamela A. Rodgers

Kim Sullivan

Introduction

212

(1)

Diagnosis and Symptom Assessment

213

(4)

Health History and Risk Assessment

213

(1)

Symptom Assessment

214

(1)

Diagnostic Testing for Rubber-Based Allergies

214

(1)

Diagnostic Testing for Type I NRL Hypersensitivity

215

(1)

Diagnostic Testing for Type IV Hypersensitivity to Rubber Chemicals

216

(1)

Education of Allergic Dental Professionals

217

(1)

Allergens in Natural and Synthetic Rubber

218

(9)

NRL Extractable Total Protein Content

221

(1)

NRL Extractable Allergenic Protein Content

222

(1)

Glove Powder and NRL Protein Allergens

222

(1)

Allergenic Rubber Chemicals

223

(2)

Exposure Routes and Thresholds for Rubber-Based Allergens

225

(1)

Other Dental Allergens

226

(1)

Mitigating Rubber Allergen Exposure

227

(9)

Administrative Controls

228

(1)

Dental Operatory Cleaning and NRL Remediation

228

(1)

NRL Product Substitution

229

(1)

Guidelines and Glove Standards

229

(2)

Product Substitutions for Type I NRL Hypersensitivity

231

(2)

Product Substitutions for Type IV Rubber Chemical Hypersensitivity

233

(1)

Considerations for the Dental Patient with Rubber-Based Allergies

234

(1)

Procedures Requiring Local Anesthesia

234

(1)

Endodontic Procedures

235

(1)

Emergency Preparedness

236

(1)

Psychological Issues

236

(1)

Examples of Successful Management of Rubber-Based Allergies

236

(1)

Summary and Recommendations

237

(12)

References

238

(11)

Management of Latex Allergy: Allergist's Perspective

249

(12)

Ignatius C. Chua

Alison J. Owen

Paul E. Williams

Introduction

249

(1)

Management of NRL Allergy

250

(6)

Principles Underlying Drug Management

250

(1)

Increasing Patient Awareness of NRL allergy

250

(1)

Treatment of Local Symptoms

251

(1)

Treatment of Systemic Symptoms

252

(1)

Emergency Rescue Medication for Patient Self-Medication

252

(2)

Training Patients to Deal with Severe Allergic Reactions

254

(2)

Planned Clinical Management of NRL Allergic Patients

256

(1)

Spina Bifida Patients

256

(1)

Patients with Symptoms/Confirmatory Evidence of NRL Allergy

256

(1)

NRL-Free Environments

256

(1)

Latex Immunotherapy

256

(1)

Prognosis

257

(1)

Useful Addresses

258

(3)

References

258

(3)

Index

261

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Latex Intolerance

Summary

Table of Contents

Supplemental Materials