allergy
[Latex allergy in health care workers: frequency, exposure quantification, efficacy of criteria used for job fitness assessment]

[Article in Italian]

Crippa M, Gelmi M, Sala E, Zefferino R, Baccolo TP, Alessio L.

Cattedra di Medicina del Lavoro, Scuola di Specializzazione in Medicina del Lavoro, Universita degli Studi di Brescia.

BACKGROUND: The main purpose of this study was to evaluate the latex allergy prevalence in a large population of health care workers, to quantify latex exposure deriving from use of gloves and to verify the efficacy of job fitness evaluations in allergic workers. METHODS: In the period 2001-2002, latex allergy prevalence was evaluated in 1962 health care workers by means of a self-administered questionnaire, clinical evaluation and specific allergological tests. Also, the total protein content (by means of Lowry method modified EN455-3: 1996) and the antigenic latex proteins (by means of RAST inhibition) in 4 different types of gloves were measured. Job fitness assessments for latex allergic workers were made in accordance with the criteria established by the Italian Association of Preventive Medicine for Health Care Workers criteria. The efficacy was verified one year later. RESULTS: 1557 questionnaires out of 1962 (79.35%) were completed; 504 (32.4%) reported work-related symptoms, in particular 283 subjects had probable irritant contact dermatitis, 66 allergic contact dermatitis and 118 reported irregular non-specific symptoms related to the use of both vinyl and latex gloves; 20 subjects out of the remaining 37 had a latex allergy (1.3% out of the 1557 workers responding to the questionnaire), 8 subjects had only urticaria while 12 subjects had urticaria associated with respiratory symptoms and/or angioedema. The measurement of total protein and antigenic protein content showed the highest levels in powdered latex examination gloves, the lowest levels in surgical powder-free latex gloves. Low concentrations of antigenic proteins were also found in nitrile gloves. Job fitness evaluations were efficacious in 11 out of 20 workers, and inefficacious in 3 cases (6 workers had resigned). CONCLUSIONS: This study revealed a very low prevalence of latex allergy probably due to the fact that we examined an unselected population, and only symptomatic subjects were considered; moreover, in our hospital, vinyl examination gloves had been prevalently used during the last ten years. The criteria followed for job fitness assessment seem to be efficacious on the whole. In spite of a low prevalence of latex allergy, we found a high frequency of irritant contact dermatitis in the examined workers, mainly due to the lubricant powder in both synthetic and natural rubber gloves. Most workers made a complete recovery when they started using powder-free gloves. The high biocompatibility of powder-free gloves was confirmed by the measurement of total protein and latex antigenic protein content in the gloves used in the hospital. Moreover, it should be noted that latex antigenic proteins were also demonstrated in nitrile gloves, this is a relevant information since nitrile gloves are often used as an alternative in latex allergic workers.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15112749&dopt=Abstract allergy medicine



allergy
Prevalence of heat shock protein in patients with Meniere's disease and allergy.

Derebery MJ.

House Ear Clinic, House Ear Institute, Los Angeles, CA 90057, USA. jderebery hei.org

OBJECTIVE: The study purpose was to investigate the prevalence of elevated heat shock protein 70 (HSP-70) in patients with Meniere's disease who have milk allergy compared with those who are not allergic to milk. METHODS: Fifty-five patients with Meniere's disease and allergy in whom milk allergy had been confirmed by intradermal progressive dilutional food testing or skin testing to milk antigen were included. Blood serum was tested for HSP-70 elevation with a Western blot assay using bovine renal extract. The 29 women and 26 men ranged in age from 29 to 76 years (mean age 52.8 years). Forty percent of the patients had bilateral Meniere's disease. RESULTS: Overall prevalence of HSP-70 elevation was 29.1%. This was higher in bilateral patients (50%) than unilateral patients (15%) (P <or= 0.007). The effect was based primarily on elevated HSP-70 in bilateral (62.5%) and unilateral (7.7%) patients in those with no milk allergy (P <or= 0.006). The prevalence of HSP-70 elevation was actually lower in those with milk allergy (19.2%) than in those with no milk allergy (37.9%). This difference was statistically significant only in the subset of patients who were <50 years old (0% vs 33.3%, respectively; P <or= 0.04). CONCLUSIONS: We found no relationship between the presence of antibodies to HSP-70 and allergy to milk. The significance of elevated HSP-70 in patients with Meniere's disease has yet to be defined.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12087337&dopt=Abstract allergy medicine



allergy
[Prevalence of latex-fruit syndrome in health workers with latex allergy]

[Article in Spanish]

Ramirez Cruz NE, Castrejon Vazquez MI, Espinoza Goldman MB, Martinez-Cairo Cueto S.

Departamento de Alergia e Inmunologia Clinica, Hospital de Especialidades, CMN Siglo XXI, IMSS.

BACKGROUND: Prevalence of latex allergy in the general population is lesser than 1%. These patients have clinical and immunochemical cross-reactivity between latex and fruits; sometimes this has been referred to as the "latex-fruit-syndrome" (LFS); atopy was found to be a risk factor to sensitization to fruits. OBJECTIVE: To investigate the prevalence of LFS, in a group of health care workers with latex-allergy. METHODS: Hospital employees were initially screened for latex allergy with a questionnaire; these patients were divided into the following two groups: 1) health care workers with latex-allergy, classified into two subgroups: a) with a familial history of atopy; b) without a familial history of atopy, and 2) health care workers with familial history of atopy but without latex-allergy. Skin prick tests with latex and fruits extracts (kiwi, avocado, banana and chestnut) were done. RESULTS: Based in clinical history and with confirmation by skin testing, three patients of the health care workers' group with latex allergy have LFS (prevalence of 12.5%). Sensitivity and specificity for skin prick test in health care workers with latex-fruit syndrome were: latex, kiwi and chestnut sensitivity: 100%; latex and avocado specificity: 90%; chestnut and kiwi specificity: 100%. CONCLUSION: A low prevalence of latex-fruit syndrome was detected in our population. We found a higher prevalence in females with a history of atopy. Our findings were consistent with other literature reports.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12092525&dopt=Abstract allergy medicine



allergy
Incorrect allergy injections: allergists' experiences and recommendations for prevention.

Aaronson DW, Gandhi TK.

Finch University School of Health Sciences, The Chicago Medical School, 3500 N. Lake Shore Drive, #9C, Chicago, IL 60657, USA.

There are several reports of fatalities caused by allergen immunotherapy and skin testing. Patients have been reported who have received incorrect allergy injections. These could put them at risk for anaphylactic reaction and a possible fatality. We performed a survey to determine allergists' experiences with incorrect injections and to identify opportunities for prevention. This study was endorsed by the American Academy of Allergy, Asthma and Immunology and the Joint Council of Allergy, Asthma and Immunology. We conducted an e-mail survey of 1717 allergists, asking whether they knew of an incorrect injection administered within the last 5 years in their offices. An incorrect injection is an injection given to the wrong patient or a correct patient receiving an injection of an incorrect dose. Fifty-eight percent of responders reported an event in which a patient had received an injection meant for another patient. Seventy-four percent of responders reported that patients had received an incorrect amount of vaccine. The effect on patients ranged from local reactions to one fatality. Specific reasons given for the incorrect injections were patient name similar to that of another patient with incorrect name check and nurse error resulting in an incorrect dose. We conclude that allergy injections are a potential safety concern. There are a variety of prevention strategies that could be implemented to reduce or eliminate this risk, such as improved nurse training in the administration of allergy injections and compliance with the recommendations in the "Allergen Immunotherapy: A Practice Parameter" for use of patient-specific vials, standardized dosage sheets, and implementation of triple-checking of identity to make sure the correct patient is receiving the correct injection.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15208593&dopt=Abstract allergy medicine



allergy
Polymorphism in the STAT6 gene encodes risk for nut allergy.

Amoli MM, Hand S, Hajeer AH, Jones KP, Rolf S, Sting C, Davies BH, Ollier WE.

The Centre for Integrated Genomic Medical Research, Manchester University Medical School, Stopford Building, Oxford Road, Manchester M13 9PT, UK.

Nut allergy is an important and potentially life threatening food allergy with a prevalence of one in 150 children in the UK population. STAT6 (signal transducer and activator of transcription) is an important molecule in the induction and regulation of an allergic response, which maps to chromosome 12q in a region previously linked with total serum IgE concentration and atopy in different populations. We have examined the frequency of a single nucleotide polymorphism (SNP) in the 3'UTR region of STAT6 gene in 71 UK Caucasoid patients diagnosed with nut allergy and 45 atopic patients without nut allergy using PCR-RFLP and compared these with 184 UK healthy controls. The STAT6 G allele frequency was significantly increased in nut allergy patients compared with blood donor controls (P < 0.0001, OR = 2.9, 95% CI: 1.7-4.9), which was under a recessive model (GG vs GA+AA, P = 0.0001, OR = 3.2, 95% CI: 1.7-5.8) but not in atopic patients without nut allergy. The G allele was most frequent in the severe cases and GG homozygosity was associated with the increased risk of severe reaction (OR = 3.9, 95% CI: 1.9-8.3). We conclude that STAT6 3'UTR polymorphism is associated with susceptibility and severity in nut allergic patients in our population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12058257&dopt=Abstract allergy medicine



allergy
Patient's perspective and public policy regarding anaphylaxis.

Munoz-Furlong A.

The Food Allergy & Anaphylaxis Network, 11781 Lee Jackson Hgwy, Suite 160, Fairfax, VA 22033, USA.

It is estimated that dose to 7 million Americans have food allergy. The incidence of food allergy, particularly peanut allergy, is believed to be on the rise. Several studies have shown that in spite of a patient's best efforts to avoid ingesting the allergy-causing food, reactions will occur. These reactions occur from incorrect ingredient information in food service or restaurant settings, incorrect product labels, or mistakes in label reading. In the hospital setting, patients are sometimes treated for an anaphylactic reaction in the emergency room but are not given instructions to see a specialist to determine the cause of their reaction, nor are they given a prescription for epinephrine to arm them to treat future allergic emergencies. Two studies of fatal and near fatal allergic reactions concluded that a delay in administration of epinephrine could have been a factor in the fatal outcomes. However, schools often do not have written emergency action plans in place for children with documented food allergy, and patients and caregivers often report not knowing when to use the epinephrine kit or how to use it. Until there is a cure for food allergy and anaphylaxis, avoidance of the allergen is key. There is much work to be done in education and public policy regarding anaphylaxis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15025404&dopt=Abstract allergy medicine



allergy
Boletus edulis: a digestion-resistant allergen may be relevant for food allergy.

Helbling A, Bonadies N, Brander KA, Pichler WJ.

Division of Allergology, Department of Rheumathology and Clinical Immunology/Allergology, University Hospital, 3010 Bern, Switzerland. arthur.helbling insel.ch

BACKGROUND: Fungal components can cause allergic symptoms either through inhalation, ingestion or contact. Whereas respiratory allergy is thought to be induced by spores, allergic reactions following ingestion are attributed to other parts of the mushroom. Reports of food-related allergic reactions due to the edible mushroom Boletus edulis have occasionally been reported. OBJECTIVE: The aim of the study was to investigate whether separate allergens may be detected in alimentary allergy to Boletus edulis. METHODS: Sera of two subjects, one with recurrent anaphylaxis and the other with a predominantly oral allergy syndrome following ingestion of Boletus edulis, have been analysed by a time-course digestion assay using simulated gastric fluid and by SDS-PAGE immunoblotting. Sera of four Boletus edulis skin prick test-negative subjects and all without clinical symptoms to ingested Boletus edulis served as controls. RESULTS: In lyophilized Boletus edulis extract, at least four water-soluble proteins were detected, the most reactive at 55 kDa and at 80 kDa. Following the time-course digestion assay, IgE binding was found to a 75-kDa protein, but only if the sera of the subject with recurrent anaphylaxis was used. CONCLUSION: The data indicate that Boletus edulis can cause an IgE-mediated food allergy due to a digestion-stabile protein at 75 kDa. No IgE immune response to this protein was detected in the serum of a subject with respiratory allergy and oral allergy syndrome to Boletus edulis nor in control sera.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11994104&dopt=Abstract allergy medicine