RESUMEN
The milky sap of the rubber tree Hevea brasiliensis is the source of the commercial production of natural rubber latex (NRL) devices, and also represents a source of potent allergenic proteins. NRL materials were introduced in the health care field in about 1840 with the advent of technical abilities to produce suitable and flexible NRL materials for medical products, especially gloves. In the late 1980s, with the increase of transmittable diseases, particularly HIV infection, the use of NRL gloves increased dramatically. During the 1990s, NRL emerged as a major cause of clinically relevant allergy in health care workers using NRL gloves and spina bifida patients with operation on the first day. The increased recognition of NRL allergies, the enhanced research on allergen characterization and sensitization mechanisms, and education about this allergy in health care facilities combined with the introduction of powder-free gloves with reduced protein levels are all factors associated with a decline in the number of suspected cases of NRL allergies in the late 1990s. NRL allergy is a very good example of a 'new allergy' that suddenly arises with tremendous health and economic implications, and also of an allergy which becomes history in a relatively short period of time based on successful primary prevention strategies by strict allergen avoidance.
Asunto(s)
Látex/metabolismo , Alérgenos/química , Alérgenos/inmunología , Alérgenos/metabolismo , Reacciones Cruzadas , Personal de Salud , Historia del Siglo XX , Humanos , Látex/inmunología , Látex/toxicidad , Hipersensibilidad al Látex/etiología , Hipersensibilidad al Látex/historia , Hipersensibilidad al Látex/prevención & control , Péptidos/inmunología , Péptidos/metabolismo , Factores de RiesgoRESUMEN
La alergia al látex de hule natural, se ha convertido en un problema importante de salud en los trabajadores de la salud y en pacientes con espina bífida e intervenciones quirúrgicas múltiples. El tratamiento curativo con inmunoterapia no produce una solución al problema. Las medidas preventivas permiten reducir la incidencia de la alergia al látex y son una mejor extrategia para intervenir en este problema de salud pública. Con el objetivo de aumentar el conocimiento sobre el problema de alergia al látex, discutimos los aspectos relacionados con historia, epidemiología, diagnóstico, prevención y tratamiento. Se definen los términos sensibilización y alergia y se describen los aspectos químicos del látex de hule natural y de sus proteínas. La definición de grupos de riesgo permite desarrollar una estrategia en las instituciones de salud que disminuye la exposición y como consecuenca las manifestaciones clínicas de los individuos sensibilizados.
Asunto(s)
Humanos , Hipersensibilidad , Hipersensibilidad al Látex/diagnóstico , Hipersensibilidad al Látex/epidemiología , Hipersensibilidad al Látex/etiología , Hipersensibilidad al Látex/historia , Hipersensibilidad al Látex/terapia , Costa RicaRESUMEN
Archaeologists have found that latex items were used as early as 1600 BC, but it took until approximately 1900 AD before surgical gloves were commonly used. Descriptions of apparent allergic reactions to natural rubber appeared in the medical literature in 1927, and irritant and delayed-contact reactions were reported in 1933. Although irritant and delayed-contact reactions to rubber products were increasingly recognized, immediate-type allergic reactions were not reported again until 1979. However, after 1980, increasing numbers of contact urticarial reactions to latex were reported, and investigations suggested that many of these reactions were IgE-mediated. In 1984, the first anaphylactic reactions caused by latex surgical gloves were reported, followed in 1991 by the first report of a fatal anaphylactic reaction to latex. Increasing recognition of latex allergy led to divergent paths of investigation. Critical early questions were whether the observed reactions were truly IgE-mediated, and if they were IgE-mediated, what was the source of the allergen? If the allergen was present in latex products, where did it come from? Was it present in raw latex or was it added during processing? As knowledge about the allergens improved, efforts were made to develop and test materials for skin testing and for allergen-specific IgE assays. Now more than 10 unique proteins are recognized as major latex allergens. Although much has been learned about latex allergy, important unanswered questions remain, including the sources of latex exposure that led to sensitization, why latex allergy increased dramatically during the 1980s, and the prevalence of latex allergy in diverse populations. This review concentrates on the history of latex use in medicine and the dramatic emergence of immediate-type latex allergy.
Asunto(s)
Hipersensibilidad al Látex/historia , Guantes Protectores/efectos adversos , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Humanos , Hipersensibilidad Tardía/diagnóstico , Hipersensibilidad Tardía/epidemiología , Hipersensibilidad Tardía/historia , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/epidemiología , Hipersensibilidad Inmediata/historia , Hipersensibilidad al Látex/diagnóstico , Hipersensibilidad al Látex/epidemiologíaRESUMEN
The widespread use of powdered latex gloves, following the institution of universal precautions in 1987, increased the occurrence of a host of adverse reactions to natural rubber latex (NRL). Although the most common reactions are irritant or allergic dermatitis reactions to manufacturing chemicals, a spectrum of type I IgE-mediated reactions to NRL proteins are of great concern. IgE-mediated reactions range from contact urticaria to occupational asthma and anaphylaxis, resulting in significant morbidity and potential mortality. At-risk populations include highly exposed groups like health care workers and certain patient groups requiring extensive medical treatment. A significant complicating factor is the association with clinically significant adverse reactions to certain foods because of allergen cross-reactivity. Institution of policies to use only low-protein, powder-free gloves, has resulted in a dramatic reduction of visits to occupational health departments and workmen's compensation claims due to occupational asthma.
Asunto(s)
Guantes Quirúrgicos/historia , Hipersensibilidad al Látex/historia , Hipersensibilidad a los Alimentos/epidemiología , Hipersensibilidad a los Alimentos/historia , Historia del Siglo XX , Humanos , Hipersensibilidad al Látex/epidemiología , Precauciones Universales/historiaRESUMEN
During the past 10 years the incidence of natural rubber latex (NRL) allergy has dramatically increased. It occurs predominantly in certain high risk group: health care workers, latex industry workers, immune compromised individuals (such as children with spina bifida) and persons with positive risk factors (such as multiple surgeries). The epidemiology, history, mechanism, clinical symptoms and signs, and diagnosis of latex allergy are presented briefly. The subject of this review is to understand the importance in reducing the prevalence of latex allergy: reducing exposure, using appropriate work practices, training and educating workers, monitoring symptoms and substituting non latex products when appropriate.
Asunto(s)
Hipersensibilidad al Látex/historia , Adulto , Niño , Factores Epidemiológicos , Historia del Siglo XX , Humanos , Látex/efectos adversos , Látex/historia , Látex/inmunología , Hipersensibilidad al Látex/diagnóstico , Hipersensibilidad al Látex/prevención & control , National Institute for Occupational Safety and Health, U.S. , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/historia , Enfermedades Profesionales/prevención & control , Factores de Riesgo , Estados UnidosRESUMEN
The authors review several of the most important aspects of latex allergy, an increasing problem in Public Health, which should be understood by all health professionals. After briefly presenting the history of the origin latex, from Hevea brasiliensis the authors describe the antigens of latex: Hev b1 to Hev b8, major allergens. They also note the crossed reactivity not only with foods, exotic fruits, but also with pneumoallergens and in particular the pollens. The groups at risk are essentially workers in the latex industry, health professionals and finally infants with spina bifida or other severe urological anomaly. The clinical signs are reactions of type 1 hypersensitivity, to urticaria and/or angio-oedema and anaphylactic shock. Diagnosis is based on a search for specific serum IgE, skin tests and provocation tests. Prophylaxis depends on removal of all substances that are based on latex, especially replacement of gloves with vinyl, but also on a food diet that excludes all foods that have a cross-reactivity with latex.