RESUMO
Latex allergy, or natural rubber latex allergy (NRLA), is a global health concern, even among the pediatric population, with symptoms varying in severity from mild to potentially life-threatening. Latex is derived from the Hevea Brasiliensis tree, producing twelve million tons annually for use in various everyday and medical products. Despite efforts to mitigate NRLA, its prevalence remains high, especially in at- risk groups such as children with spina bifida. Clinical manifestations include immediate and delayed symptoms, even anaphylactic reactions. Diagnosis involves a detailed medical history and specific tests. Prevention focuses on avoiding exposure, especially in medical and educational settings. Treatment, including immunotherapy, exhibits variable efficacy. NRLA has a strong negative impact on children's quality of life. The objective of this publication is to provide updated information and practical tools for the pediatrician's and allergist's practice.
La alergia al látex del caucho natural (ALCN) es un problema de salud global, incluso en población pediátrica, con síntomas de gravedad variable, desde leves hasta potencialmente mortales. El látex se obtiene del árbol Hevea brasiliensis; se producen doce millones de toneladas anuales que se utilizan en diversos productos cotidianos y médicos. A pesar de los esfuerzos para mitigar la ALCN, su prevalencia sigue siendo alta, especialmente en grupos de riesgo, como niños con espina bífida. Las manifestaciones clínicas incluyen síntomas inmediatos y retardados, hasta reacciones anafilácticas. El diagnóstico requiere una historia clínica detallada y pruebas específicas. La prevención se centra en evitar la exposición, especialmente en entornos médicos y escolares. El tratamiento, incluida la inmunoterapia, muestra eficacia variable. La ALCN tiene un fuerte impacto negativo en la calidad de vida. El objetivo de esta publicación es proveer información actualizada y herramientas prácticas para el consultorio del pediatra y el alergólogo.
Assuntos
Hipersensibilidade ao Látex , Criança , Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/terapia , Hipersensibilidade ao Látex/prevenção & controleRESUMO
This allergy is a hypersensitivity reaction that is triggered by contact with latex. Symptoms vary depending on factors such as route, frequency, and exposure dose, as well as individual susceptibility. The clinical manifestations can be localized at the site of contact with latex or generalized. Exposure can occur directly as a result of contact with the skin and mucous membranes, that is by touching or being touched by objects with latex, or by inhaling (breathing) particles from objects with latex. Contact can also be indirect; for example, by ingesting food that has been handled by a worker wearing latex gloves or by having contact with a person who has been blowing up balloons. The diagnosis of latex allergy is made based on the patient's medical history and on what has been reported in the interrogation, and it is complemented with in vivo studies (such as skin tests and provocation tests) or in vitro studies (determination of specific IgE). The fundamental pillar in the treatment of latex allergy is the education of the patient to achieve the avoidance of products made with this material or the contact and intake of food that has had contact with latex. In view of the foregoing, latex allergy has a great medical and social relevance due to all the safety measures that the patient must take.
La alergia es una reacción de hipersensibilidad desencadenada tras el contacto con el látex. Los síntomas varían dependiendo de factores como la ruta, frecuencia y dosis de exposición, además de la susceptibilidad individual. Las manifestaciones clínicas pueden darse de forma localizada, en el sitio de contacto con el látex, o generalizadas. La exposición puede ocurrir de forma directa como resultado del contacto con la piel y mucosas, por tocar o ser tocado por objetos con látex, o al inhalar partículas provenientes de objetos con látex. El contacto también puede ser indirecto, al ingerir alimentos que fueron manipulados por un trabajador con guantes de látex, al tener contacto con una persona que ha estado inflando globos, por ejemplo. El diagnóstico de alergia al látex se realiza basado en la historia clínica del paciente, lo reportado en el interrogatorio y se complementa con estudios in vivo (como las pruebas cutáneas y las pruebas de provocación) o estudios in vitro (determinación de IgE específica). El pilar fundamental en el tratamiento de la alergia al látex es la educación del paciente para lograr la evitación de productos elaborados con este producto o el contacto e ingesta de alimentos que tuvieron contacto con el látex. Por lo anterior, la alergia al látex tiene una gran relevancia médica y social por todas las medidas de seguridad que debe llevar el paciente.
Assuntos
Hipersensibilidade ao Látex , Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/epidemiologia , Hipersensibilidade ao Látex/etiologia , Testes CutâneosRESUMO
Latex allergy is a major problem worldwide due to both the severity of the symptomatology it produces and the risk groups that are exposed to it. Complete avoidance is difficult, if not impossible, due to its ubiquity. Natural rubber latex (NRL) is a natural polymer that is released by the Hevea brasiliensis (Hev b) tree, which functions as a protective sealant. It is currently used for the manufacture of health-care products such as tube caps, pistons, masks, and cannulas. The purpose of this review is to highlight the epidemiological, clinical, and diagnostic aspects of NRL allergy, and to conduct a review of the literature on its management through a bibliographic search of articles in databases such as PubMed, Cochrane, UpToDate, and Google Scholar, up to September 2021. About 121 articles were reviewed, of which 76 were used as a reference. We concluded that latex allergy is an entity for which its treatment, even nowadays, is avoidance, despite having a worldwide prevalence of 4.3 % and representing a surgical complication in about 20 % of surgeries with an anaphylactic reaction and a mortality rate that can reach 9 %. The only treatment that could modify the evolution of this disease is immunotherapy, but there are no standardized extracts yet and it has not been possible to determine the safest and most effective way to apply it.
La alergia al látex es un problema importante en el mundo debido a la gravedad de la sintomatología que produce y a los grupos de riesgo expuestos. La evitación completa es difícil, casi imposible, dada su ubicuidad. El látex de caucho natural (LCN) es un polímero secretado por el árbol Hevea brasiliensis (Hev b), que funciona como sellador protector. Actualmente se usa para fabricar productos para el cuidado de la salud como tapones para tubos, pistones, mascarillas y cánulas. El objetivo de esta revisión es resaltar los aspectos epidemiológicos, clínicos y diagnósticos de la alergia al LCN, y realizar una revisión de la literatura sobre su manejo, mediante una búsqueda bibliográfica de artículos en bases de datos como PubMed, Cochrane, UpToDate y Google Académico, hasta septiembre del 2021. Se revisaron aproximadamente 121 artículos, de los cuales se utilizaron 76 como referencia. Concluimos que la alergia al látex es una entidad cuyo tratamiento aún hoy en día es la evitación, a pesar de tener una prevalencia mundial de 4.3 % y representar una complicación quirúrgica de cerca de 20 % de las cirugías con una reacción anafiláctica y una mortalidad que puede llegar a 9 %. El único tratamiento que podría modificar la evolución de esta enfermedad es la inmunoterapia, pero aún no se cuenta con extractos estandarizados y no se ha podido determinar la vía más segura y efectiva.
Assuntos
Hevea , Hipersensibilidade ao Látex , Alérgenos , Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/epidemiologia , Hipersensibilidade ao Látex/terapia , Prevalência , BorrachaRESUMO
Introduction: International publications estimate a 7 %-17 % latex sensitization (LS) prevalence among health care workers, but values in Argentina are unknown. Objectives: To estimate the prevalence of latex sensitization and allergy among residents of a children's hospital using the immediate-reading prick test and to assess associated risk factors in this population. Population and methods: Cross-sectional study. Residents, trainers, and Chief residents of the Departments of Pediatrics, Orthopedics, Surgery and Intensive Care were included between June and October 2017. All of them were administered a questionnaire (assessing atopic diseases and other risk factors) and underwent the immediatereading prick test. Total and latex-specific immunoglobulin E levels were determined in a subgroup of individuals (first- and fourth-year residents, surgical specialties, and intensive care). Results: A total of 113 participants were included. LS prevalence was 7.96 % (95 % confidence interval: 3.70-14.58); 4 participants were allergic to latex. A history of latex-related symptoms (LRS) was significantly associated with a positive result in the immediate-reading prick test (p = 0.0196; odds ratio: 6.13; 95 % confidence interval: 1.44-26.04). There was no association between LS and the year of the residency program. Conclusions: The observed LS prevalence was 7.9 %. There was a significant relation between a history of LRS and a positive result in the immediate-reading prick test.
Introducción. Publicaciones internacionales estiman una prevalencia de sensibilización al látex (SL) en el personal de salud del 7 % al 17 %, y se desconocen los valores en la Argentina. Objetivos. Estimar la prevalencia de sensibilización y alergia al látex en médicos residentes de un hospital pediátrico mediante la prueba epicutánea de lectura inmediata y evaluar factores de riesgo asociados en dicha población. Población y métodos. Estudio de corte transversal. Se incluyeron los residentes, jefes e instructores de Pediatría, Ortopedia, Cirugía y Terapia Intensiva entre junio y octubre de 2017. En todos, se realizó un cuestionario (que evaluó enfermedades atópicas y otros factores de riesgo) y la prueba epicutánea de lectura inmediata. En un subgrupo (residentes de 1ero, 4to año, especialidades quirúrgicas y terapia) se dosó inmunoglobulina E total y específica para látex. Resultados. Se incluyeron 113 participantes. La prevalencia de SL fue del 7,96 % (intervalo de confianza del 95 %: 3,70-14,58); 4 participantes resultaron alérgicos al látex. El antecedente de síntomas relacionados con el látex se asoció significativamente con prueba epicutánea de lectura inmediata + (p = 0,0196; odds ratio 6,13; intervalo de confianza del 95 %: 1,44-26,04). No hubo asociación entre SL y año de residencia. Conclusiones. La prevalencia de SL hallada fue del 7,9 %. Se evidenció una relación significativa entre el antecedente de SRL y un resultado de prueba epicutánea de lectura inmediata positiva.
Assuntos
Imunoglobulina E/imunologia , Internato e Residência , Hipersensibilidade ao Látex/epidemiologia , Médicos/estatística & dados numéricos , Adulto , Argentina , Estudos Transversais , Feminino , Hospitais Pediátricos , Humanos , Hipersensibilidade ao Látex/diagnóstico , Masculino , Recursos Humanos em Hospital/estatística & dados numéricos , Prevalência , Fatores de Risco , Testes Cutâneos , Inquéritos e QuestionáriosRESUMO
Kounis syndrome consists of the simultaneous occurrence of anaphylaxis and acute coronary syndrome. It is a rare entity that may be underdiagnosed in paediatrics. The clinical presentation is variable, atypical and usually unexpected, and it carries possible serious complications such as ventricular arrhythmias, myocardial infarction and sudden death. Therefore, an early diagnosis and treatment for myocardial revascularization and the anaphylactic reaction are crucial. We report the case of an 11-year-old male who, after contact with latex, presented an anaphylactic reaction associated with coronary vasospasm, with rapid and complete recovery after administration of intramuscular adrenaline. The cardiological study ruled out coronary pathology as the cause of the event. The allergy study revealed a latex-fruit (kiwi and pineapple) cross-reactivity syndrome. The patient was diagnosed with type I Kounis syndrome triggered by latex, recommending the avoidance of possible triggers.
El síndrome de Kounis consiste en la aparición simultánea de anafilaxia y síndrome coronario agudo. Se trata de una entidad poco descrita y que puede estar infradiagnosticada en pediatría. Es crucial, por su presentación variable, atípica e inesperada, y por sus posibles complicaciones graves (arritmias ventriculares, infarto de miocardio, muerte súbita), su reconocimiento y tratamiento precoz, dirigido a la revascularización del miocardio y al tratamiento de la reacción anafiláctica concomitante. Se presenta el caso de un varón de 11 años que, tras el contacto con látex, presentó una reacción anafiláctica asociada a vasoespasmo coronario, con recuperación rápida y completa con la administración de adrenalina intramuscular. El estudio cardiológico descartó patología coronaria como causa del evento. El estudio alergológico puso de manifiesto un síndrome de reactividad cruzada látex-frutas (kiwi y piña). Se diagnosticó síndrome de Kounis tipo i desencadenado por látex, y se recomendó evitar posibles factores desencadenantes.
Assuntos
Anafilaxia/etiologia , Vasoespasmo Coronário/etiologia , Síndrome de Kounis/diagnóstico , Hipersensibilidade ao Látex/diagnóstico , Criança , Vasoespasmo Coronário/tratamento farmacológico , Epinefrina/administração & dosagem , Humanos , Síndrome de Kounis/etiologia , Hipersensibilidade ao Látex/complicações , MasculinoRESUMO
ABSTRACT CONTEXT: Adverse reactions associated with prick tests are rare but may be present as serious systemic reactions. CASE REPORT: A 38-year-old female nursing technician complained of three episodes of anaphylaxis in one year, all in the workplace. To investigate latex allergy, the patient underwent the prick test with latex, and immediately developed a rash, itchy skin, hoarseness, dyspnea and dry cough. Her condition improved promptly after appropriate measures were established for controlling her anaphylaxis. CONCLUSION: The skin test must be performed under medical supervision, since complications that can lead to life-threatening reactions, if support measures are not readily implemented, have been attributed to this test.
Assuntos
Humanos , Feminino , Adulto , Testes Cutâneos/métodos , Hipersensibilidade ao Látex/diagnóstico , Anafilaxia/etiologia , Doenças Profissionais/etiologia , Hipersensibilidade ao Látex/complicações , Anafilaxia/diagnóstico , Doenças Profissionais/diagnósticoRESUMO
CONTEXT: Adverse reactions associated with prick tests are rare but may be present as serious systemic reactions. CASE REPORT: A 38-year-old female nursing technician complained of three episodes of anaphylaxis in one year, all in the workplace. To investigate latex allergy, the patient underwent the prick test with latex, and immediately developed a rash, itchy skin, hoarseness, dyspnea and dry cough. Her condition improved promptly after appropriate measures were established for controlling her anaphylaxis. CONCLUSION: The skin test must be performed under medical supervision, since complications that can lead to life-threatening reactions, if support measures are not readily implemented, have been attributed to this test.
Assuntos
Anafilaxia/etiologia , Hipersensibilidade ao Látex/diagnóstico , Doenças Profissionais/etiologia , Testes Cutâneos/métodos , Adulto , Anafilaxia/diagnóstico , Feminino , Humanos , Hipersensibilidade ao Látex/complicações , Doenças Profissionais/diagnósticoRESUMO
BACKGROUND: Prevalence of latex allergy in medical students is not known. OBJECTIVE: To determine the prevalence of self-reported latex allergy and associated factors in medical students. METHODS: Cross-sectional, analytical study of students with or without self-reported latex allergy. By means of a structured questionnaire, past personal and family history of allergic disease, time and frequency of exposure to latex gloves and symptoms after exposure to products or foods associated with latex allergy were inquired. Logistic regression models were carried out. RESULTS: Out of 854 subjects, 431 (50.5%) were females. Median age was 21 years. Overall prevalence of latex allergy was 4.3% (95% CI = 3.1 to 5.9). Associated risk factors were age (OR = 1.37; 95% CI = 1.05 to 1.79), personal history of atopic dermatitis (OR = 7.32; 95% CI = 3.14 to 17.08), use of gloves ≥ 15/week (OR = 2.59; 95% CI = 1.17 to 5.76), use of latex products (OR = 5.76; 95% CI = 2.15 to 15.49) and fruit allergy (OR = 3.24; 95% CI = 1.27 t o8.27). CONCLUSION: Four out of a hundred students reported latex allergy. Age, personal history of atopic dermatitis, higher frequency of exposure to latex gloves and history of fruit allergy were risk factors for self-report latex allergy.
Antecedentes: La prevalencia de la alergia al látex se desconoce en los estudiantes de medicina. Objetivo: Determinar prevalencia y factores asociados con autorreporte de alergia al látex en estudiantes de medicina. Métodos: Estudio transversal de estudiantes con o sin autorreporte de alergia al látex. Mediante cuestionario estructurado se indagó historia personal y familiar de enfermedad alérgica; tiempo y frecuencia de exposición a guantes de látex y síntomas tras la exposición a productos o alimentos relacionados con alergia al látex. Se realizaron modelos de regresión logística. Resultados: De 854 sujetos, 431 (50.5 %) fueron mujeres. La mediana de edad fue de 21 años. La prevalencia global de alergia al látex fue 4.3 % (IC 95 % = 3.1 a 5.9). Los factores de riesgo relacionados fueron edad (RM = 1.37; IC 95 % = 1.05 a 1.79), historia personal de dermatitis atópica (RM = 7.32; IC 95 % = 3.14 a 17.08), uso de guantes ≥ 15/semana (RM = 2.59; IC 95 % = 1.17 a 5.76), uso de productos con látex (RM = 5.76; IC 95 % = 2.15 a 15.49) y alergia a frutas (RM = 3.24; IC 95 % = 1.27 a 8.27). Conclusión: Cuatro de cada 100 estudiantes reportaron alergia al látex. La edad, la historia personal de dermatitis atópica, la mayor frecuencia de exposición a guantes de látex y antecedente de alergia a frutos fueron factores de riesgo.
Assuntos
Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/epidemiologia , Autorrelato , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Estudantes de Medicina , Adulto JovemRESUMO
BACKGROUND: Latex-fruit syndrome (LFS) is characterized by allergy to latex and plants. Papain, chymopapain, caricaine and class I chitinases are papaya's most allergenic proteins. The similarity between latex hevein epitopes and papaya class I chitinases might explain the latex-papaya syndrome (LPS). OBJECTIVE: To describe the clinical characteristics of patients with LPS. METHODS: Cross-sectional, observational, descriptive study where 11 patients diagnosed with latex allergy by skin prick test and clinically diagnosed with papaya-induced anaphylaxis were included. The results were analyzed with descriptive statistics. RESULTS: Out of 11 patients with LPS, 72.7% were females (7 to 46 years), all with a history of papaya-induced anaphylaxis, identified by medical history and medical notes plus latex-positive skin prick tests, with 63.3% exhibiting anaphylaxis in the skin prick tests. Risk factors included multiple surgeries, another allergic disease, and being employed in the field of health; 63.6% were allergic to to other foods, 45.4% to medications, 45.4% had allergic rhinitis and 27.3% had asthma. CONCLUSIONS: Hypersensitivity to papaya increases the risk of anaphylaxis in patients with latex allergy and, therefore, mortality. Clinical data is the main diagnostic tool. Education for the management of anaphylaxis with adrenaline self-administration is essential.
Antecedentes: El síndrome látex-fruta (SLF) se caracteriza por alergia al látex y vegetales. La papaína, quimopapaína, caricaína y las quitinasas clase I son las proteínas más alergénicas de la papaya. La similitud entre epítopos de heveína del látex y las quitinasas clase I de la papaya puede explicar el síndrome látex-papaya (SLP). Objetivo: Describir las características clínicas de pacientes con SLP. Métodos: Estudio transversal, observacional y descriptivo en el que se incluyeron 11 pacientes con diagnóstico por punción cutánea de alergia al látex y diagnóstico clínico de anafilaxia a papaya. Los resultados fueron analizados con estadística descriptiva. Resultados: De 11 pacientes con SLP, 72.7 % fue del sexo femenino (7 a 46 años), todos con antecedente de anafilaxia a papaya, identificada por historia clínica y notas médicas más pruebas cutáneas positivas a látex; 63.3 % presentó anafilaxia en las pruebas cutáneas. Los factores de riesgo fueron múltiples cirugías, otra enfermedad alérgica y ser empleado en el ámbito de la salud; 63.6 % tenía alergia a otros alimentos, 45.4 % a medicamentos, 45.4 % rinitis alérgica y 27.3 % asma. Conclusiones: La hipersensibilidad a la papaya incrementa el riesgo de anafilaxia en individuos con alergia al látex, por tanto, la mortalidad. La clínica es la herramienta principal para el diagnóstico. La educación para el manejo de la anafilaxia con autoadministración de adrenalina es fundamental.
Assuntos
Carica , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade ao Látex/diagnóstico , Adolescente , Adulto , Anafilaxia/etiologia , Carica/efeitos adversos , Criança , Estudos Transversais , Feminino , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Síndrome , Adulto JovemRESUMO
Summary: Background. Microarray technique employing molecular allergens is pointed out as a new method to evaluate allergic patients. Objective. To evaluate if microarray technique (ImmunoCAP-ISAC®; I-ISAC®) is similar to fluorescence enzyme immunoassay (FEIA; ImmunoCAP®) in the diagnosis of latex allergy (specific IgE to latex plus symptoms) and latex sensitization (only antibody) in pediatric (9-mo to 14-yrs) patients with myelomeningocele undergone to surgical repair. Methods. Patients underwent skin prick testing (SPT) to latex and food (prick to prick), and dosage of serum specific IgE to latex and recombinant latex allergens (rHev b 1, rHev b 3, rHev b 5, rHev b 6.01, rHev b 6.02, rHev b 8, rHev b 9, and rHev b 11) by ImmunoCAP® and I-ISAC®. Results. The comparison between the two methods showed high level of concordance considering positive and negative results. A statistically significant correlation for rHev b 3 and rHev b 6.01 for the allergic patients, and for rHev b5 and rHev b6.01 for those sensitized to latex, was observed. I-ISAC® is limited to 5 recombinant latex allergens (rHev b 1, 3, 5, 6.01 and 8). Despite the presence of antibodies against pollens, LTP and profilins (I-ISAC®) in some patients, none of them reported symptoms related with intake of fruits and/or vegetables. Conclusion. Both methods are effective in assisting the diagnosis of latex allergy, but differ in the assessment of sensitized pediatric patients with myelomeningocele. The assessment of latex sensitized patients is more complete using the 8 recombinant latex fractions available for ImmunoCAP®, instead of I-ISAC®.
Assuntos
Fluorimunoensaio/métodos , Hipersensibilidade ao Látex/diagnóstico , Meningomielocele/cirurgia , Análise Serial de Proteínas/métodos , Adolescente , Criança , Pré-Escolar , Hipersensibilidade Alimentar/diagnóstico , Humanos , Imunoglobulina E/sangue , Lactente , Látex/imunologia , Meningomielocele/patologiaRESUMO
BACKGROUND: Perioperative hypersensitivity reactions constitute a global health problem, with an estimated incidence of 1 per 100,000 procedures and a mortality rate of 0.1 to 9 %. Main risk factors are a history of allergy to other drugs, atopy, associated psychiatric disorders and previous surgeries. OBJECTIVES: To determine the frequency of sensitization and the type of drugs involved in perioperative allergy in a tertiary care hospital, over a 3-year period. METHODS: Retrospective, cross-sectional, descriptive study of perioperative allergy, corroborated by skin tests for each drug and latex, of patients treated at the Allergy and Clinical Immunology Department of Hospital General de Mexico. RESULTS: Twenty-eight patients diagnosed with perioperative allergy were included. Main triggers were neuromuscular blocking agents (46.42 %), latex (28.52 %) and propofol (14.28 %). The main risk factor was a history of previous surgeries (89.28 %). Most perioperative allergic reactions were mild (71.42 %) and occurred within the postoperative period (60.71 %). CONCLUSIONS: Initial diagnosis and Treatment should always be carried out by the anesthesiologist or surgeon, who should focus on the withdrawal of possible causative agents.
Antecedentes: Las reacciones de hipersensibilidad perioperatorias constituyen un problema de salud mundial, con una incidencia estimada de uno por cada 100 000 procedimientos y una tasa de mortalidad de 0.1 a 9 %. Los principales factores de riesgo son antecedentes de alergia a otros fármacos, atopia, trastornos psiquiátricos asociados y cirugías previas. Objetivos: Determinar la frecuencia de sensibilización y tipo de medicamentos implicados en la alergia perioperatoria en un hospital de tercer nivel, durante tres años. Método: Estudio retrospectivo, transversal, descriptivo de alergia perioperatoria corroborada mediante pruebas cutáneas a cada medicamento y al látex, de pacientes atendidos en el Servicio de Alergia e Inmunología Clínica del Hospital General de México. Resultados: Se incluyeron 28 pacientes con el diagnóstico de alergia perioperatoria. Los principales desencadenantes fueron los bloqueadores neuromusculares (46.42 %), el látex (28.52 %) y el propofol (14.28 %). El principal factor de riesgo fue el antecedente de cirugías previas (89.28 %). En su mayoría, las reacciones de alergia perioperatoria fueron leves (71.42 %) y se presentaron en el periodo posoperatorio (60.71 %). Conclusiones: El diagnóstico y tratamiento iniciales siempre deberán efectuarse por el médico anestesiólogo o el cirujano, enfocados en el retiro de los posibles agentes causales.
Assuntos
Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/epidemiologia , Estudos Transversais , Hipersensibilidade a Drogas/complicações , Feminino , Humanos , Hipersensibilidade ao Látex/complicações , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: In our country, the prevalence of latex allergy in health personnel has rarely been studied. OBJECTIVE: To determine the prevalence and associated factors to self-reported latex allergy in health care workers. METHODS: A cross-sectional study was conducted among 1,292 health care workers of a second level hospital. All workers were included and they were required to answer a structured questionnaire aimed at identifying latex allergy, atopic personal and family history, exposure to latex gloves and surgical background. Odds ratio (OR) and 95 % confidence interval (95 % CI) were estimated using regression logistic to investigate factors associated to latex allergy. RESULTS: The female to male ratio was 2.4:1. The men age 38.4 ± 11.6 years. The prevalence of latex allergy auto-reported was 9.7 %, with a confidence interval of 95 % (95 % CI) 8.1 %-11.3 %. There was no statistical difference by workplace (p = 0.508). Factors associated with latex allergy included female gender (OR = 1.68; 95 % CI: 1.03-2.73, p = 0.037), personal history of atopy (OR = 4.82; 95 % CI: 3.19-7.26, p < 0.0001), family history of atopic dermatitis (OR = 4.33, 95 % CI: 1.20-4.41) and history of allergy to fruits (OR = 4.33; 95 % CI: 2.62-7.14, p < 0.0001). CONCLUSIONS: Up to 10 out to 100 health workers may have latex allergy. The main factors associated with latex allergy in this study were: being a female, personal or familiar atopy and allergy to fruits.
Antecedentes: pocas veces ha sido estudiada la prevalencia de alergia al látex en personal de la salud en México. Objetivo: determinar la prevalencia de autorreporte de alergia al látex y los factores asociados en trabajadores de la salud. Métodos: estudio trasversal de 1292 trabajadores de la salud de un hospital de segundo nivel, a quienes se les aplicó un cuestionario estructurado para identificar alergia al látex, historia personal y familiar de atopia, exposición a guantes de látex y antecedente de cirugías. La búsqueda de asociaciones entre variables se realizó mediante regresión logística. Se calcularon razones de momios (RM) e intervalo de confianza a 95 % (IC 95 %) Resultados: la relación mujer:hombre fue de 2.4:1. Edad media de 38.4 ± 11.6 años. La prevalencia de alergia al látex fue de 9.7 %, IC 95 %, 8.1-11.3 %. No hubo diferencia estadística por área laboral (p = 0.508). Los factores asociados con la alergia al látex fueron sexo femenino (RM = 1.68; IC 95 %, 1.03-2.73), historia personal de atopia (RM = 4.82; IC 95 %, 3.19-7.26), historia familiar de dermatitis atópica (RM = 4.33; IC 95 %, 1.20-4.41) e historia de alergia a frutos (RM = 2.30; IC 95 %, 2.62-7.14). Conclusiones: hasta 10 % los trabajadores de la salud podría presentar alergia al látex; los principales factores asociados fueron sexo femenino, atopia personal o familiar y alergia a frutos.
Assuntos
Hipersensibilidade ao Látex/epidemiologia , Doenças Profissionais/epidemiologia , Autorrelato/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Hipersensibilidade ao Látex/diagnóstico , Masculino , Doenças Profissionais/diagnóstico , Prevalência , Fatores de RiscoRESUMO
INTRODUCTION: Latex allergy is common in the hospital setting. OBJETIVE: To describe the clinical situation of three pediatric interns with latex allergy and the prevention strategies implemented during clinical clerkships in pediatric and neonatal intensive care units. PATIENTS, METHODS, AND OUTCOMES: The three interns referred symptom exacerbation during their internship program. Diagnosis was confirmed based on a compatible history and positive specific immunoglobulin E. A semi-structured interview was done to describe perceptions about prevention strategies, the personnel were trained, and nitrile gloves were provided for carrying out procedures. Interns completed their clinical clerkships without having allergic reactions. Positive aspects referred by interns were that they felt cared for and experienced an improved quality of life; negative aspects were a bad predisposition and resistance against change among some other interns. Strategies designed to this end permitted interns to continue their internship program.
INTRODUCCIÓN: La alergia al látex es frecuente en ámbitos hospitalarios. OBJETIVO: Describir la situación clínica de tres residentes de Pediatría con alergia al látex y las estrategias de prevención en las rotaciones de Terapia Intensiva Pediátrica y Neonatal. PACIENTES, MÉTODOS Y RESULTADOS: Las tres profesionales manifestaron exacerbación de síntomas durante la residencia. Se confirmó el diagnóstico con historia compatible e inmunoglobulina E específica positiva. Se realizó una entrevista semiestructurada para describir sus percepciones en relación con las estrategias de prevención, se capacitó al personal y se incorporaron guantes de nitrilo para los procedimientos. Las residentes realizaron las rotaciones sin presentar manifestaciones alérgicas. Refirieron como aspectos positivos sentirse cuidadas y mejor calidad de vida; como aspectos negativos, mala predisposición y resistencia al cambio en algunos compañeros. Las estrategias diseñadas permitieron que las residentes pudieran continuar su programa de formación.
Assuntos
Internato e Residência , Hipersensibilidade ao Látex/prevenção & controle , Pediatria/educação , Adulto , Dermatoses da Mão/etiologia , Dermatoses da Mão/prevenção & controle , Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/psicologiaRESUMO
Introducción: La prevalencia de sensibilización al látex es variable. Se describen diversos factores de riesgo para la sensibilización al látex, como riesgo genético, atopia y múltiples intervenciones quirúrgicas. Objetivo: Caracterizar los pacientes con sospecha de alergia al látex, analizar sus características clínicas y factores de riesgo. Pacientes y método: Estudio retrospectivo, descriptivo, en niños derivados a la Unidad de Inmunología pediátrica por sospecha de alergia al látex y para confirmación diagnóstica. Se revisaron síntomas por contacto o exposición a materiales con látex. Se identificó factores de riesgo para la sensibilización al látex: patologías con múltiples intervenciones quirúrgicas (espina bífida, mielomeningocele, escoliosis y alteraciones nefrourológicas), atopia (rinitis o asma, dermatitis atópica), y se realizó prick test y/o IgE específica para látex. Se efectuó un modelo de regresión logística multivariado para asociar síntomas de exposición al látex con enfermedades de base y condiciones de riesgo. Resultados: Se reclutaron 106 pacientes, de los cuales 50 fueron analizables. El 96% eran mayores de 5 años de edad al momento del diagnóstico. La mayoría de los factores de riesgo descritos en la literatura eran observables en estos pacientes (múltiples cirugías, malformaciones neurológicas y nefrourológicas, intervenciones quirúrgicas antes del año de edad y cateterismo vesical repetido). Luego de la exposición, las manifestaciones cutáneo-mucosas fueron las más frecuentes (52%), seguidas por las respiratorias (36%). El 100% de los pacientes estaban sensibilizados al látex. Conclusión: La sensibilización y alergia al látex es un problema relevante en niños con factores de riesgo. Los resultados mostrados plantean importantes desafíos en relación con medidas preventivas.
Introduction: The prevalence of latex sensitisation varies according to the population studied. There are various risk factors that increase latex sensitisation, such as genetic risk, atopy, and multiple surgeries. Objective: To characterise patients referred to an Immunology Unit with suspected latex allergy, and to analyse their clinical features and risk factors. Patients and method: A retrospective, descriptive study was conducted on children suspected of latex allergy. Their medical records were reviewed in order to assess symptoms with contact or exposure to latex materials. Known risk factors to latex sensitisation, such as pathologies requiring repeated surgery (spina bifida, myelomeningocele, scoliosis and nephro-urological alterations), atopy (rhinitis, asthma, atopic dermatitis) were investigated. A prick test and/or specific IgE to latex were also performed. A multivariate logistic regression model was performed to find associations between symptoms triggered by exposure to latex with underlying diseases and other risk conditions. Results: A total of 106 patients were enrolled in the study, of whom 50 were evaluable. At diagnosis 96% of patients were older than five years. Most of the risk factors described were observable in these patients, such as multiple surgeries, neurological and nephro-urological malformations, surgery before one year-old, and repeated bladder catheterisation. After latex exposure, mucous cutaneous manifestations were the most common (52%), followed by respiratory symptoms (36%). All patients were sensitised and allergic to latex. Conclusion: Latex allergy is a significant problem in children with risk factors. The results shown in this study raise important challenges for preventive measures and awareness.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Imunoglobulina E/imunologia , Testes Cutâneos/métodos , Hipersensibilidade ao Látex/epidemiologia , Modelos Logísticos , Prevalência , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/etiologia , Hospitais PediátricosRESUMO
INTRODUCTION: The prevalence of latex sensitisation varies according to the population studied. There are various risk factors that increase latex sensitisation, such as genetic risk, atopy, and multiple surgeries. OBJECTIVE: To characterise patients referred to an Immunology Unit with suspected latex allergy, and to analyse their clinical features and risk factors. PATIENTS AND METHOD: A retrospective, descriptive study was conducted on children suspected of latex allergy. Their medical records were reviewed in order to assess symptoms with contact or exposure to latex materials. Known risk factors to latex sensitisation, such as pathologies requiring repeated surgery (spina bifida, myelomeningocele, scoliosis and nephro-urological alterations), atopy (rhinitis, asthma, atopic dermatitis) were investigated. A prick test and/or specific IgE to latex were also performed. A multivariate logistic regression model was performed to find associations between symptoms triggered by exposure to latex with underlying diseases and other risk conditions. RESULTS: A total of 106 patients were enrolled in the study, of whom 50 were evaluable. At diagnosis 96% of patients were older than five years. Most of the risk factors described were observable in these patients, such as multiple surgeries, neurological and nephro-urological malformations, surgery before one year-old, and repeated bladder catheterisation. After latex exposure, mucous cutaneous manifestations were the most common (52%), followed by respiratory symptoms (36%). All patients were sensitised and allergic to latex. CONCLUSION: Latex allergy is a significant problem in children with risk factors. The results shown in this study raise important challenges for preventive measures and awareness.
Assuntos
Imunoglobulina E/imunologia , Hipersensibilidade ao Látex/epidemiologia , Testes Cutâneos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/etiologia , Modelos Logísticos , Masculino , Análise Multivariada , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
INTRODUCTION: Latex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce. OBJECTIVE: To estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors. POPULATION AND METHODS: Descriptive, cross-sectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact with latex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit. RESULTS: Eighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ± 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures. CONCLUSION: According to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.
INTRODUCCIÓN: La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos. OBJETIVO: Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados. PACIENTES Y MÉTODOS: Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada. RESULTADOS: Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas. CONCLUSION: El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones.
Assuntos
Hipersensibilidade ao Látex/epidemiologia , Meningomielocele/complicações , Adolescente , Criança , Estudos Transversais , Humanos , Imunoglobulina E/sangue , Látex/efeitos adversos , Hipersensibilidade ao Látex/diagnóstico , Masculino , Prevalência , Testes Cutâneos , Adulto JovemRESUMO
Introducción: La alergia al látex se encuentra dentro de las primeras causas de anafilaxia en el quirófano. La prevalencia de esta enfermedad es más elevada en pacientes con mielomenigocele. Existen escasos datos epidemiológicos en pacientes argentinos. Objetivo: Estimar la prevalencia de la sensibilidad y de la alergia al látex en una población de pacientes con mielomeningocele y describir los factores de riesgo asociados. Pacientes y métodos: Estudio descriptivo, transversal, observacional. Se analizaron los antecedentes familiares y personales de alergia, el número de procedimientos quirúrgicos, la historia de síntomas ante el contacto con látex o alimentos con reactividad cruzada, el recuento de eosinófilos, la inmunoglobulina E total y la inmunoglobulina E específica mediante pruebas serológicas y cutáneas para el látex, los aeroalérgenos y las frutas con reactividad cruzada. Resultados: Se evaluaron 82 pacientes con diagnóstico de mielomeningocele, 41 del sexo masculino (50%), con edad promedio de 15,3 ± 7,66 años. Del total de los pacientes, 2 no realizaron las pruebas cutáneas y serológicas. De los 80 restantes, 16 (19,51%) presentaban alergia al látex, 46 (57,5%) no eran alérgicos y 18 (22%) fueron sensibles pero no alérgicos. Se observó que haber tenido más de 5 cirugías representaba un factor de riesgo asociado a alergia al látex (p= 0,035). No se encontró una asociación significativa con el resto de las variables evaluadas. Conclusión: El estudio estima que la prevalencia de alergia al látex en esta población de pacientes es de 19,51% y que el factor de riesgo más importante para el desarrollo de esta patología es el antecedente de haber sido sometido a más de 5 intervenciones.
Introduction: Latex allergy is one of the main reasons of anaphylaxis in the operating room. The prevalence of this condition is higher among patients with myelomeningocele. Epidemiological data obtained from Argentine patients is scarce. Objective: To estimate the prevalence of latex sensitivity and latex allergy in a population of patients with myelomeningocele and to describe associated risk factors. Population and Methods: Descriptive, crosssectional, observational study. Family and personal history of allergy, number of surgeries, history of symptoms caused by having been in contact withlatex or cross-reactive foods, eosinophil count, measurement of total immunoglobulin E and specific immunoglobulin E levels by means of skin and serologic testing for latex, aeroallergens and cross-reactive fruit. Results: Eighty-two patients diagnosed with myelomeningocele were assessed: 41 were males and their average age was 15.3 ? 7.66 years old. Out of all patients, two did not complete skin and serologic testing. Among the remaining 80 patients, 16 (19.51%) had latex allergy, 46 (57.5%) were not allergic, and 18 (22%) showed sensitivity but not allergy. Having undergone more than five surgeries was a risk factor associated with latex allergy (p= 0.035). No significant association was observed with the remaining outcome measures. Conclusion: According to this study, the prevalence of latex allergy in this population of patients is 19.51% and the most important risk factor for this condition is a history of having undergone more than five surgeries.
Assuntos
Humanos , Criança , Adolescente , Imunoglobulina E/sangue , Testes Cutâneos , Prevalência , Estudos Transversais , Meningomielocele/complicações , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/epidemiologia , Látex/efeitos adversosRESUMO
El látex o caucho natural es un producto vegetal que se obtiene de la savia de la Hevea brasiliensis. Ampliamente utilizado para la fabricación de productos de uso doméstico (guantes, preservativos, globos, etc.) y del área de la salud, donde se estima que el 50% de los artículos médicos contienen látex. La alergia al látex es un problema de salud mundial. Se estima que la prevalencia de sensibilización al látex en población general es del 1%. Clínicamente, puede generar una reacción de hipersensibilidad tipo I, IgE mediada, en respuesta a las proteínas del látex que se manifiesta como una urticaria hasta la anafilaxia. También se describe dermatitis de contacto irritativa y la dermatitis de contacto alérgica, 12 a 96 horas luego del contacto, por una reacción de hipersensibilidad retardada tipo IV, secundaria a los aditivos del látex. El diagnóstico se basa en la sospecha clínica, confirmado con pruebas cutáneas y medición de IgEs específicas. Realizar una anamnesis que permita sospechar una alergia al látex y si se determina que el paciente tiene riesgo, realizar el estudio complementario para confirmar el diagnóstico. El enfrentamiento se basa en la prevención de la exposición y el tratamiento de la reacción aguda. Es necesario conocer los alérgenos y procesos implicados en la alergia al látex pues de este modo se podrá sospechar e identificar a pacientes o funcionarios que puedan sufrir o estar en riesgo de presentarla, disminuyendo de este modo las posibles complicaciones.
Latex or natural rubber is a vegetable product which is obtained from the sap of the Hevea brasiliensis. It is widely used to manufacture domestic products (gloves, condoms, balloons, etc.) and used in the health area, where it is estimated that 50% of medical articles contain latex. Latex allergy is a global health problem. It is estimated that the prevalence of latex sensitization is 1% in the general population. The clinical presentation can be a type I hypersensitivity reaction, IgE mediated, in response to latex proteins, manifested as a rash or even as an anaphylaxis. Irritant contact dermatitis and allergic contact dermatitis, 12 to 96 hours after contact, is also described, due to a delayed type IV hypersensitivity reaction, secondary to latex additives. The diagnosis of latex allergy is based on clinical suspicion and confirmed with skin tests measuring specific IgEs. Management is based on the exposure prevention and treatment of the acute reaction. A detailed anamnesis must be made to suspect a latex allergy and if the patient is at risk of presenting it, perform additional study to confirm the diagnosis. It is necessary to know the allergens and processes involved in latex allergy, to be able to suspect and identify patients or staff who may suffer or be at risk of presenting it, thus reducing potential complications.
Assuntos
Humanos , Hipersensibilidade ao Látex/diagnóstico , Hipersensibilidade ao Látex/terapia , Látex/efeitos adversos , Testes Cutâneos , Fatores de RiscoRESUMO
Latex or natural rubber latex is a processed plant-based product, extracted from the tropical tree Hevea Brasiliensis. This raw material is widely used in about 40.000 medical and daily-used products. Latex allergy is a relevant pathology in surgical environments that arose after the establishment of universal precautions during the nineties. Risk groups include health-care workers and children with spine bifida who have a prevalence ranging between 2.9-17 percent and 30-70 percent, respectively. Latex allergy occurs in a variety of ways in health facilities including hypersensitivity reaction type IV or type I. In the former, chemical substances added to latex trigger the allergic reactions; where allergic dermatitis is the most-frequently found case. In the latter, the reactions are triggered by the contact with latex proteins causing from urticarial to anaphylactic shock and death. Diagnosis of latex allergy is based on a clinical history and/or physical examination associated with a confirmatory test as prick test (latex allergy type I) or cutaneous patches (latex allergy type IV). Nowadays, there is no definitive cure for the latex allergy and its treatment is based on allergen avoidance.
El látex o caucho natural es un producto vegetal procesado que se obtiene a partir del árbol tropical Hevea Brasiliensis. Esta materia prima es ampliamente usada, estando presente en hasta 40.000 productos médicos y de uso diario. La alergia al látex es una patología relevante en el ámbito quirúrgico, que surgió posterior a la instauración de las precauciones universales en la década del 90. Dentro de los grupos de riesgo se encuentran trabajadores de la salud y pacientes con espina bífida con una prevalencia que oscila entre 2,9 a 17 por ciento y 30 a 70 por ciento, respectivamente. La presentación clínica de alergia al látex tiene un espectro amplio, pudiendo presentarse como reacciones por hipersensibilidad tipo IV o tipo I. En el primer grupo, las reacciones son gatilladas por los químicos adicionados al látex, siendo la dermatitis alérgica de contacto su presentación más frecuente. En el segundo grupo, las reacciones son secundarias al contacto con proteínas del látex, pudiéndose manifestar desde urticaria hasta shock anafiláctico y muerte. El diagnóstico de alergia al látex se basa en una historia clínica y/o examen físico compatible asociado a un examen confirmatorio, como el prick test (alergia al látex tipo I) y el parche cutáneo (alergia al látex tipo IV). Actualmente no existe una cura definitiva para la alergia al látex y su tratamiento se basa en evitar la exposición al alérgeno.