Prevalence of latex-specific IgE antibodies in hospital personnel

Hand hygiene practices among community Health Officers in Rivers State, Nigeria

BACKGROUND

Health care associated infections are most commonly transmitted by the hands of Health care workers and other hospital personnel.

OBJECTIVE

To investigate compliance with hand hygiene guidelines and methods of hand hygiene practice among community health officers in Rivers State Nigeria.

METHODS

Self administered questionnaires were distributed to 68 community health officers. The questionnaires consisted of 19 items which contained information on bio-demographic characteristics and hand hygiene practices. Data were analysed using SPSS-16 statistical software. Proportions were compared using Chi- square test and 'p' value less than 0.05 was considered statistically significant.

RESULTS

The response rate was 97.1%. There were 11 (16.7%) males and 55 (83.3%) females with a male to female ratio of 1: 5. The age of the participants ranged from 28-56 years with a mean age of 39.7±6.7. Washing of hands before and after contact with patient was 60.1% and 97% respectively. The difference was significant (p<0.01). Allergy to gloves was 15.2%. About three-quarter (77.3%) of the workers used soap and water to wash the hands when soiled or visibly contaminated. None of the workers used alcohol hand rub.

CONCLUSION

Though there was improved compliance to hand hygiene guidelines, this still fall short of acceptable standards. The provision and promotion of the proper use of alcohol-based hand rub may further improve compliance with hand hygiene by reducing the time required to perform it and the convenience of the method.

Latex allergy in clinical practice

A continuous exposure or contact to latex products may sensitize the human body by causing mild to fatal reactions. Despite the availability of the literature, medical personnel are still unaware of the implications of the use of latex materials. The increased awareness to prevent the transmission of infectious blood borne pathogens has lead to increased usage of medical gloves among health care workers. This increased usage of medical gloves, along with improved methods in diagnosing latex allergy, has been the reason for the rise in the number of reported cases. This has lead to recognition of latex allergy as a serious medical concern. Patients in high-risk groups must be assessed carefully, so that appropriate protocols can be used to protect them from contact with latex.

Occupational dermatoses in health care workers evaluated for suspected allergic contact dermatitis

BACKGROUND

Occupational skin diseases, including allergic contact dermatitis (ACD), irritant contact dermatitis, and allergic contact urticaria (ACU), occur commonly among health care workers (HCWs).

PURPOSE

To evaluate the aetiology of the various skin diseases afflicting HCWs evaluated for suspicion of ACD and/or ACU and to identify the most common allergens among HCWs found to have ACD and/or ACU.

METHODS

A total of 1434 patients underwent patch testing. The demographic data and most common allergens for HCWs (n = 100) and non-HCWS (n = 1334) were compared.

RESULTS

HCWs were statistically more likely than non-HCWS to be female, have hand dermatitis, and have a history of atopy. HCWs were also more likely to have work-related ACD especially to quaternium-15, thiuram, carba mix, glutaraldehyde and benzalkonium chloride, and to have ACU to latex.

LIMITATIONS

This study was retrospective and is subject to the resultant biases of all such investigations. Only patients suspected of having ACD and who underwent patch testing are included in our database. The prevalence of ACD and ACU is likely to be higher than that seen in the general HCW population.

CONCLUSIONS

Our results underscore the importance of thoroughly evaluating HCWs for ACD and ACU with the use of expanded standard allergen series and prick or radioallergosorbent testing to latex.

Self-reported allergy to latex gloves among health care workers in Jordan

The objective of this study is to determine the prevalence of natural rubber latex allergy and its associated factors among health care workers in Jordan based on a self-administered questionnaire. In this cross-sectional study, the data were obtained through a self-reported hand-delivered questionnaire that was distributed to 500 health care workers who use natural rubber latex gloves. A total of 420 (84%) health care workers responded by filling the questionnaire. Of the total number of 420 health care workers who filled the questionnaire, 57 (13.6%) reported allergy to latex gloves. The prevalence of allergy to latex gloves was significantly higher for those who had allergy to some foodstuffs (especially avocado, kiwifruits and chestnuts) or with history of eczema and hay fever. However, allergy to latex gloves was independent of gender, age, job, family history, type of gloves, hours of use/day and number of years of use. It is concluded that a high rate of allergy to latex gloves was reported among health care workers in Jordan.

Latex allergy

Allergy to natural rubber latex affects people routinely exposed to rubber products. Groups thought to be at highest risk include atopics, health care workers, rubber industry workers, and individuals who have undergone multiple surgical procedures, especially those with spina bifida. Allergy to latex is a type I, immediate, IgE-mediated reaction that can lead to anaphylaxis and death. The prevalence, risk factors, clinical manifestations, diagnosis, and management of latex allergy are summarized in this review.

Prevalence of skin test reactions to natural rubber latex in hospital personnel in Russia and eastern Europe

BACKGROUND

Allergic reactions to natural rubber latex have increased during the past 10 years, especially in many health care workers (HCWs) who have high exposure to latex allergens. The prevalence of skin test reactions to natural rubber latex in Russia, the Commonwealth of Independent States (CIS), and eastern Europe is unknown.

OBJECTIVE

The purpose of this study was to determine the prevalence of skin test reactivity to natural rubber latex in a population of HCWs exposed to latex.

METHODS

Nine hundred one HCWs regularly exposed to latex were evaluated using an allergy history questionnaire. Subjects were tested for latex allergy by titrated skin prick test with a biologically standardized latex extract. The diagnosis of latex allergy was defined by the presence of clinical symptoms when exposed to latex along with a positive skin prick test to latex.

RESULTS

Forty-nine (5.4%) HCWs were skin test-positive to latex. Seventeen (1.9%) HCWs were classified as latex-allergic based upon positive skin tests to latex associated with allergy symptoms with exposure. Seven of 901 HCWs had experienced anaphylactic reactions to latex. The most frequently reported symptom related to latex exposure was contact urticaria.

CONCLUSIONS

The prevalence of latex allergy among HCWs in Russia, the CIS, and adjacent eastern European countries is considerably less than reported in HCWs exposed to latex in western Europe and the United States. The low prevalence of latex allergy in Russia and the CIS suggests that lessened exposure to natural latex powdered gloves may diminish the prevalence of latex sensitization in HCWs in Russia and the CIS.

The prevalence of latex-specific IgE in patients presenting to an urban emergency department

STUDY OBJECTIVE

Since the first report of immediate hypersensitivity to latex was documented in 1979, latex allergy has been increasingly recognized as a medical problem in patient populations. However, there are no data available regarding the seroprevalence of latex sensitization in patients presenting to the emergency department. The overall aim of this study was to determine the prevalence of latex IgE seropositivity (L-IgE) in ED patients.

METHODS

We measured latex-specific IgE antibodies among a convenience sample of 1,027 patients using the AlaSTAT assay. We also measured serum IgE antibodies specific for 12 common inhalant allergens using the AlaTOP Microplate Allergy Screen assay. Demographic data were collected. Two questions related to latex allergy were queried. Descriptive statistics are presented. Point estimates and 95% confidence intervals (CIs) were calculated for each seroprevalence test. Odds ratios (ORs) and 95% CIs were used to assess the relationship between sex, race, and seropositivity to inhalant allergens and L-IgE.

RESULTS

The participation rate was 90% (1,027). The mean age of the patients was 46.9 years, 47.6% (489) were male, and 13.9% (143) were white. Eighty-four (8.2%; 95% CI 6.5% to 10.0%) had positive L-IgE results, and 23.8% (20) of patients with positive L-IgE results were classified as having strongly positive results. Bivariate analyses showed that being nonwhite (OR 4.7; 95% CI 1.5 to 15.1) and being seropositive for inhalant allergens (OR 7.4; 95% CI 4.2 to 13.1) were associated with L-IgE.

CONCLUSION

The prevalence of latex sensitization in our sampling is substantial and higher than previously estimated in the general adult population. The clinical significance of seropositivity requires further evaluation.

Epidemiology of latex sensitization and allergies in health care workers

Although it is often claimed that health care workers are at increased risk of latex sensitization and type I allergies, there has been no systematic analysis of the epidemiologic studies that are relevant to this conclusion. A systematic analysis of the epidemiologic literature found that, in the past 14 years, there have been 48 epidemiologic studies of type I latex allergy among health care workers. Of these, 2 cohort studies estimated the incidence of latex sensitization by skin prick testing at between 1% and 2.5% per year. Neither compared the risk to that in the general population. The prevalence of sensitization in health care workers varied between 0% and 30%, yet this large variation was unexplained. Increased risk of sensitization was not clearly associated with the duration of work in health care, the time spent wearing latex gloves, the frequency of exposure, the specific job categories, the use of powdered versus nonpowdered latex gloves, the use of latex versus nonlatex gloves, or any measurements of ambient exposure to latex proteins. The epidemiologic studies do not support a conclusion that health care workers are at clearly increased risk of latex sensitization or type I allergies compared to other occupations in the United States. The role of latex gloves in causing latex sensitization and type I allergic symptoms remains poorly defined because of the inconsistent results across studies. Future epidemiologic studies are needed that include measured exposures to latex antigens, that compare health care workers to appropriate referent groups, and that address confounding by atopy, age, sex, and race.

Allergic and latex-specific sensitization: route, frequency, and amount of exposure that are required to initiate IgE production

Quantitative data that documents human exposure-response relationships for IgE sensitization to allergens are limited. Although seemingly straightforward, documentation of exposure-response relationships can be difficult. Issues that are related to study design, allergen standardization, exposure assessment, and evaluation for sensitization can impact greatly on study results. Despite these issues, exposure-response relationships for sensitization to protein allergens have been documented in several occupational groups, which include enzyme-detergent workers, bakers, and laboratory animal workers. In general, atopy acts as an effect modifier in these settings, steepening the exposure-response relationship. Several studies suggest that the greatest risk for sensitization is within the first several years of exposure. For 1 allergen, the protease subtilisin, a short-term exposure limit of 60 ng/m(3) has been recommended by the American Council of Governmental Industrial Hygienists. With regard to natural rubber latex, exposure-related factors such as number of operations have been shown to be risk factors for sensitization of children with spina bifida. By contrast, fewer studies show exposure-response relationships for IgE sensitization of health care workers to natural rubber latex, and the area remains controversial. However, a recent cohort study that evaluated incident sensitization in dental hygiene students suggests strongly that, with sufficient exposure, employment in health care can lead to an increased risk of IgE sensitization to natural rubber latex.

Occupational asthma and rhinoconjunctivitis induced by natural rubber latex exposure

A number of reports indicate that occupational exposure to natural rubber latex (NRL) in health care workers can elicit symptoms of rhinoconjunctivitis with or without asthma in selected individuals who are sensitized. The prevalence or risk of NRL-induced asthma in relation to rhinoconjunctivitis is small in comparison with other forms of occupational allergic respiratory disease. The lower risk of NRL-induced asthma appears to be related to poor penetration of the allergen into the lower respiratory tract because of the relatively large particle size of allergen-bearing cornstarch particles. Because of a lack of large prospective studies, little is know about the incidence and natural history of latex-induced respiratory disease. Because of heightened awareness of NRL allergy and changing patterns in glove manufacturing and glove use, it is likely that the occurrence of NRL-induced occupational respiratory disease will decline and its natural history will change. Nevertheless, because large number of individuals are exposed to NRL in various occupations, the incidence, prevalence, and natural history of NRL allergy merit further monitoring.

Health effects associated with medical glove use

Adverse reactions to medical gloves represent an important public health issue. Accordingly, there is increasing interest in understanding the information reported to the US Food and Drug Administration (FDA) describing health effects associated with the use of medical gloves. This article provides a retrospective analysis and summary of health effects associated with medical glove use reported to the FDA. The FDA's medical device adverse event databases were searched via computer using keywords to identify reports of reactions associated with any type of medical glove. Demographic and clinical information abstracted from these reports was used to perform frequency and trend analyses. The reported medical glove-related events, including the noted trends in reporting, suggest the need for further study and continued monitoring of such reports.

A hospital-based screening program for natural rubber latex allergy

BACKGROUND

Natural rubber latex (NRL) allergy has become an important occupational health problem for health care workers, of whom approximately 10% are reportedly sensitized. Some medical facilities have chosen to convert entirely to NRL-free gloves, but others have found this to be financially or logistically unfeasible.

OBJECTIVES

The goals of this study were 1) to devise a NRL allergy screening program that could identify sensitized (at-risk) employees for the purpose of providing them with a safe working environment; and 2) to develop a glove conversion plan that would lead to the removal of all NRL gloves from the institution.

METHODS

A multidisciplinary University of Maryland Medical System NRL risk team developed a mandatory NRL screening program for all newly hired employees and any existing employees transferring into or within patient care positions. Employees were screened with a clinical questionnaire and a serology for immunoglobulin (Ig)E anti-NRL. Some employees voluntarily received an experimental NRL skin test to evaluate their skin reactivity to NRL. Each employee reporting respiratory or systemic symptoms associated with NRL exposure was evaluated by an allergist.

RESULTS

During the 15-month study period from April 1998 to July 1999, 1,795 employees were screened for NRL allergy. Of the whole group, 8% (144 of 1,795) were NRL-specific IgE antibody-positive by CAP radioallergosorbent test (Pharmacia-Upjohn Diagnostics, Kalamazoo, MI) and/or NRL skin test, 57.3% of whom reported symptoms with powdered NRL glove exposure. The NRL IgE-positive rates of nonpatient-care employees (who did not use NRL gloves on a regular basis) and direct patient-care employees was 5.9% and 8.6%, respectively. Most NRL-sensitized employees were successfully accommodated with the use of synthetic gloves and continued to work in the positions for which they were hired.

CONCLUSIONS

The University of Maryland Medical System NRL screening program has been successful in identifying at-risk employees and ensuring them a safe working environment during a progressive conversion of the hospital to a NRL-safe environment.

Natural rubber pharmaceutical vial closures release latex allergens that produce skin reactions

BACKGROUND

The release of allergenic proteins from natural rubber vial closures (stoppers) into aqueous pharmaceuticals may induce allergic reactions in individuals with latex allergy (LA) receiving medications from such vials.

OBJECTIVE

The goal of this study was to determine whether solutions stored in vials containing natural rubber closures release allergenic proteins detectable by skin testing of subjects with LA.

METHODS

Five pharmaceutical vial closures (2 natural rubber and 3 synthetic) were coded, inserted onto vials containing phenol-saline-human serum albumin, and stored in an inverted position before use. Twelve volunteers with and 11 volunteers without LA underwent skin testing with solutions from each of the 5 vials, either those not punctured (0P) or those punctured 40 times with a 21-gauge needle 12 to 24 hours before testing (40P).

RESULTS

All intradermal skin test responses in the group without LA were negative. Two and 5 of the 12 subjects with LA had positive intradermal skin reactions to 0P and 40P solutions, respectively, from vials containing rubber closures. Two subjects with LA had inexplicable, positive, nonreproducible intradermal skin test reactions to solutions from vials containing bromobutyl but not vials with isoprene synthetic closures. In vitro inhibition analysis detected 6 to 7 AU/g latex allergen in extracts of cut natural rubber containing closures but not in extracts of synthetic closures.

CONCLUSION

Natural rubber vial closures released allergenic latex proteins into the tested solutions in direct contact during storage in sufficient quantities to elicit positive intradermal skin reactions in some individuals with LA. These data support a recommendation to eliminate natural rubber from closures of pharmaceutical vials.

Health-care workers and latex allergy

Latex hypersensitivity can pose a threat to anyone, but health-care providers are among the high-risk groups for developing latex hypersensitivity. Latex hypersensitivity likely results from health-care workers' increased use of gloves following implementation of universal precautions. It is also believed that the antigenic load of latex gloves causes an increase in latex hypersensitivity resulting from massive production of gloves. Although there are many studies on the prevalence of latex hypersensitivity among health-care workers, there appear to be discrepancies, which may affect the different apparent prevalence. Testing for latex hypersensitivity raises another problem. Latex allergens cannot be identified specifically; therefore, there is no standard test or testing solution that can identify hypersensitive persons. Although latex glove hypersensitivity was first identified in the late 1970s, there remain many uncertainties associated with it; as a result, there is a growing concern among health-care providers. The authors offer several precautions to avoid the development of latex hypersensitivity.

Latex allergy

Latex allergy continues to be an important medical problem. In this review we re-examine the definition of latex allergy, the offending allergens, the factors that enhance sensitization, the threshold levels that sensitize and elicit reactions in sensitized individuals, current diagnostic techniques, avoidance measures, the barrier properties of nonlatex alternatives, and the roles of premedication and immunotherapy. Twenty years after its resurgence, latex allergy is a well-defined condition with established diagnostic criteria and rational treatment and prevention strategies. However, in spite of advances associated with molecular studies of latex allergens and improved understanding of immunotherapy, avoidance remains the only effective treatment.

Natural rubber latex: glove use, sensitization, and airborne and latent dust concentrations at a Denver hospital

Exposure to natural rubber latex may cause immediate hypersensitivity reactions. Published latex sensitization prevalence rates range from 2.9% to 22% among health care workers, and from 0.12% to about 20% of occupationally unexposed populations. In this study, self-administered questionnaires addressed job and personal characteristics, glove use, and symptoms in two groups of hospital workers: those who regularly used latex gloves and those who did not. Serum was tested for latex-specific immunoglobulin E. Air, surface, and air-filter dust samples for natural rubber latex were collected. The prevalence of latex sensitization was 6.3% in the non-users and 6.1% in the latex glove users (P = 0.9); 81.3% of sensitized workers were atopic compared with 59.5% of non-sensitized workers (P < 0.05). Reporting of work-related hand dermatitis was more common in the latex glove users (23.4%) than in the non-users (4.9%), as were rhino-conjunctivitis (16.3% and 7.9%, respectively, [P < 0.01]), and hand urticaria (9.9% and 2.1%, respectively, [P < 0.01]). There was no significant difference in work-related symptoms between the sensitized and non-sensitized workers. Environmental concentrations of latex were higher in the work areas of the non-sensitized workers, but higher in the clinical than in the non-clinical areas. Occupational latex glove use was not a risk factor for sensitization.

A global inventory of hospitals using powder-free gloves: a search for principled medical leadership

Scientific experimental and clinical studies have demonstrated that cornstarch on surgical and examination gloves promotes disease by acting as a reactive foreign body in tissue and serving as a vector for latex allergy. Consequently, hospitals have selected an innovative glove selection program utilizing only powder-free gloves. Healthcare workers in emergency medical systems are now wearing powder-free, latex-free gloves to care for the growing number of patients sensitized to latex. A global Internet search has now identified 70 hospitals in the United States and three hospitals in Europe that use only powder-free gloves.

Alison Bell Memorial Award. Latex sensitivity and allergy: fact and fiction

Health care workers (HCW) have a higher incidence of latex sensitivity than car maintenance workers! The wearing of latex gloves over several years increases the risk of developing latex allergy! All glove related skin reactions are due to latex! People with spina bifida have a high incidence of latex sensitivity! There is a relationship between allergies to natural latex rubber and avocados, chestnuts and bananas! We should all stop using latex products! Powdered gloves are as safe as unpowdered ones, as long as they are rinsed well!

The dental team and latex hypersensitivity. ADA Council on Scientific Affairs

BACKGROUND

In the late 1980s, there were notable increases in reports of allergic reactions to natural rubber latex, or NRL, particularly in association with barium enema procedures and medical procedures performed on children with spina bifida. These reports also raised awareness of the growing concern about NRL allergy in both patients and health care workers.

DESCRIPTION OF THE DISORDER

This report by the American Dental Association Council on Scientific Affairs summarizes the signs and symptoms of NRL protein allergy, allergic contact dermatitis and irritant dermatitis; offers information on means to diagnose these conditions definitively; and suggests means of reducing occupational exposure to the causative allergens and irritants in the dental office.

CLINICAL IMPLICATIONS

Reducing health care workers' occupational exposure may assist in minimizing adverse reactions associated with frequent wearing of gloves. The Council on Scientific Affairs will address issues relating to latex hypersensitivity among patients in a future report.

Anaphylaxis: diagnosis and treatment

Anaphylaxis is a clinical syndrome and is caused by many different agents. Acute therapy is epinephrine. Chronic therapy depends on the agent causing the anaphylaxis, but usually consists of avoidance of the agent only. Individuals who suffer from this problem should be issued epinephrine and wear or carry medical alert bracelets.

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.

Prevalence of IgE-mediated allergy to latex in hospital nursing staff

BACKGROUND

IgE-mediated hypersensitivity to latex proteins has become a significant clinical problem over the last decade. Nursing and medical staff are at risk because of their occupational exposure to latex.

AIMS

To determine the prevalence of type I hypersensitivity to latex allergens in the nursing staff of an Australian hospital.

METHODS

A questionnaire which asked about symptoms associated with the use of latex gloves was completed by 140 nurses working in the Alfred Hospital (72 in general medical wards, 68 in intensive care units). Skin prick tests with eluates of five different types of latex glove as well as common aeroallergens (rye pollen and house dust mite) and banana extract were performed.

RESULTS

Thirty-one nurses (22%) were skin prick test positive to at least one of the five latex glove eluates. All of these nurses were atopic, having positive skin prick tests to rye pollen or house dust mite. Symptoms of local dryness, itch and erythema associated with glove use were reported by more than half the study group, but not more frequently by those who were skin prick test positive to latex. Urticaria associated with glove use was reported more frequently by those with positive latex skin prick tests (13% vs 4%, p = 0.05). Eighty-seven per cent of the nurses who were latex skin test positive were also positive to banana extract.

CONCLUSIONS

IgE-mediated hypersensitivity to latex is common in nurses working in an Australian hospital. Glove associated symptoms were frequently reported, but in most cases the symptoms were more typical of irritant or contact dermatitis rather than type I hypersensitivity reactions. However, the extent of subclinical sensitisation to latex found in this study suggests that symptomatic latex allergy is likely to emerge as an increasing problem for nursing staff in this country.

Natural rubber latex skin testing reagents: safety and diagnostic accuracy of nonammoniated latex, ammoniated latex, and latex rubber glove extracts

BACKGROUND

Nonammoniated latex, ammoniated latex, and rubber glove extracts are the only sources of natural rubber (Hevea brasiliensis) latex that have potential for use as skin testing reagents in the diagnosis of latex allergy. Their diagnostic sensitivity and specificity as skin test reagents are unknown.

OBJECTIVE

We conducted a phase 1/2 clinical study to examine the safety and diagnostic accuracy (sensitivity and specificity) of nonammoniated latex, ammoniated latex, and rubber glove extracts as skin test extracts to identify the most efficacious source material for future skin test reagent development.

METHODS

Twenty-four adults not allergic to latex, 19 adults with hand dermatitis or pruritus, and 59 adults with a latex allergy were identified by clinical history. All provided blood and then received puncture skin tests and intradermal skin tests with nonammoniated latex, ammoniated latex, and rubber glove extracts from Malaysian H. brasiliensis latex by use of sequential titration. A glove provocation test and IgE anti-latex RAST were used to clarify positive history-negative skin test response and negative history-positive skin test response mismatches.

RESULTS

All three extracts were biologically safe and sterile. After normalization to 1 mg/ml of total protein, all three extracts produced equivalent diagnostic sensitivity and specificity in puncture skin tests and intradermal skin tests at various extract concentrations. Optimal diagnostic accuracy was safely achieved at 100 micrograms/ml for intradermal skin tests (e.g., nonammoniated latex: puncture skin test sensitivity 96%, specificity 100%; intradermal skin test sensitivity 93%, specificity 96%). The presence of IgE antibody in skin was highly correlated with IgE anti-latex in serum (nonammoniated latex: r = 0.98, p < 0.001; ammoniated latex: r = 0.94, p < 0.001; rubber glove extract: r = 0.96, p < 0.001). All five available subjects with a positive history, negative skin test response, and absence of IgE antibody in serum had a negative glove provocation test response, indicating no clinical evidence of latex allergy. No systemic or large local allergic reactions were observed with puncture skin tests or intradermal skin tests.

CONCLUSIONS

Equivalent diagnostic sensitivity and specificity were observed with the nonammoniated latex, ammoniated latex, and rubber glove extract skin test reagents after normalization for total protein; nonammoniated latex may be considered the reagent of choice on the basis of practical quality control and reproducibility considerations.