Latex allergen in respirable particulate air pollution

Antigen array for serological diagnosis and novel allergen identification in severe equine asthma

Severe equine asthma (sEA), which closely resembles human asthma, is a debilitating and performance-limiting allergic respiratory disorder which affects 14% of horses in the Northern Hemisphere and is associated with increased allergen-specific immunoglobulin E (IgE) against a range of environmental proteins. A comprehensive microarray platform was developed to enable the simultaneous detection of allergen-specific equine IgE in serum against a wide range of putative allergenic proteins. The microarray revealed a plethora of novel pollen, bacteria, mould and arthropod proteins significant in the aetiology of sEA. Moreover, the analyses revealed an association between sEA-affected horses and IgE antibodies specific for proteins derived from latex, which has traditionally been ubiquitous to the horse’s environment in the form of riding surfaces and race tracks. Further work is required to establish the involvement of latex proteins in sEA as a potential risk factor. This work demonstrates a novel and rapid approach to sEA diagnosis, providing a platform for tailored management and the development of allergen-specific immunotherapy.

Latex Allergy and Sensitization in Cities: A Survey in a Population at Risk

The constant increase in allergic diseases in western countries is correlated with changes in lifestyle and with the deterioration of the air inhaled by the inhabitants because of the growing concentrations of pollutant substances present. Within a population at risk, i.e., the inhabitants of cities, a group of subjects at even higher risk was selected, whose job exposes them to automobile exhaust fumes for many hours a day. All the study subjects underwent allergological screening and spirometry. The results obtained show an overall increase of respiratory allergic diseases but no increased sensitisation to latex. It therefore seems plausible that, besides social and lifestyle changes, the deterioration of the quality of the air could be considered responsible, at least in part, for the growing numbers of allergic subjects. This study offers an opportunity to reconsider the validity of the “hygiene hypothesis” as an explanation for the increase of allergic disease in western countries, although recent reports have indicated that a sedentary lifestyle may also contribute, together with environmental degradation, to the notably increased prevalence of allergic diseases in large cities in industrialized nations.

Inhaled environmental allergens and toxicants as determinants of the asthma phenotype

The driving environmental factors behind the development of the asthma phenotype remain incompletely studied and understood. Here, we present an overview of inhaled allergic/atopic and mainly nonallergic/nonatopic or toxicant shapers of the asthma phenotype, which are present in both the indoor and outdoor environment around us. The inhaled allergic/atopic factors include fungus, mold, animal dander, cockroach, dust mites, and pollen; these allergic triggers and shapers of the asthma phenotype are considered in the context of their ability to drive the immunologic IgE response and potentially induce interactions between the innate and adaptive immune responses, with special emphasis on the NADPH-dependent reactive oxygen-species-associated mechanism of pollen-associated allergy induction. The inhaled nonallergic/nonatopic, toxicant factors include gaseous and volatile agents, such as sulfur dioxide, ozone, acrolein, and butadiene, as well as particulate agents, such as rubber tire breakdown particles, and diesel exhaust particles. These toxicants are reviewed in terms of their relevant chemical characteristics and hazard potential, ability to induce airway dysfunction, and potential for driving the asthma phenotype. Special emphasis is placed on their interactive nature with other triggers and drivers, with regard to driving the asthma phenotype. Overall, both allergic and nonallergic environmental factors can interact to acutely exacerbate the asthma phenotype; some may also promote its development over prolonged periods of untreated exposure, or possibly indirectly through effects on the genome. Further therapeutic considerations should be given to these environmental factors when determining the best course of personalized medicine for individuals with asthma.

Metals contained and leached from rubber granulates used in synthetic turf areas

The aim of this study was to quantify metals contained in and leached from different types of rubber granulates used in synthetic turf areas. To investigate the total content of metals, ca 0.5 g of material was added with HNO(3), HF and HClO(4) and microwave digested with power increasing from 250 W to 600 W. Leachates were prepared by extraction of about 5.0 g of material at room temperature for 24 h in an acidic environment (pH 5). Leaching with deionized water was also performed for comparison. Aluminium, As, Ba, Be, Cd, Co, Cr, Cu, Hg, Fe, Li, Mg, Mn, Mo, Ni, Pb, Rb, Sb, Se, Sn, Sr, Tl, V, W and Zn were quantified by high-resolution inductively coupled plasma mass spectrometry (HR-ICP-MS) and ICP optical emission spectrometry (ICP-OES). Results indicated that the developed method was accurate and precise for the multi-element characterization of rubber granulates and leachates. The total amount and the amount leached during the acidic test varied from metal to metal and from granulate to granulate. The highest median values were found for Zn (10,229 mg/kg), Al (755 mg/kg), Mg (456 mg/kg), Fe (305 mg/kg), followed by Pb, Ba, Co, Cu and Sr. The other elements were present at few units of mg/kg. The highest leaching was observed for Zn (2300 microg/l) and Mg (2500 microg/l), followed by Fe, Sr, Al, Mn and Ba. Little As, Cd, Co, Cr, Cu, Li, Mo, Ni, Pb, Rb, Sb and V leached, and Be, Hg, Se, Sn, Tl and W were below quantification limits. Data obtained were compared with the maximum tolerable amounts reported for similar materials, and only the concentration of Zn (total and leached) exceeded the expected values.

Occurrence and effects of tire wear particles in the environment--a critical review and an initial risk assessment

This review summarizes the existing knowledge on the occurrence of tire wear particles in the environment, and their ecotoxicological effects. A meta-analysis on tire components in the environment revealed that tire wear particles are present in all environmental compartments, including air, water, soils/sediments, and biota. The maximum Predicted Environmental Concentrations (PECs) of tire wear particles in surface waters range from 0.03 to 56 mg l(-1) and the maximum PECs in sediments range from 0.3 to 155 g kg(-1) d.w. The results from our previous long-term studies with Ceriodaphnia dubia and Pseudokirchneriella subcapitata were used to derive Predicted No Effect Concentrations (PNECs). The upper ranges for PEC/PNEC ratios in water and sediment were >1, meaning that tire wear particles present potential risks for aquatic organisms. We suggest that management should be directed towards development and production of more environmentally friendly tires and improved road runoff treatment.

The effects of allergens in outdoor air on both atopic and nonatopic subjects with airway disease

BACKGROUND

Reports on air pollution and asthma exacerbations have been inconsistent, although effects of airborne allergen can be spectacular. With no generalized test for allergen in air, it is not known how far allergen is responsible for nonepidemic exacerbations of the disease.

METHODS

Two hundred and ninety-seven patients using bronchodilators aged 18-64 years attending a London practice provided serum samples and were asked to report any acute respiratory events over the coming months. Small particles with a mean aerodynamic diameter <10 microm (PM(10)) were collected using a high volume sampler on the roof of the practice. The ability of airborne particles to bind IgE from the patients was compared for particles sampled on the weekend before their reported exacerbation with particles sampled on the weekend 2 weeks before or after.

RESULTS

Exacerbations were associated with a 25% increase in IgE binding to particles collected on the previous weekend compared with the control weekends (95% confidence interval: 10-43%; P = 0.00089). This increase was not higher in patients with positive skin tests or in those sensitized to grass or tree pollens.

CONCLUSIONS

Airborne allergen is an important cause of exacerbations even in those with 'intrinsic' asthma. It is important to identify the allergens responsible, as some of these may be controllable. Interpretation of associations of asthma exacerbations with other air pollutants is difficult in the light of these findings.

Other Allergic Skin Disorders

In this chapter we discuss allergic skin disorders other than atopic dermatitis (AD): the urticaria-angioedema syndrome, allergic contact dermatitis (ACD), protein contact dermatitis (PCD), phytodermatitis, allergic photodermatitis and allergic vasculitis.

Correlations of asthma mortality with traffic-related factors: use of catalytic converters and radial tires

OBJECTIVE

: The objective of this study was to test the hypotheses that the post-1970 rise in asthma mortality in industrialized nations was related to introduction of catalytic converters and/or radial tires.

METHODS

: Annual asthma mortality data were plotted on linear coordinates for fraction of automobile fleet with converters or radial tires in Canada, Germany, Japan, and the United States.

RESULTS

: Catalytic converter association could not account for asthma mortality that rose in Germany before general adoption of the technology there. Radial tire use was, however, linearly correlated with asthma mortality in all four countries.

CONCLUSION

: Rising exposure to materials related to radial tire use may account for a substantial fraction of increased asthma mortality risk since approximately 1970.

A case study of tire crumb use on playgrounds: risk analysis and communication when major clinical knowledge gaps exist

Physicians and public health professionals working with the U.S. Environmental Protection Agency's Region 8 Pediatric Environmental Health Specialty Unit (PEHSU) received several telephone calls requesting information regarding the safety of recycled tire crumb as a playground surface constituent placed below children's play structures. There were no reported symptoms or adverse health effects in exposed children. The literature available on the safety and risk of exposure to crumb rubber constituents was limited and revealed no information quantifying exposures associated with product use. Callers were informed by the PEHSU that no evidence existed suggesting harm from intended use of the product, but gaps in knowledge about the product were identified and communicated. Here the case of crumb rubber on playgrounds is used as a model to present an approach to similar environmental medicine questions. From defining the question, to surveying traditional and nontraditional resources for information, synthesis of findings, and risk communication, the case provides a model to approach similar questions.

Impact of tire debris on in vitro and in vivo systems

BACKGROUND: It is estimated that over 80% of respirable particulate matter (PM10) in cities comes from road transport and that tire and brake wear are responsible for the 3-7% emission of it. Data on the indicators of environmental impact of tire debris (TD), originated from the tire abrasion on roads, are extremely scarce, even though TD contains chemicals (zinc and organic compounds) which can be released in the environment. METHODS: TD particle morphology was analysed with SEM, TEM and FIB instruments. TD eluates and TD organic extracts were tested at dilution series on human cell lines and Xenopus laevis embryos. 50 and 100 g/L TD were used for the eluates obtained after 24 h at pH 3 and the quantity of zinc present was measured with a ICP-AES. Eluates diluted to 1%, 10%, 50% in culture media and undiluted were used on X. laevis embryos in the FETAX test. HepG2 cells were exposed for 24 h to 0.05 - 50 mug/ml of zinc salt while A549 cells were exposed for 24, 48 and 72 h to 10, 50, 60, or 75 mug/ml of TD extract. X. laevis embryos were exposed to 50, 80, 100, or 120 mug/ml TD extract. RESULTS: The solution of undiluted 50 g/L TD produced 80.2% mortality (p < 0.01) in X. laevis embryos and this toxic effect was three times greater than that produced by 100 g/L TD. Zn accumulation in HepG2 cells was evident after 4 h exposure. A549 cells exposed to TD organic extract for 72 h presented a modified morphology, a decrease in cell proliferation and an increase in DNA damage as shown by comet assay. The dose 80 mug/ml of TD extract produced 14.6% mortality in X. laevis embryos and 15.9% mortality at 120 mug/ml. Treatment with 80, 100, or 120 mug/ml TD organic extract increased from 14.8% to 37.8% malformed larvae percentages compared to 5.6% in the control. CONCLUSION: Since the amount of Zn leached from TD is related to pH, aggregation of particles and elution process, the quantity of TD present in the environment has to be taken into account. Moreover the atmospheric conditions, which may deeply influence the particle properties, have to be considered. The TD organic fraction was toxic for cells and organisms. Thus, because of its chemical components, TD may have a potential environmental impact and has to be further investigated.

Socioeconomic status and prevalence of allergic rhinitis and atopic eczema symptoms in young adolescents

Environmental factors are known to influence the development of allergic rhinitis and atopic eczema in genetically susceptible individuals. Socioeconomic status (SES) may be an important indicator of risk for these conditions. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase 1 written questionnaire was used to determine the prevalence and severity of allergic rhinoconjunctivitis and atopic eczema symptoms in 4947 pupils aged 13-14 years attending 30 schools in socioeconomically diverse areas of Cape Town. Home addresses were used to stratify participants into five SES bands. Relationships between symptom prevalence and severity, and SES, recent urbanization and upward socioeconomic mobility were examined. Logistic regression was used to generate odds ratios (OR) and 95% confidence intervals (CI) in order to assess overall trends by SES. The prevalences of self-reported allergic rhinitis symptoms and recurrent itchy rash in the past year were 33.2% and 11.9% respectively. Girls had a significantly higher prevalence of all symptoms than boys. The prevalence of allergic rhinitis symptoms increased from lowest to highest SES (overall OR for rhinitis symptoms in past year = 1.16, 95% CI 1.11-1.21). There was no significant trend in reported eczema symptoms by SES other than for the question, 'Have you ever had eczema' (OR = 0.88, 95% CI 0.83-0.93). Longer period of urbanization was weakly associated only with recurrent itchy skin rash (OR = 1.05, 95% CI 1.01-1.09). 'Socially mobile' pupils, i.e. those resident in the lowest SES areas but attending highest SES schools showed significantly higher prevalences of eczema and some rhinitis symptoms than pupils attending lowest SES schools. These findings may reflect differences in reporting related to language, culture and access to medical care rather than real differences in prevalence.

Coarse(PM(2.5-10)), fine(PM(2.5)), and ultrafine air pollution particles induce/increase immune costimulatory receptors on human blood-derived monocytes but not on alveolar macrophages

Diesel particles have been shown to possess adjuvant activity and influence the development of allergic sensitization. Also, more heterogeneous mixtures of pollution particles have been shown to affect host defenses and development of immunity in animal models. In the present study it was determined whether freshly collected particulate matter (PM(10)) in the size ranges 2.5-10 micro m (PM(2.5-10), coarse), 0.1-2.5 micro m (PM(2.5), fine), and </=0.1 micro m (ultrafine) in diameter affected the development of antigen presenting cells by evaluating the expression of surface receptors involved in T-cell interaction on both human alveolar macrophages (AM) and blood-derived monocytes (Mo). A Mo-AM coculture was exposed to 50 micro g/ml of particles and expression of HLA-DR, CD40, CD80, and CD86 on each cell type was assessed by flow cytometry. Mo upregulated the expression of all four receptors in response to each of the particle fractions, while expression was unaffected in AM. The cells were also exposed to two model air pollution particles, diesel dust and volcanic ash, neither of which affected receptor expression. Furthermore, Mo and AM were separately exposed to the three PM size fractions and supernatants assessed for the T-helper (CD4(+)) lymphocyte chemoattractant interleukin-16 (IL-16). AM, but not Mo, produced IL-16, and this chemoattractant was released only in response to PM(2.5-10). These data suggest that a wide size range of pollution particles contain materials that may promote antigen presentation by Mo, while the capability to specifically recruit CD4(+) lymphocytes is contained in AM stimulated with the coarse PM fraction.

Latex allergies in the health care worker

A dramatic increase in the incidence of latex allergies in health care workers followed the surge in latex glove use accompanying the rise of human immunodeficiency virus (HIV) in the early 1980s. This increase in latex glove use was driven by the release of Universal Precautions issued by the Centers for Disease Control (CDC) in response to the rise of HIV and other blood-borne pathogens. Efforts to stem allergic responses in the workplace have relied on the substitution of other materials for latex. Unfortunately, there is so much latex in everyday life that avoiding this allergen is exceedingly difficult once one is sensitized. Additionally, there are numerous cross reactants that are present in the environment. The situation is further confounded by the introduction of genetically manipulated foods and agricultural products that contain defense proteins genetically inserted to protect plants from pests and pathogens. Many of these defense proteins are antigens that will cross react with latex. Sensitivity reactions, once developed, may progress to the point at which the health care worker is excluded from working. This report provides an overview of rubber products and cross reactants, allergic reactions, and latex sensitivity for the health care worker.

Management of occupational allergy to natural rubber latex in a medical center: the importance of quantitative latex allergen measurement and objective follow-up

When our employees began coming to the Occupational Health Service, Dermatology, and Allergy Clinics with symptoms of allergy to rubber gloves 12 years ago, the Mayo Clinic initiated 3 responses. (1) The Allergic Disease Research Laboratory adapted well-established technology to measure both the IgE antibody specific to natural rubber allergens, and by use of this IgE antibody, the allergens in rubber products and in the air of the workplace. (2) The Division of Allergic Diseases and Internal Medicine reviewed the prevalence and severity of the problem. (3) The Clinical Practice Committee appointed a multidisciplinary task force to implement measures to reduce exposure. The 3 sections of this article describe the Mayo Clinic's experience of successful control of this occupational health problem. Use of only gloves with low or undetectable allergen content greatly reduced the concentration of allergen in the work site, reduced the number of new cases of occupational allergy to rubber, and allowed individuals with latex allergy to work at their usual jobs.

Evaluation of the efficiency of extraction of ultraviolet-absorbing pollen allergens and organic pollutants from airborne dust samples by capillary electromigration methods

Capillary electromigration methods, zone electrophoresis (CZE) and micellar electrokinetic chromatography (MEKC), have been used for evaluation of the efficiency of different extraction agents applied to the extraction of pollen allergens and organic pollutants from dust samples collected during different periods (before, during and after pollen seasons) and in different locations in air-filtration devices (car-traffic tunnel in Prague and a metro station in Paris). Water and acetic acid extracts were analyzed by CZE using acetic acid as background electrolyte (BGE). Water and alkaline water-SDS-buffer extracts were analyzed by MEKC in Tris-phosphate BGE with anionic detergent sodium dodecylsulfate (SDS) micellar pseudophase. More material was extracted and more components were found in the water-buffer extracts than in the water extracts, and better resolution of the components was achieved by MEKC than by CZE. Significant differences have been found in the analyses of dust extracts of different origin. More material and more components have been found in the extracts of the dust collected in the pollen-rich period (March, April) than in the pollen-free period (December, January).

Latex allergy: past and present

Although latex products have been in use for over a century, allergic responses to latex proteins have only been recognized as a serious health problem for the past 15 years. Latex allergy particularly affects two groups, health care workers (HCW) and children with spina bifida (SB). This manuscript provides a brief history of latex allergy, and a review of the following: the manufacturing process for dipped latex products, the 11 latex allergens that have been characterized and received allergen designations by the International Union of Immunological Societies, the methods used in exposure assessment, the epidemiology and clinical management of latex allergy, and the use of animal models in investigating mechanisms underlying latex allergy.

Severe anaphylaxis induced by latex as a contaminant of plastic balls in play pits

BACKGROUND

Latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant.

OBJECTIVE

Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred.

METHODS

A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an American-style fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. Latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. Immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed.

RESULTS

In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific Hevea species allergen similar to that of the foam layer sample.

CONCLUSION

Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets.

Dermal exposure, handwashing, and hand dermatitis in the rubber manufacturing industry

Skin diseases, such as hand dermatitis, are thought to be a common problem in the rubber manufacturing industry, as workers are exposed to a wide range of chemicals with known irritant and sensitizing potential. We conducted a cross-sectional survey of a representative sample of rubber manufacturing workers (N = 202), selected from nine different rubber companies. Prevalence of hand dermatitis ("major" and "minor" dermatitis) and skin injuries was assessed on the basis of a diagnosis by a dermatologist. We investigated the possible relations between actual skin exposure, handwashing practices, and hand dermatitis. Prevalence of major hand dermatitis (7%) was comparable with that in the general population; however, minor signs of dermatitis were more common among the surveyed population (28%), as were traumata of the skin (17%). Dermal exposure to cyclohexane-soluble agents at work was related to the occurrence of major hand dermatitis, but not to the occurrence of minor hand dermatitis. Moderate and frequent handwashing especially with industrial surfactants containing scrubbing particles were found to be strongly associated with the occurrence of minor dermatitis [odds ratio = 4.27 (95% confidence interval = 0.90-20.27) and odds ratio = 6.38 (95% confidence interval = 1.33-30.17, respectively)].

Traffic exposure and allergic sensitization against latex in children

BACKGROUND

Latex antigens have been found in urban air samples and in debris deposited near freeways.

OBJECTIVE

We investigated whether exposure to road traffic in a large city is associated with allergic sensitization against latex in children.

METHODS

A population-based sample of 2505 children aged 5 to 11 years was examined in a cross-sectional study in the city of Dresden, Germany. Specific IgE levels against latex and a panel of common aeroallergens (timothy grass, rye, birch, mugwort, Cladosporium herbarum, Dermatophagoides pteronyssinus, cat dander, and dog dander) was determined by using a fluorescence immunoassay (CAP Pharmacia). Traffic exposure was assessed by (1) parental self-report on traffic frequency and truck traffic in the street of residence, (2) traffic counts, and (3) measurements of benzene at 182 points on a 1-km(2) grid for 1 year, which were used to estimate the children's individual exposure at the home address.

RESULTS

Eight hundred fifty-four (34.1%) of the children were sensitized against any of the allergens, and 150 (6.0%) had specific IgE (>0.35 kU/L) against latex. The prevalence of latex sensitization was not positively associated with self-reported traffic exposure, traffic counts in the street of residence (adjusted prevalence odds ratio for >5000 vs < or =5000 cars/d, 0.7; 95% confidence interval, 0.4-1.3), or benzene exposure (adjusted prevalence odds ratio for an increase of 1 microg/m(3) air, 0.8; 95% confidence interval, 0.7-1.05).

CONCLUSION

The data suggest that exposure to road traffic is not associated with allergic sensitization to latex in children.

Prevalence of IgE to natural rubber latex in unselected blood donors and performance characteristics of AlaSTAT testing

BACKGROUND

The prevalence of IgE to natural rubber latex (NRL) proteins in the general population remains unsettled, both because of the difficulty of obtaining an unbiased population representative of the general population of the United States and because of concerns about the reproducibility of tests for anti-latex IgE antibodies. Establishing the prevalence in the population is important toward defining the potential risks of persons entering areas where latex exposure may occur.

OBJECTIVE

The purposes of this study were to determine the prevalence of IgE to latex in a general population and to assess the performance characteristics of the AlaSTAT microtiter plate test for anti-latex IgE when performed independently by different laboratories.

METHODS

One thousand nine hundred and ninety-seven consecutive blood samples obtained from the Oklahoma Blood Institute were assayed independently in three laboratories for IgE to NRL using the FDA-approved AlaSTAT ELISA for IgE to NRL. The group consisted of 56% men and 44% women. Ninety percent were Caucasian, 4% African American, and 6% were "other."

RESULTS

The prevalence IgE to NRL between the 3 laboratories varied from 5.4% to 7.6% at the designated cut off of 0.35 kU/L. Examination of results for specific individuals demonstrated >90% agreement between the three sites with the most reproducible results at the Class II cutoff of > or =0.7 kU/L. There was no difference in the percent of positive values at the three laboratories.

CONCLUSIONS

There is good agreement between laboratories as to NRL IgE reactive and non-reactive sera using the AlaSTAT test. This report of the largest sample of blood donors confirms earlier reports as to the prevalence of IgE NRL in blood donors.

Epidemiological analyses of the relationship between environmental pollution and asthma

Epidemiological studies performed on children and young adults indicate that the prevalence of asthma has increased over the past decades in a number of countries. Since genetic determinants alone are unlikely to explain these findings, environmental factors are expected to have an important impact on the prevalence of this disease. Environmental pollution, among many other factors, may play a role in the initiation and manifestation of asthma. However, there is little epidemiological evidence for a causal association between the classical major outdoor air pollutants, such as SO2 or particulate matter, and asthma. Evidence for an association between air pollution from motor vehicles and asthma is still controversial. Thus the indoor environment and other environmental determinants--including lifestyle factors--are likely to be more important as causes of asthma. Epidemiological studies are able to evaluate the effects of environmental factors on the health of human populations in their usual environments. In addition, they can measure associations between long-term environmental exposures and health outcomes. By using refined techniques for exposure and disease assessment, as well as time and cost-effective study designs, environmental epidemiology will increase the knowledge about the role of pollution as a possible cause of asthma.

Latex sensitivity: a public health care challenge

Latex sensitivity is becoming epidemic in the health care arena. Providers of health care need to be aware of the signs and symptoms, the treatments, and the consequences of latex sensitive reactions. In this article, I will provide information about latex sensitivities that will enable health care workers and their patients to have a better understanding of the phenomena. Resource information is provided for the latest information pertaining to latex sensitivities to aid in the education of health care providers and their patients.

The R.U.B.B.E.R. tool: screening children for latex allergy

The pediatric nurse practitioner may encounter IgE-mediated allergic reactions to natural latex rubber not only in patients with spina bifida but also in the general pediatric population. The R.U.B.B.E.R. screening tool is a short research-based questionnaire that elicits unrecognized past allergic reactions to latex and identifies children at risk for this condition. Management strategies include patient identification, referral for allergy evaluation, patient and family education about avoiding latex, and design of a latex-safe practice environment.

Latex allergy

Coined the next major health concern of the decade, allergy to natural rubber latex affects people routinely exposed to rubber products. Groups at highest risk include health care workers, rubber industry workers, and persons who have undergone multiple surgical procedures, especially those with spina bifida. Allergy to latex is a type I, immediate, IgE-mediated reaction, which can lead to anaphylaxis and death. Much of latex research is published in allergy journals. Dermatologists may not be aware of the prevalence, symptoms, risks, diagnosis, and treatment of latex allergy. These topics are the subject of this review. Research concerning antigenic proteins, as well as sources of latex alternatives, is also summarized. (J Am Acad Dermatol 1998;39:1-24.)

LEARNING OBJECTIVE

At the completion of this learning activity, participants should have a clear understanding of the history, biology, epidemiology, mechanism, clinical characteristics, diagnostic work-up, and treatment of latex allergy. Readers should also have a greater understanding of multiple potential allergenic latex proteins and their importance in preventing future latex-sensitization.

Rubber tire leachates in the aquatic environment

Tires have a deleterious effect on the environment. This review discusses the background of scrap tires discarded in the environment, including tire composition, adverse environmental effects, threats to public health and safety, and solid waste management. Despite the widespread use of scrap tires in environmental applications, both land-based and aquatic, data on the indicators of environmental degradation are extremely scarce. Indicators of environmental degradation include analysis of chemicals within the water and sediment, analysis of contaminants within organisms, and analysis of the biological effects of these compounds on plants, animals, microbes, and organelles. Although these indicators are most useful when used in parallel, a review of the available information on chemical characterization of tire leachate from tire storage facilities, manufacturing, usage in recycling applications, and toxicity exposure studies, of vegetation surveys from waste tire areas and reviews of mammalian tire product toxicity, and of toxicity, mutagenicity, and carcinogenicity of tire exposure in experimental aquatic animals, microbes, and organelles is presented. The major characteristics of these studies are discussed in specific sections. The "Discussion and Conclusions" section discusses and summarizes the biological effects and chemical characterization of tire leachates. A global environmental perspective is included to improve our understanding of the deficiency of the current knowledge of tire leachate toxicity from various sources and to encourage interdisciplinary studies to establish the pattern of pollution associated with waste tire management.

Measurement of natural rubber proteins in latex glove extracts: comparison of the methods

BACKGROUND

Health care workers and individuals with frequent contact with latex are at risk for latex protein allergy.

OBJECTIVE

The purpose of this study was to compare several established methods for measuring protein in extracts from latex-containing medical devices.

METHODS

Extracts from latex gloves were analyzed for natural rubber proteins using a modified Lowry assay and two different immunochemical assays. The immunochemical methods were competitive inhibition assays that employed either immune rabbit serum or human serum with antibodies directed against natural rubber proteins.

RESULTS

Seventy extracts representing five different brands of gloves from four manufacturers were analyzed. A good linear correlation (R = 0.88) was found between the immunoassay methods. Correlation to the modified Lowry method was not possible because many of the samples were below the limit of detection for the Lowry assay. Reference extracts and antisera were further characterized by Western blot analysis. The data demonstrate that the proteins recognized by rabbit antisera and the proteins recognized by human IgE are similar. The greatest difference in the immunochemical assays appears to be the relative binding of the antibody sources to high and low molecular weight natural rubber proteins in the reference extracts.

CONCLUSIONS

The immunochemical assays are specific for latex proteins and provide a more sensitive and biologically relevant method for determining protein levels in latex medical products.