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Doyen V, Gautrin D, Vandenplas O, Malo JL. Comparison of high- and low-molecular-weight sensitizing agents causing occupational asthma: an evidence-based insight. Expert Rev Clin Immunol 2024; 20:635-653. [PMID: 38235552 DOI: 10.1080/1744666x.2024.2306885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION The many substances used at the workplace that can cause sensitizer-induced occupational asthma are conventionally categorized into high-molecular-weight (HMW) agents and low-molecular-weight (LMW) agents, implying implicitly that these two categories of agents are associated with distinct phenotypic profiles and pathophysiological mechanisms. AREAS COVERED The authors conducted an evidence-based review of available data in order to identify the similarities and differences between HMW and LMW sensitizing agents. EXPERT OPINION Compared with LMW agents, HMW agents are associated with a few distinct clinical features (i.e. concomitant work-related rhinitis, incidence of immediate asthmatic reactions and increase in fractional exhaled nitric oxide upon exposure) and risk factors (i.e. atopy and smoking). However, some LMW agents may exhibit 'HMW-like' phenotypic characteristics, indicating that LMW agents are a heterogeneous group of agents and that pooling them into a single group may be misleading. Regardless of the presence of detectable specific IgE antibodies, both HMW and LMW agents are associated with a mixed Th1/Th2 immune response and a predominantly eosinophilic pattern of airway inflammation. Large-scale multicenter studies are needed that use objective diagnostic criteria and assessment of airway inflammatory biomarkers to identify the pathobiological pathways involved in OA caused by the various non-protein agents.
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Affiliation(s)
- Virginie Doyen
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Denyse Gautrin
- Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Jean-Luc Malo
- Université de Montréal and Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
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Rojruthai P, Sakdapipanich J, Wiriyanantawong J, Ho CC, Chaiear N. Effect of Latex Purification and Accelerator Types on Rubber Allergens Prevalent in Sulphur Prevulcanized Natural Rubber Latex: Potential Application for Allergy-Free Natural Rubber Gloves. Polymers (Basel) 2022; 14:4679. [PMID: 36365670 PMCID: PMC9654386 DOI: 10.3390/polym14214679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2024] Open
Abstract
Natural rubber (NR) gloves manufactured from NR latex are widely utilized in various applications as a personal protective device due to their exceptional barrier characteristics in infection control. However, the use of NR gloves was associated with concerns on NR protein allergy. With comprehensive leaching procedures now a common practice in NR latex glove factories to eliminate latent rubber proteins and chemical allergens, occurrences and complaints of protein allergy from medical glove users have decreased drastically over the past two decades. The present work aims to eliminate further the residual rubber allergens in NR latex through effective purification of the NR latex and compounding the thus purified latex with an established formulation for allergy-free NR for glove applications. NR latex was purified by deproteinization and saponification, respectively. Several analytical techniques were used to verify rubber allergens eliminated in the purified latexes. Saponified NR (SPNR) latex was the purified NR latex of choice since it is devoid of allergenic proteins and poses the lowest risk of Type I allergy. The purified NR latex was compounded with zinc diethyldithiocarbamate (ZDEC), zinc dibutyldithiocarbamate (ZDBC), and zinc 2-mercaptobenzothiazole (ZMBT), respectively, for glove dipping. Among the investigated accelerators, only ZDBC was not detected in the artificial sweat that came into contact with the dipped articles. Thus, it is deduced that ZDBC poses the lowest risk of Type IV allergy to consumers. Additionally, the morphological and physical properties of dipped articles were assessed. It was revealed that the dipped film from the SPNR latex compounded with ZDBC provided thinner and less yellow products with a more uniform internal structure and a tensile strength comparable to those of commercial NR gloves.
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Affiliation(s)
- Porntip Rojruthai
- Division of Chemical Industrial Process and Environment, Faculty of Science, Energy and Environment, King Mongkut’s University of Technology North Bangkok, Rayong 21120, Thailand
| | - Jitladda Sakdapipanich
- Department of Chemistry and Center of Excellence for Innovation in Chemistry (PERCH-CIC), Faculty of Science, Mahidol University, Salaya Campus, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Jinjutha Wiriyanantawong
- Department of Chemistry and Center of Excellence for Innovation in Chemistry (PERCH-CIC), Faculty of Science, Mahidol University, Salaya Campus, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Chee-Cheong Ho
- Sungai Long Campus, University Tunku Abdul Rahman, Cheras Kajang 43000, Malaysia
| | - Naesinee Chaiear
- Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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Caballero ML, Quirce S. Identification and practical management of latex allergy in occupational settings. Expert Rev Clin Immunol 2015; 11:977-92. [PMID: 26099284 DOI: 10.1586/1744666x.2015.1059754] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Allergy to natural rubber latex (NRL) from Hevea brasiliensis is a relevant occupational health hazard. The use of gloves and products manufactured with latex and environmental allergen exposure in the work environment are risks factors for the development of occupational allergy among different job categories. Healthcare workers have been the most commonly affected, but other professions with exposure to latex products such as hairdressers, cleaners, food handlers and those making natural rubber latex (NRL) products are also at risk of developing occupational allergy. Clinical manifestations of IgE-mediated latex allergy can range from troublesome skin disorders to life-threatening systemic reactions. It is very important to identify the occupational allergic diseases in their early stages in order to implement avoidance strategies. For this purpose, the interventions for prevention should emphasize the importance of latex allergy awareness and surveillance among exposed workforces.
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Affiliation(s)
- María Luisa Caballero
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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Sanguanchaiyakrit N, Povey AC, de Vocht F. Personal exposure to inhalable dust and the specific latex aero-allergen, Hev b6.02, in latex glove manufacturing in Thailand. ACTA ACUST UNITED AC 2014; 58:542-50. [PMID: 24569810 DOI: 10.1093/annhyg/meu013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Latex product manufacturing is an important industry in south-east Asia but has the potential for considerable occupational exposure of workers to latex allergens. Although exposure to latex allergens can result in adverse health reactions, few studies to characterize this exposure have been conducted to date. This study therefore aimed to characterize current airborne inhalable dust and the specific allergen, Hev b 6.02, exposures in this industry in Thailand. METHODS Workers were recruited from three factories in the southern part of Thailand. Full-shift inhalable dust personal air sampling was conducted using IOM sampling heads equipped with polytetrafluoroethylene filters at a 2.0 l min(-1) flowrate. After weighing to determine inhalable dust levels, filters were extracted and analysed for Hev b 6.02 using an enzyme immunometric assay. RESULTS Two hundred and seventy-five workers agreed to participate, resulting in a total of 292 measurements. Geometric mean (GM) personal exposure to inhalable dust was 0.88 mg m(-3), but individual exposures up to 12.34 mg m(-3) were measured. The pattern of exposure was similar across factories, with highest exposures in the stripping (GM 2.08-4.05 mg m(-3) for the 3 factories) and tumbling departments (1.11-2.17 mg m(-3)). Within-worker (day-to-day) variability contributed 92% to total variability. The Hev b 6.02 exposure pattern was similar with time-weighted average GM exposure levels in the oldest factory ranging from 8.7 mg m(-3) in the laboratory to 30.2mg m(-3) in the stripping department. In contrast to inhalable dust exposure, total exposure variability was primary driven by variability between workers (67%). CONCLUSIONS Workers in these latex product factories get routinely exposed to measurable Hev b 6.02 levels, which may give rise to increased incidence of allergic symptoms and occupational asthma. Also, in this measurement campaign a 10mg m(-3), but not 15 mg m(-3), occupational exposure limit for inhalable dust was occasionally exceeded. Highest Hev b 6.02 exposures were found in the stripping and tumbling departments, which would be natural targets for interventions aimed at reducing exposure.
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Affiliation(s)
- Nuthchyawach Sanguanchaiyakrit
- 1.Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester M13 9PL, UK 2.Occupational Safety and Health Standard Development Group, Occupational Safety and Health Bureau, Department of Labour protection and Welfare, Bangkok, Thailand
| | - Andrew C Povey
- 1.Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester M13 9PL, UK
| | - Frank de Vocht
- 1.Centre for Occupational and Environmental Health, Centre for Epidemiology, Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Oxford Road, Manchester M13 9PL, UK
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Moghtaderi M, Farjadian S, Momeni Z, Najib K. Natural latex sensitization and respiratory function among workers in latex glove factories: a pilot study. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2012; 9:D183-D185. [PMID: 22937976 DOI: 10.1080/15459624.2012.711608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Mozhgan Moghtaderi
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Palosuo T, Antoniadou I, Gottrup F, Phillips P. Latex medical gloves: time for a reappraisal. Int Arch Allergy Immunol 2011; 156:234-46. [PMID: 21720169 DOI: 10.1159/000323892] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Many hospitals have implemented policies to restrict or ban the use of devices made of natural rubber latex (NRL) in healthcare as precautionary measures against the perceived risk of NRL allergy. Changes in glove technology, progress in measuring the specific allergenic potential of gloves and a dramatic decrease in the prevalence of NRL allergies after interventions and education prompted us to revisit the basis for justifiable glove selection policies. The published Anglophone literature from 1990 to 2010 was reviewed for original articles and reviews dealing with the barrier and performance properties of NRL and synthetic gloves and the role of glove powder. The review shows that NRL medical gloves, when compared with synthetic gloves, tend to be stronger, more flexible and better accepted by clinicians. The introduction of powder-free gloves has been associated with reductions in protein content and associated allergies. Recently, new methods to quantify clinically relevant NRL allergens have enabled the identification of gloves with low allergenic potential. The use of low-protein, low-allergenic, powder-free gloves is associated with a significant decrease in the prevalence of type I allergic reactions to NRL among healthcare workers. Given the excellent barrier properties and operating characteristics, dramatically reduced incidences of allergic reactions, availability of specific tests for selection of low-allergen gloves, competitive costs and low environmental impact, the use of NRL gloves within the hospital environment warrants reappraisal.
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Affiliation(s)
- Timo Palosuo
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland.
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Prevalance of latex sensitization and associated risk factors in Turkish children with spina bifida. Pediatr Surg Int 2010; 26:535-8. [PMID: 20162419 DOI: 10.1007/s00383-010-2575-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Among children with spina bifida there is a high prevalence of latex allergy in reports from Europe and USA. The aim of this study was to investigate the incidence of latex sensitization and associated risk factors in children with spina bifida in Middle-Eastern region (Istanbul, Turkey). MATERIALS AND METHODS Eighty consecutive children affected with spina bifida were included in the study. Data were collected about age, sex, family and personal history of atopy, and the number and type of operations classified as neurosurgical, urological, and orthopedic. All patients underwent skin prick test using latex solutions and cross-reacting foods. Total and latex-specific IgE levels were also measured. RESULTS Latex sensitization was shown in 16% (13/80) of the patients with specific IgE > 0.7 kU/L. The number of operation, using intermittent bladder catheterization and ventricular-peritoneal shunt were significantly associated with latex sensitization. CONCLUSION The incidence of latex sensitization in this study was lower than reported in the literature. Environmental factors such as the type and number of operations and geographical location may play a role in the development of latex sensitization.
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Mérat F, Mérat S. Risques professionnels liés à la pratique de l’anesthésie. ACTA ACUST UNITED AC 2008; 27:63-73. [DOI: 10.1016/j.annfar.2007.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 10/31/2007] [Indexed: 10/22/2022]
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Johar A, Lim DL, Arif SAM, Hawarden D, Toit GD, Weinberg EG, Motala C, Fieggen G, Yeang HY, Potter PC. Low prevalence of latex sensitivity in South African spina bifida children in Cape Town. Pediatr Allergy Immunol 2005; 16:165-70. [PMID: 15787875 DOI: 10.1111/j.1399-3038.2005.00221.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Spina bifida children have a high prevalence of latex allergy in studies reported from Europe and the USA. This study investigated the prevalence of latex allergy in a cohort of 24 spina bifida children at the Red Cross Children's Hospital from Cape Town, South Africa. The children were investigated using a detailed questionnaire, skin prick tests (ALK-Abello), ImmunoCap RASTs, Western blotting and ELISA, using the purified latex proteins Hev b1 and Hev b3 and whole latex preparation. A low overall prevalence of latex sensitization of 16.7% was found in the children. Children who were sensitive reacted to water insoluble to Hev b1 and Hev b3 proteins. The low prevalence of latex sensitization in the South African children may not be entirely explained by stringent latex avoidance. The children were from a low socioeconomic social status and 'hygiene' and other factors should be considered.
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Affiliation(s)
- Asmah Johar
- Department of Dermatology, Hospital Kuala Lumpur, Malaysia
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Affiliation(s)
- B B Knudsen
- Department of Dermatology, Copenhagen University Hospital, Gentofte, DK-2900 Hellerup, Denmark.
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Piskin G, Akyol A, Uzar H, Tulek N, Boyvat A, Gurgey E. Comparative evaluation of Type 1 latex hypersensitivity in patients with chronic urticaria, rubber factory workers and healthy control subjects. Contact Dermatitis 2003; 48:266-71. [PMID: 12868968 DOI: 10.1034/j.1600-0536.2003.00112.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Latex hypersensitivity manifests itself most commonly with contact urticaria. In this study, we investigated the frequency of latex hypersensitivity as a possible aetiological factor in patients with chronic urticaria (CU) and compared latex hypersensitivity of CU patients (n = 50) with that of rubber factory workers (n = 50) and healthy controls (n = 50). Prick test with latex and fruit extracts and determination of latex-specific immunoglobulin E (IgE) were performed. As a risk factor, contact dermatitis due to rubber additives was tested by patch test. Latex hypersensitivity was detected in 14% of CU patients, 12% of rubber factory workers and 12% of healthy controls (P > 0.05). Positive patch test with rubber additives was detected in 6% of CU and 4% of rubber factory workers. 3 of 7 CU patients had sensitivity to fruits in addition to latex hypersensitivity. In 1 patient with CU, the clinical complaints were found to be related to latex hypersensitivity. These findings suggest that the frequency of latex hypersensitivity in CU patients is no higher than that in healthy individuals. However, CU patients should be carefully asked about latex allergy, as we demonstrated that 1 of the CU patients had undiagnosed symptomatic latex allergy.
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Affiliation(s)
- Gamze Piskin
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey.
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Abstract
Allergy to natural rubber latex is an important cause of occupational allergy in healthcare workers. Disposable medical gloves are the major reservoir of latex allergens, particularly powdered gloves, in healthcare delivery settings. Diagnosis of latex allergy requires a history of exacerbation of cutaneous, respiratory, ocular, or systemic signs and symptoms after exposure to natural rubber latex products; and evidence of sensitization by patch testing, skin testing, measurement of latex-specific IgE antibodies, or challenge testing. Optimal management of latex allergy involves education concerning cross-reacting allergens, reduction of cutaneous or mucosal contact with dipped rubber products, and minimization of exposure to latex aeroallergens in work environments.
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Affiliation(s)
- Debra D Fett Ahmed
- Indiana University Dermatology Clinic, 550 North University Boulevard, Suite 3240, Indianapolis, IN 46202, USA
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Abstract
BACKGROUND Latex allergens released from gloves and bound to airborne cornstarch powder have been shown to cause respiratory allergy in health care workers. OBJECTIVE Cornstarch from powdered latex gloves is a well-known carrier of airborne allergens. It should be investigated whether cotton fluffs used to lubricate household and industrial gloves also function as airborne carriers for latex allergens. METHODS Latex gloves, cotton fluffs with or without latex glove contact, dipping water from the glove cooling tank, a dust sample from the floor, and 10 samples from area dust samplers were analyzed for their allergen content by using a CAP inhibition method. Furthermore, 84% (119/142) of the working group participated in a cross-sectional study involving a questionnaire and measurement of latex-specific IgE by means of CAP inhibition. RESULTS Latex gloves, area dust samples from latex glove production sites, and the floor dust sample contained high concentrations of latex allergens. Cotton fluffs were free of allergens before being in contact with gloves but showed considerable allergen concentrations after their removal from gloves. The dipping water of the cooling tank also contained latex allergens. Of the examined employees, 12.6% had IgE-mediated sensitization, and a third of the sensitized subjects (ie, 4% of the total group) reported work-related hypersensitivity reactions. CONCLUSIONS Cotton fluffs bind latex allergens and behave like cornstarch as airborne allergen carriers causing conjunctivitis and allergic respiratory disorders.
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Affiliation(s)
- Xaver Baur
- Institute of Occupational Medicine, University of Hamburg, Hamburg, Germany
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