在避免接触天然橡胶乳胶后，医护人员对天然橡胶乳胶蛋白的经皮反应依然存在。

Percutaneous reactivity to natural rubber latex proteins persists in health-care workers following avoidance of natural rubber latex.

作者信息

Smith A M, Amin H S, Biagini R E, Hamilton R G, Arif S A M, Yeang H Y, Bernstein D I

机构信息

Department of Internal Medicine, Division of Allergy/Immunology, University of Cincinnati, Cincinnati, OH, USA.

出版信息

Clin Exp Allergy. 2007 Sep;37(9):1349-56. doi: 10.1111/j.1365-2222.2007.02787.x.

DOI:10.1111/j.1365-2222.2007.02787.x

PMID:17845416

Abstract

BACKGROUND

Long-term avoidance of natural rubber latex [Hevea brasiliensis (Hev b)] is currently recommended for health-care workers (HCWs) with established natural rubber latex (NRL) allergy. Percutaneous sensitivity to eight Hev b NRL allergens was evaluated in HCWs in 2000. To date, no studies have evaluated the longitudinal effects of NRL avoidance on percutaneous sensitivity to NRL allergens.

OBJECTIVE

The aims of this study were to evaluate changes in percutaneous reactivity to non-ammoniated latex (NAL) and NRL allergens in HCWs 5 years after a recommendation to avoid NRL and to evaluate factors that predict the persistence of in vivo sensitivity to NAL and NRL allergens.

METHODS

Skin prick testing was performed with NAL, seven NRL allergens (Hev b 1, 2, 3, 4, 6.01, 7.01, and 13), and recombinant Hev b 5 (rHev b 5) in 34 HCWs who were initially evaluated in 2000 for occupationally related NRL allergy. Serial 10-fold dilutions of NAL and NRL allergens were employed in skin testing. Sera from the HCWs were assayed for latex and enhanced latex (rHev b 5-enriched allergosorbent)-specific IgE antibodies using the ImmunoCAP assay.

RESULTS

The prevalence of work-related symptoms significantly decreased between 2000 and 2005 with avoidance of NRL (P<0.05). A >/=100-fold reduction in percutaneous sensitivity to Hev b 2 and Hev b 7 was less likely in those with prior history of systemic reactions to NRL (P=0.0053), reported history of reaction to cross-reactive foods (P=0.014), continued local reactions to NRL gloves (P<0.0001), or high NRL glove exposure since the initial study (P=0.0075). The diagnostic sensitivity and specificity of the latex-specific IgE serology was 54% and 87.5%, respectively, in comparison with NAL skin tests. The addition of rHev b 5 to the ImmunoCAP (enhanced latex) allergosorbent altered the diagnostic sensitivity and specificity of the ImmunoCAP to 77% and 75%, respectively.

CONCLUSION

While symptoms may resolve quickly with NRL avoidance therapy, detectable IgE indicating continued sensitization remains beyond 5 years, and thus continued avoidance of NRL should be recommended.

摘要

背景

目前建议对已确诊天然橡胶乳胶（NRL）过敏的医护人员（HCW）长期避免接触天然橡胶乳胶[巴西橡胶树（Hev b）]。2000年对医护人员的8种Hev b NRL过敏原的皮肤敏感性进行了评估。迄今为止，尚无研究评估避免接触NRL对NRL过敏原皮肤敏感性的长期影响。

目的

本研究的目的是评估在建议避免接触NRL 5年后，医护人员对非氨化乳胶（NAL）和NRL过敏原的皮肤反应性变化，并评估预测对NAL和NRL过敏原体内敏感性持续存在的因素。

方法

对34名医护人员进行皮肤点刺试验，使用的过敏原包括NAL、7种NRL过敏原（Hev b 1、2、3、4、6.01、7.01和13）以及重组Hev b 5（rHev b 5），这些医护人员最初于2000年因职业相关的NRL过敏接受评估。在皮肤试验中使用NAL和NRL过敏原的系列10倍稀释液。使用免疫捕获法检测医护人员血清中的乳胶和增强乳胶（富含rHev b 5的过敏原吸附剂）特异性IgE抗体。

结果

2000年至2005年期间，随着避免接触NRL，与工作相关症状的发生率显著降低（P<0.05）。既往有NRL全身反应史（P=0.0053）、报告有交叉反应性食物反应史（P=0.014）、持续对NRL手套有局部反应（P<0.0001）或自初始研究以来NRL手套接触量高（P=0.0075）的患者，对Hev b 2和Hev b 7的皮肤敏感性降低≥100倍的可能性较小。与NAL皮肤试验相比，乳胶特异性IgE血清学的诊断敏感性和特异性分别为54%和87.5%。在免疫捕获（增强乳胶）过敏原吸附剂中添加rHev b 5后，免疫捕获法的诊断敏感性和特异性分别改变为77%和75%。