Biomedical subjects
Publications and source records attributed to W O Wagner.
Angioedema can have a variety of causes, including drug reactions, food allergies, and C1 esterase inhibitor deficiency, but many cases are idiopathic. Swelling usually subsides in days if the offending agent can be removed. The throat is often involved, but few patients actually require intubation.
BACKGROUND: Emergency medical service providers have a high degree of exposure to latex products. Patients utilizing emergency medical services can be allergic to latex products used during rescue efforts. OBJECTIVE: To determine the prevalence of latex hypersensitivity among emergency medical service providers. METHODS: Study questionnaires were distributed to a group of emergency medical service providers. Skin prick testing was performed using latex, common aeroallergens, and food extracts. Patch testing was done using latex and individual rubber additives. Serum latex-specific IgE was also measured. RESULTS: A total of 93 completed surveys were collected. Average exposure to latex in the work environment was 8.2 years. Eighty-four (90%) used latex gloves routinely at work. Of those, thirteen (14%) gave history of reaction to latex gloves. Sixty-two percent were not aware of the possibility of latex allergy in themselves or their patients. Forty-one (44%) had skin testing. Of those, four (10%) had positive prick tests for at least one of the four latex preparations used. Five had positive skin tests to avocado extract without supporting clinical history. Two had positive skin tests to banana, one with supporting clinical history for banana allergy. No food cross-reactivity with latex was demonstrated. Latex-specific serum correlated with prick skin test results. No positive reactions were noted with patch testing. CONCLUSIONS: A significant percentage of emergency medical service providers were not aware of the occupational risk of latex allergy or the potential risk in their patients. A positive prick skin test for latex was present in 4 of 41 (10%), representing one-third of those who reported symptoms from latex exposure.
Allergy to natural rubber latex is a growing medical problem with life-threatening aspects. The aim of this study was to learn if guinea pigs could serve as a suitable model for immediate-type hypersensitivity to latex. Guinea pigs were immunized either with whole non-ammoniated latex extract, or with one of nine SDS-PAGE-separated components. Other animals were injected with electroeluted latex components localized on gel at 14, 24 and a cluster around 45 kD. Before and after immunization, sera from the animals were examined by ELISA, immunoblots, passive cutaneous anaphylaxis (PCA) and passive systemic anaphylaxis. Latex-specific antibodies were detected by ELISA and immunoblots in sera from all immunized animals. PCA assays showed that the guinea pigs had homocytotropic antibodies dilutable to 1:250. PCA was abolished when sera from animals immunized with allergens in alum were heated at 56 degrees C for 30 min indicating the antibodies were of the E isotype. Passive systemic anaphylaxis was induced in 4 of 10 guinea pigs. The results show that guinea pigs are capable of making antibodies to latex protein components that mediate dermal and systemic anaphylaxis, paralleling the spectrum of clinical and laboratory findings of humans with immediate-type clinical latex hypersensitivity.
BACKGROUND: IgE-mediated allergy to proteins present in natural rubber latex is a well-recognized problem. Latex contains a complex mixture of proteins ranging in molecular weight from 6 to > 200 kD. OBJECTIVE: The aim of this study was to determine whether shared allergenic sites exist on separate latex components. METHODS: Following electrophoresis, latex components at 14, 24, and 46 kD were electroeluted from SDS-polyacrylamide gels and used in ELISA inhibition and immunoblot inhibition studies of human latex-specific IgE antibodies. RESULTS: A minimum of 4 major allergenic sites (for convenience labeled A through D) were found to exist in 3 components of nonammoniated latex. Minimally, 2 are present in the 14-kD component (A, B) and 3 in the 24-kD component (A-C). The 46-kD fraction has 3 or more antigenic sites (A, C, D) but lacks one (B) that is present in both the 14- and 24-kD components. CONCLUSIONS: Four different IgE-binding moieties were detected among three latex protein components (14, 24 and 46 kD). Some of these allergenic sites were shared by two or more components. Recovery of these and others from fragmented latex components will allow identification of their amino acid composition and their availability will ultimately lead to better diagnostic and therapeutic options for patients with latex allergy.
STUDY OBJECTIVE: We set out to determine if there is a significant difference in the morbidity and mortality between the anergic and reactive groups. DESIGN: A retrospective study of the heart transplant population was performed. SETTING: We studied the results of delayed hypersensitivity skin tests (DHSTs) in all cardiac transplant recipients at the Cleveland Clinic between May 1985 and November 1991 to determine whether DHST results were of prognostic significance. RESULTS: Preoperative skin testing was reactive to two or more antigens in 90 of the 127 patients whose DHSTs were interpretable, and the remainder were anergic. Anergic response was associated with increased bilirubin and decreased albumin levels, but gender, race, primary underlying heart disease, age at transplantation, creatinine level, hematocrit, glucose level, and ejection fraction were not related to anergy. Anergic patients had significantly higher mortality at 30, 60, and 90 days after transplantation, but long-term mortality was not significantly different from patients reactive on DHSTs (p = 0.267). CONCLUSION: We conclude that the DHSTs provide useful information regarding risk of early mortality after heart transplantation.
We report 16 cases of latex allergy and the diagnostic methods used to determine sensitivity. By history, eight had usually experienced anaphylaxis during operative procedures, and eight experienced contact urticaria. Skin prick tests were positive in all subjects and negative in ten controls. In vitro analysis by ELISA for latex-specific IgE was positive in only three subjects. No adverse reactions occurred during testing. We conclude that prick skin testing is the preferred diagnostic method, and that the in vitro method used in this study has an unacceptable lack of sensitivity.
Astemizole is a new, long-acting H1 receptor antagonist that has proven effective in controlling the signs and symptoms of chronic idiopathic urticaria, without the sedative and anticholinergic side effects that typify use of many antihistamines. In an eight-week open study of 20 patients, astemizole significantly decreased the signs and symptoms of urticaria, as well as the severity of urticaria by anatomic location. Five patients reported complete clearing. Modest weight gain while on chronic therapy appears to be a significant side effect.
Urticaria can be caused by a multitude of factors, both internal (eg, ingested drugs or foods) and external (eg, skin contact, heat, cold). Skin testing, ice-cube testing, skin biopsy, and food-challenge testing are some of the methods that can help link cause and effect. Acute urticaria may require the administration of epinephrine and diphenhydramine or a lowering of the antigen dose in an allergy shot. Chronic urticaria is plainly visible in clinical presentation but is more elusive in diagnosis and treatment. It constantly challenges the physician's investigative acumen.