Simons FER. World Allergy Organization survey on global availability of essentials for the assessment and management of anaphylaxis by allergy-immunology specialists in health care settings. Journal of Allergy and Clinical Immunology. Recommendations for appropriate sublingual immunotherapy clinical trials. Zuberbier T et al. Allergy , ; 64 10 Abstract. Epinephrine: the drug of choice for anaphylaxis. A Statement of the World Allergy Organization.
What is an allergist? Full text. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organization, October Prevention of allergy and allergic asthma. In: Ring J et al, eds. Chemical Immunology and Allergy. Vol Basel, Switzerland: Karger; This site uses cookies. By continuing to browse this site, you are agreeing to our use of cookies. Review our cookies information for more details.
In and , 2 double-blind placebo, controlled DBPC studies were published on the efficacy of subcutaneous immunotherapy SCIT with latex extracts. In , another DBPC trial failed to show a significant improvement of symptoms and medication scores using latex SCIT, probably because of the low level of symptoms at baseline and the low maintenance dose of therapy; 64 moreover, the incidence of systemic reactions was very high in the active group.
After the publication of anecdotal cases of latex allergy treated with sublingual immunotherapy SLIT , subsequent SLIT trials in Europe began to show safety and efficacy of this route of administration.
In 2 Italian DBPC trials conducted in 20 children and 35 adults, respectively, using a rapid-induction protocol, cutaneous exposure tolerance significantly improved after 1 year of treatment and very few or no local oral reactions were reported. In an attempt to find correlations to predict clinical efficacy or safety outcomes, a month open, case-control study of 23 children failed to show consistent significant immunological changes. Unfortunately, there are several limitations to SLIT studies.
The overall quality of the studies is moderate and the sample size is small in the DBPC trials. Patients with different symptoms are often grouped together in these studies, limiting their power. Moreover, long-term data to confirm sustained efficacy after AIT discontinuation are lacking. Finally, in a recent systematic review and meta-analysis of randomized controlled trials, including four studies, a statistically significant difference was observed only with the glove provocation test, leading the authors to conclude that more clinical trials are required to better define the clinical usefulness and safety of latex immunotherapy.
No trials on latex AIT are currently ongoing. To date there is only 1 study showing that the treatment with the monoclonal anti -IgE antibody omalizumab has clinically relevant ocular and skin antiallergic activity in healthcare workers with occupational latex allergy. This review attempts to highlight the international relevance of NRLA. While on the one hand considerable progress has been made regarding this disease, on the other hand there are still great disparities in knowledge, diagnosis, and treatment in different regions of the world.
In developed countries, due to the relaxation of preventive measures, anaphylactic accidents still occur since some materials containing latex can go unnoticed. Developing countries do not appear to be exposed to a similar situation, no updated epidemiological data are available and this limited information has an impact on the scope of institutional and governmental policies.
This situation, together with economic difficulties, results in a lack of basic measures, such as the provision of non-powdered, low-protein gloves or synthetic gloves. Moreover, not all patients have access to epinephrine autoinjectors; therefore, they have to carry adrenaline ampoules with them and be trained in its proper use.
Many developing countries either do not have either standardized diagnostic methods or more sophisticated tests, such as CDR, to differentiate between true sensitization and cross-reactivity, or these techniques are not accessible to the majority of the population.
It is necessary to conduct epidemiological studies and to assess direct and indirect costs of latex allergy. It is also necessary to maintain the warnings and provide ongoing educational activities on NRLA in training programs, medical internships and residences, nursing education, and for all personnel in contact with the patient. In addition, the COVID pandemic has increased the use of latex gloves by institutions and the general population.
It would be also useful to identify which elements of personal protective equipment other than latex gloves are a source of latex. All of this confers a greater risk of presenting allergic reactions in sensitized individuals in contact with these elements, as well as a potential risk, in the medium term, of an increase in the number of subjects allergic to latex.
Regarding the new biologics, beyond the few studies with omalizumab, exploring those with other therapeutic targets upstream in the T2 inflammatory cascade such as dupilumab or tezepelumab, could have a potential role in the treatment of NRLA in the future.
Finally, more research is needed to find economically and ecologically sustainable alternatives. All authors have contributed to the writing and revision of the manuscript. All authors agreed to the publication of this work in the World Allergy Organization Journal. No ethical consent was required since this study does not involve human or animals.
The authors have not received any funding to prepare the manuscript. The authors declare that they do not have conflict of interests related to the contents of this article. For the special contribution and support for writing the manuscript: Mario Sanchez Borges and Ignacio J. We also would like to honor the memory of the late Mario Sanchez Borges, our esteemed colleague. National Center for Biotechnology Information , U.
World Allergy Organ J. Published online Jul Claudio A. Kelly , b Ignacio J. Kevin J. Ignacio J. Mario A. Author information Article notes Copyright and License information Disclaimer. Parisi: ra. Associated Data Data Availability Statement The raw data will be made available with the acceptance of the submitted manuscript.
Abstract Despite the efforts made to mitigate the consequences of this disease, natural rubber latex allergy NRLA continues to be a global health problem and is still considered one of the main worries in the working environment in many countries throughout the world.
Current epidemiology and risk factors People with frequent and intense contact with latex products were identified as having a higher risk of developing NRLA.
Open in a separate window. Clinical manifestations Clinical manifestations induced by type I hypersensitivity reactions to NRL vary greatly depending on the route of exposure cutaneous, percutaneous, mucosal, or parenteral , the amount and features of the allergens, the level of sensitization, and individual factors.
Skin symptoms Immunological contact urticaria ICU occurs in previously sensitized individuals and is a type I hypersensitivity reaction mediated by latex-specific immunoglobulin E. Respiratory symptoms NRL was recognized as a major cause of IgE-mediated occupational asthma in the early s, especially in the healthcare setting.
Systemic reactions Anaphylactic reactions 25 generally occur during medical-surgical procedures, such as surgery, gynaecological interventions, or dental examination. Table 2 Characterized Latex Allergens and clinical relevance. Diagnosis: usefulness and limitations of available tests The initial step in diagnosing latex allergy is obtaining a complete clinical history. Intradermal tests are not recommended. Patch tests Used in suspected delayed-type hypersensitivity reactions, most of which are attributable to additives.
Challenge Tests With suggestive medical history but negative skin and laboratory tests Glove use test Put a latex glove on one finger, from 15 min to 2 h. If the result is negative, the full glove is placed on one hand and a vinyl, or nitrile glove, on the other hand. The test is considered positive when it causes itching, erythema, vesicles or respiratory symptoms.
Rubbing test The rubbing test gives false positives and is not standardized. Thus, its diagnostic yield is very low and it is not used. Specific bronchial provocation test Are classified into those, the ones that use an aqueous latex extract with a nebulizer or in a chamber with aerosolized glove extract and those consisting in handling or shaking gloves to generate a dust aerosol.
The lung functions and the occurrence of bronchial symptoms are then evaluated. Conjunctival provocation and nasal challenge They have been used in some studies, however they have little significance. Basophil activation test BAT Flow cytometry is also used by some groups in Europe to determine the activation of basophils after stimulation with recombinant latex allergens.
Component-resolved diagnosis CRD Over the past decade, increased availability of allergenic molecules for diagnosis, known as precision allergy molecular diagnostic applications PAMD , has improved the management of allergic diseases. Management of latex allergy Individual strategies Management of IgE-mediated latex allergy involves primary prevention of sensitization through reduction of natural rubber exposure which will be discussed under the workplace strategy and strategies for the latex-allergic patient that involve avoidance and education.
Avoidance Subjects diagnosed with latex allergy should strive to avoid latex allergens contacting skin, mucosa, and respiratory epithelium. Institutional and workplace avoidance Starting after , purchasing practices at healthcare institutions in high-income countries reduced the use of latex gloves. Possible actions for latex avoidance in the workplace Description Positive effect Pitfalls Personal impact Qualifies for disability. Termination of employment The patient qualifies for disability due to an occupational disease Definitively avoids contact with the allergen in the workplace Loss of human resources and increased social costs Affected individuals feel alone and abandoned.
They have to reconsider their professional life. The economic impact may lead to depression Relocation of the patient The patient is relocated to places without direct contact with latex, such as administrative areas Avoids contact with latex in the workplace This may lead to a loss of employment status and human resources.
Options are: 1 The use of latex-free gloves both for the affected workers and their colleagues 2 The use of latex-free gloves for the affected workers and non-powdered, low-protein gloves for the remaining colleagues No loss of human resources The patient may be at risk in other areas of the institution and potential new cases are not avoided.
This type of avoidance requires changes in the institutional policies The patient can continue working which compensates for the fact that the appearance of the disease was work related Creation of a completely latex-free environment Turn the institution into a latex-free environment No loss of human resources, new sensitizations are avoided.
Beneficial for the workers and the quality of the work environment This requires a delicate balance between the management of the budget and the human resources. This long-term measure implies a financial risk and can likely not be achieved in many institutions worldwide. The feeling of loss is dramatically reduced.
School environment Little has been written about latex allergy in the school environment. Immunotherapy Since it is still quite difficult to achieve complete avoidance of contact with NRL, allergen-specific immunotherapy AIT may be an option, with the chance to reduce the severity of the disease and improve the patient's quality of life.
Biologic drugs To date there is only 1 study showing that the treatment with the monoclonal anti -IgE antibody omalizumab has clinically relevant ocular and skin antiallergic activity in healthcare workers with occupational latex allergy.
Conclusions and future perspectives This review attempts to highlight the international relevance of NRLA. Author contributions All authors have contributed to the writing and revision of the manuscript. Consent for publication All authors agreed to the publication of this work in the World Allergy Organization Journal. Availability of data and materials The raw data will be made available with the acceptance of the submitted manuscript.
Ethics approval No ethical consent was required since this study does not involve human or animals. Funding The authors have not received any funding to prepare the manuscript.
Declaration of competing interest The authors declare that they do not have conflict of interests related to the contents of this article.
Acknowledgement For the special contribution and support for writing the manuscript: Mario Sanchez Borges and Ignacio J. References 1. Kawai M. Changes in the characteristics of patients with latex allergy from to Fujita medical journal. Saleh M. Profile shift in latex sensitization over the last 20 years. Int Arch Allergy Immunol. Kelly K. Skin and serologic testing in the diagnosis of latex allergy. J Allergy Clin Immunol. PMID: It has been rated the 1 respiratory hospital in the nation for 15 straight years by U.
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Some aspects of anaphylaxis treatment have been prospectively studied. Novel investigations of self-injectable epinephrine for treatment of anaphylaxis recurrences in the community have been performed.
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