Contact urticaria to rubber.
A case of contact wealing to rubber gloves attributed to natural latex from Hevea braziliensis is described.
Adult↗
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The allergen of Ficus benjamina in house dust.
Ficus benjamina, a member of the Moraceae family, is a tropical, non-flowering green plant which is widely used for ornamental purposes. It is an occupational allergen in plant keepers but sensitization is also increasingly found in non-occupationally exposed atopic and non-atopic patients. The allergen of Ficus benjamina is located in the plant sap, a so-called latex. By radioallergosorbent test-(RAST)-inhibition studies allergen could also be demonstrated in the dust collected from the leaf surface and in dust samples from the floor of rooms where the plant was placed. These findings could result in more extensive preventive measures in patients sensitized to Ficus benjamina. In addition there is some evidence that possibly a crossreactivity between latex of Ficus benjamina and latex from the rubber tree Hevea brasiliensis, a member of the Euphorbiaceae family, may exist.
Adolescent↗
Characterization of cross-reactive bell pepper allergens involved in the latex-fruit syndrome.
BACKGROUND: Between 30% and 50% of individuals who are allergic to latex products are also allergic to specific plant foods, a fact that is well documented as the latex-fruit syndrome. Simultaneous sensitization to latex and bell pepper has been previously reported. Although bell pepper fruits are frequently consumed raw, cooked or as a spice, little is known about the cross-reactive allergens. OBJECTIVE: In this study we wished to identify bell pepper allergens involved in the latex-fruit syndrome. METHODS: Sera of four patients who displayed clinical symptoms to latex and bell pepper were used in immunoblot studies on protein extracts of three different cultivars of fresh bell pepper and fresh Hevea latex. Cross-reactive allergens were identified by inhibition experiments using recombinant Hev b 8 (latex profilin), and natural Hev b 2 (latex beta-1,3-glucanase) in addition to the protein extracts. A novel cross-reactive IgE-reactive 30 kDa protein was subjected to sequence analysis. RESULTS: Three patients displayed IgE to profilins from bell pepper fruits and latex. Two patients possessed IgE to Hev b 2, a latex beta-1,3-glucanase, and a homologous protein in bell pepper. One patient possessed IgE reactive with a protein of 30 kDa identified by N-terminal sequencing as an l-ascorbate peroxidase and another patient to a protein of 38 kDa. Additionally, IgE binding proteins in two higher molecular weight ranges showed cross-reactive capacities. CONCLUSION: Our findings show on the molecular level that bell pepper is part of the latex-fruit syndrome. For the first time we have identified the major latex allergen Hev b 2, a beta-1,3-glucanase, and the bell pepper l-ascorbate peroxidase as cross-reactive allergens. We were also able to show that profilins are responsible for some of the IgE cross-reactivity.
Adult↗
The hevein domain of the major latex-glove allergen Hev b 6.01 contains dominant T cell reactive sites.
BACKGROUND: Sensitization to natural rubber latex (Hevea brasiliensis) is a major cause of occupational asthma and rhinitis affecting frequent latex-glove users. Hev b 6.01, a known major latex allergen, is cleaved naturally into hevein (4.7 kDa) and a C-terminal fragment (14 kDa). Hevein is an abundant protein in latex-glove extracts. As the immune response to allergens is initiated by activation of allergen-specific CD4(+) T cells, identification of dominant T cell epitopes is crucial for the development of specific immunotherapy. OBJECTIVE: To identify dominant T cell epitopes of Hev b 6.01 in latex-allergic glove users. METHODS: Ten latex-allergic frequent glove users and six non-latex-allergic atopic control subjects were selected, based on clinical symptoms and positive latex-specific serum IgE. Serum IgE reactivity to glove extract and recombinant Hev b 6.01 (rHev b 6.01) were analysed by ELISA. Latex-specific short-term oligoclonal T cell lines were generated from peripheral blood of latex-allergic subjects. These lines were tested for proliferative responses to overlapping 20-mer peptides of the Hev b 6.01 molecule. CD4(+) T cell intracellular cytokines, IL-4 and IFN-gamma were assessed following stimulation with immobilized anti-CD3 in the presence of IL-2. RESULTS: All ten of the latex-allergic patients showed serum IgE binding to glove extract while eight of these also showed IgE binding to rHev b 6.01 by ELISA. Western blotting confirmed reactivity with rHev b 6.01 at around 20 kDa. T cell proliferation assays showed that latex-specific T cell lines from all subjects responded to one or more peptides, with greatest frequency of reactivity to peptides Hev b 6.01 p(10-29) and Hev b 6.01 p(19-38) in the hevein domain. An allergic-type cytokine profile with considerable IL-4 in addition to IFN-gamma was evident from intracellular cytokine staining. CONCLUSION: Hevein is an important T cell as well as B cell immunogen and contains dominant T cell reactive sites.
Adult↗
IgE-mediated anaphylactoid reactions to rubber.
Delayed hypersensitivity to rubber chemicals is well known, but there are only a limited number of case reports on an immediate type of hypersensitivity inducing contact urticaria. We have recently seen several patients with rubber glove-induced contact urticaria who have had both positive skin prick tests and positive RAST tests to natural latex from the rubber tree (Hevea brasiliensis). We now report on five patients who also developed systemic reactions. It is clear that sensitized subjects are at risk of developing anaphylaxis during medical examination or surgery when rubber gloves are used. The occurrence of IgE-mediated allergy to rubber is probably underestimated.
Adult↗
Study of the allergenic fractions of latex.
Two latex (Hevea brasiliensis) raw materials, one from the cytosolic fraction, the other from the total natural latex have been characterised by immunoblotting techniques. The two latex fractions A and B were studied by immunoprints using eight sera from patients who were allergic to latex. They gave different profiles though there were also allergens of common molecular weights (60, 35, 30, 25, 20, 18, 15, and 10 kD). This study confirms the importance of allergic reactions to latex, that may in some patients cause anaphylactic shock.
Adolescent↗
Latex allergy from glove powder--an unintended risk with the switch from talc to cornstarch?
The present study aimed to investigate to what extent glove powders of different origins and brands bind and release latex allergens. One mineral talc and five cornstarch powders were used. The allergenic material was sap of Hevea brasiliensis. The powders were incubated together with the natural rubber latex sap, and four series of experiments were performed. The talc showed the highest tendency to bind isotope-labeled proteins. When incubated with a latex allergen solution, it reduced free allergen from 100 to 2 units/ml compared to a reduction to 70-98 units/ml for the cornstarch powders. In contrast to the nonstable binding of allergen to cornstarch, the binding to talc was irreversible. The allergen bound to talc was allergenically intact and, when incubated with serum, reduced the concentration of free IgE antibody to latex to 10% of the initial level. Mineral talc had a high capacity to bind latex allergens firmly. In contrast, cornstarch captured the latex allergen, but the binding seemed less pronounced and was unstable. The replacement of talc by cornstarch as glove-donning powder has coincided with the rapid increase in latex allergy. Mineral talc is heavy and only transiently airborne. Could this difference between talc and cornstarch in latex-allergen-binding pattern and the tendency of the latter to be airborne play an important role in the bioavailability of latex allergen and thus in the epidemic of latex sensitization.
Allergens↗
Latex allergy diagnosis: in vivo and in vitro standardization of a natural rubber latex extract.
For the diagnosis of IgE-mediated (immediate) hypersensitivity to natural rubber latex (NRL), skin prick testing with extracts of latex gloves has been widely used, but such extracts are difficult to standardize. The present study aimed to produce on an industrial scale an NRL extract from freshly collected NRL and to evaluate, calibrate, and standardize the extract by both in vivo and in vitro testing. The source material, latex of the rubber tree, Hevea brasiliensis (clone RRIM 600), was frozen immediately after collection in Malaysia and shipped in dry ice to Stallergènes SA, France. Protein and allergen profiles were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting, isoelectric focusing (IEF), crossed immunoelectrophoresis (CIE), and crossed radioimmunoelectrophoresis (CRIE). Allergen quantification was effected by RAST inhibition. The capacity of the preparation to elicit immediate hypersensitivity reactions in vivo was measured by skin prick testing in 46 latex-allergic patients and 76 nonallergic control subjects. SDS-PAGE and immunoblot profiles of the extract and an NRL standard (E8) provided by the US Food and Drug Administration were almost identical, disclosing several distinct IgE-binding proteins with apparent molecular weights of 14, 20, 27, 30, and 45 kDa, conforming to reported molecular weights of several significant NRL allergens. An arbitrary index of reactivity (IR) of 100 was assigned to the extract at 1:200 dilution (w/v), having a protein content of 22 micrograms/ml. Skin prick testing of latex-allergic patients and controls using the extract at 100 IR revealed 93% sensitivity, 100% specificity, 100% negative predictive value, and 96% positive predictive value. In conclusion, a skin prick test reagent for diagnosis of type I NRL allergy was successfully standardized. The reagent was demonstrated to contain most, if not all, of the currently known clinically significant NRL allergens, and it showed high sensitivity and specificity.
Adolescent↗
Flow-assisted allergy diagnosis: current applications and future perspectives.
Physicians predominantly rely upon quantification of serum-specific immunoglobulin E (IgE) and/or skin test to confirm clinically suspected IgE-mediated allergy. However, for various reasons, identification of the offending allergen(s) and potentially cross-reactive structures is not always straightforward. Flow-assisted allergy diagnosis relies upon quantification of alterations in the expression of particular basophilic activation markers. Actually, upon challenge with a specific allergen, basophils not only secrete quantifiable bioactive mediators but also upregulate the expression of different markers which can be detected efficiently by flow cytometry using specific monoclonal antibodies. Currently, the technique has been applied in the investigation of IgE-mediated allergy caused by classical inhalant allergens, food, Hevea latex, hymenoptera venoms and drugs. It is also appreciated; the technique proves valuable in the diagnosis of non-IgE-mediated (anaphylactoid) reactions such drug hypersensitivity and the detection of autoantibodies in certain forms of chronic urticaria. This review will not address immunologic features, characteristics and general pitfalls of flow-assisted analysis of in vitro-activated basophils as summarized elsewhere. After a recapitulation of the principles and some specific technical issues of flow-assisted analysis of in vitro-activated basophils, we principally focus on the current clinical and research applications of the basophil activation tests. Personal experience of both research groups is provided, where appropriate. Finally, a viewpoint on how the field might evolve in the following years is provided.
Cell Separation↗
The separate roles of plant cis and trans prenyl transferases in cis-1,4-polyisoprene biosynthesis.
In plants, the elongation of cis-1,4-polyisoprene (natural rubber, M(r) > 10(6) requires a small transallylic diphosphate (< or = C20) initiator. The trans-allylic diphosphates are hydrophilic cytosolic compounds, whereas cis-1,4-polyisoprene is hydrophobic and compartmentalised in subcellular rubber particles. In this paper, it is demonstrated that soluble trans-prenyl transferase from latex of Hevea brasiliensis functions solely as farnesyl diphosphate synthase, and plays no direct role in cis-1,4-polyisoprene elongation. The cis-1,4-prenyl transferase is firmly associated with the H. brasiliensis rubber particle, as is also the case in other rubber-producing species [Archer, B. L., Audley, B. G., Cockbain, E. G. & McSweeney, G. P. (1963) Biochem. J. 89, 565-574; Madhavan, S., Greenblatt, G. A., Foster, M. A. & Benedict, C. R. (1989) Plant Physiol. 89, 506-511; Siler, D. J. & Cornish, K. (1993) Phytochemistry 32, 1097-1102]. The experimental data explain and refute previous reports in which soluble trans-prenyl transferase isolated from H. brasilensis latex was attributed both trans-prenyl transferase and cis-prenyl transferase activities [Light, D. R. & Dennis, M. S. (1989) J. Biol. Chem. 264, 18589-18597; Light, D. R., Lazarus, R. A. & Dennis, M. S. (1989) J. Biol. Chem. 264, 18598-18607]. Thus, it appears that plant prenyl transferases are comparable to animal enzyme systems in which trans-prenyl transferases are soluble enzymes whilst cis-prenyl transferases are membrane-bound [Ericcson, J., Runquist, M., Thelin, A., Andersson, M., Chojnacki, T. & Dallner, G. (1992) J. Biol Chem. 268, 832-838].
Dimethylallyltranstransferase↗
The interaction of hevein with N-acetylglucosamine-containing oligosaccharides. Solution structure of hevein complexed to chitobiose.
The three-dimensional structure of hevein, a small protein isolated from the latex of Hevea brasiliensis (rubber tree), in water solution has been obtained by using 1H-NMR spectroscopy and dynamic simulated annealing calculations. The average root-mean-square deviation (rmsd) of the best 20 refined structures generated using DIANA prior to simulated annealing was 0.092 nm for the backbone atoms and 0.163 nm for all heavy atoms (residues 3-41). The specific interaction of hevein with N-acetylglucosamine-containing oligosaccharides has also been analyzed by 1H-NMR. The association constants, Ka, for the binding of hevein to GlcNAc, chitobiose [GlcNAc-beta(1-->4)-GlcNAc], chitotriose [GlcNAc-beta(1-->4)-GlcNAc-beta(1-->4)-GlcNAc], and GlcNAc-alpha(1-->6)-Man have been estimated from 1H-NMR titration experiments. Since the measured Ka values for chitobiose binding are almost identical with and without calcium ions, it is shown that these cations are not required for sugar binding. The association increases in the order GlcNAc-alpha(1-->6)-Man < or = GlcNAc < chitobiose < chitotriose. The equilibrium thermodynamic parameters entropy and enthalpy of binding, delta S0 and delta H0, for the hevein-chitobiose and hevein-chitotriose associations have been obtained from van't Hoff analysis of the temperature dependence of the Ka values between 25-40 degrees C. The driving force for the binding process is provided for a negative delta H0 which is partially compensated by a negative delta S0. These negative signs seem to indicate that hydrogen bonding and van der Waals forces are the major interactions stabilizing the complex. Protein-carbohydrate nuclear Overhauser enhancements have allowed a three-dimensional model of the hevein-chitobiose complex to be built. From inspection of this model, a hydrogen bond between Ser19 and the non-reducing N-acetyl carbonyl group is suggested, as well as between Tyr30 and HO-3 of the same sugar residue. The N-acetyl methyl group of the non-reducing GlcNAc displays non-polar contacts to the aromatic Tyr30 and Trp21 residues. In addition, the higher affinities deduced for the beta-linked oligosaccharides with respect to GlcNAc and GlcNAc-alpha(1-->6)-Man can be explained by favourable stacking of the second beta-linked GlcNAc moiety and Trp21.
Acetylglucosamine↗
Contact urticaria and rhinitis from latex surgical gloves.
Latex used in the manufacture of surgical gloves should be included in a list of allergens. It is found in the tree Hevea braziliensis. For approximately the last year, minutes after using surgical gloves, a female doctor had severe pruritus followed by a rash and angio-oedema of the contact areas. During the last 4 months, on opening the glove-bag, she experienced severe rhinitis and respiratory distress. The symptoms ceased in 1 h. Standard patch tests and with substances used in the manufacture of rubber were negative. Prick tests with glove and natural latex were strongly positive. The presence of specific IgE against natural latex was demonstrated by means of a histamine release assay as well as by immunoenzymatic methods. The antigen seems to have a MW higher than 30,000 d and is trypsin-sensitive. These facts suggest that the allergen could be a protein present in the "crude natural latex".
Adult↗
Discomfort from rubber gloves indicating contact urticaria.
Rubber glove intolerance is a common dermatological problem and hypersensitivity of both delayed and immediate types occur. In order to study immediate skin reactions induced by rubber gloves, 15 patients with discomfort and itch produced by rubber gloves were examined. The patients were provoked by wearing rubber gloves, scratch tested with gloves, rubber chemicals and powders. RAST-tests were performed using an extract from the rubber tree (Hevea brasiliensis). In 6/15 patients, contact urticaria was confirmed, in 3 of whom IgE antibodies to latex were demonstrated.
Adult↗
Comparison of diagnostic methods in latex surgical glove contact urticaria.
Surgical rubber gloves contain allergens derived from natural rubber latex which may sensitize, causing contact urticaria and even systemic reactions. We examined 15 hospital employees allergic to latex surgical gloves, using various skin tests and RAST, to determine the most reliable diagnostic method and to investigate coexistent allergy to glove powder and rubber chemicals. Prick testing using a stock solution made from one brand of latex glove yielded positive (2+ to 4+) reactions in all 15 employees: 8 retained positive reactions at a 1/10 dilution, 1 at 1/100 and 4 at 1/1000. A prick test using rubber-tree sap (Hevea brasiliensis) was positive in 12/15 employees and a scratch-chamber test using crushed rubber-tree leaf was positive in 13/15. A latex glove use test was positive in 12/13 employees and a latex RAST detected measurable amounts of specific IgE in 8/15. No positive prick test reactions were obtained using glove powder. On patch testing, 2/15 employees showed delayed allergy to rubber chemicals but no immediate reactions were detected. The present results indicate that in addition to the use test, prick testing with a stock solution prepared from latex surgical gloves is an adequate test method for routine practice when diagnosing latex glove contact urticaria. The correlation between prick tests and whole glove use tests was good, but latex RASTs yielded some negative results.
Adult↗
Detection of IgE antibodies to latex allergens in human serum.
Reports indicate increasing incidence of Type I allergic reactions to latex allergens. The proteins that act as allergens and produce such allergic reactions are found in the natural latex sap of Hevea brasiliensis. All those who are exposed to latex products, particularly healthcare workers, are potentially at risk. The lack of qualified allergen extracts makes it difficult to perform skin testing on individuals who are at high risk. Therefore, a reliable in vitro test system for the detection of IgE antibodies to latex would be of considerable utility. We have developed a serological test for the qualitative determination of specific IgE antibodies to latex. In our study, 75 sera from individuals with a history of latex allergy and 29 serum samples from healthcare workers were tested by both radioimmunoassay (RIA) and enzyme immunoassay (EIA). The allergen bound to paper discs was the same solid phase for the RIA and EIA assays. The allergen preparation used for coating the paper discs was a mixture of proteins obtained from raw latex. The data show a good correlation between the results of RIA and EIA methods with data obtained using an RIA assay at an independent laboratory and by skin prick testing. Comparing the performance of our test using our latex material with that of the latex material obtained from the Food and Drug Administration (FDA), along with results of other tests including skin tests, we found that the specificity and sensitivity of our assay method approaches 100%. The data show no significant cross-reactivity between latex and banana. A low level of cross-reactivity between latex and avocado was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Allergens↗
Anaphylaxis and angioedema due to rubber allergy in children.
Delayed hypersensitivity to rubber chemicals is well known but there are an increasing number of case reports on an immediate type of hypersensitivity inducing contact urticaria and anaphylaxis in adults. We now report on three atopic children who developed angioedema, which in two of them progressed to anaphylaxis after exposure to natural rubber products. All three patients showed positive skin prick tests and one had a positive RAST test to latex from the rubber tree (Hevea brasiliensis). It is clear that sensitized subjects are at risk of developing anaphylaxis when exposed to natural rubber products, e.g. during medical examination or surgery when rubber gloves are used.
Adolescent↗
Frequency in allergy to proteins of latex in health care workers.
OBJECTIVE: The objective of this study is to evaluate allergy prevalence to latex proteins in health care workers at the Laboratory and Surgery Room of Hospital CIMA Chihuahua. METHODOLOGY AND RESULTS: A thorough clinical chart was recorded for all health care workers studied: hematic biometry, total IgE by ELISA method, specific IgE to latex antigen by ELISA (pharmacy CAP system), cutaneous tests with latex antigen (Aphi de México, Hevea Brasiliensis Biopal Inc. Spoken WA), through scarification, together with histamine and Evans (positive-negative control). The number included is 99 individuals. Specific IgE to latex in 4 cases was positive (4%) and in the cutaneous tests to latex, 24 cases (24%) resulted positive. CONCLUSIONS: The study reports a prevalence of (4%) when performing the specific IgE to latex and (24%) to the cutaneous test with antigen to total latex. This data allows us to continue evaluating the personnel at risk at the hospital, with better results in the administration of Labor Medicine at this medical institution.
Adult↗
Cloning of the patatin-like latex allergen Hev b 7, its expression in the yeast Pichia pastoris and its immunological characterization.
The 43-kD latex allergen Hev b 7 was purified from the latex of Hevea brasiliensis and identified by N-terminal and internal peptide sequences as highly homologous to patatins. Patatins are storage proteins encoded by a multigene family found in plants such as potato and tomato. We have obtained a cDNA clone coding for a cytoplasmic form of Hev b 7. The recombinant protein was expressed in the methylotrophic yeast Pichia pastoris at 10 mg/l culture supernatant. Both natural Hev b 7 and rHev b 7 were recognized by IgE in 11% of the latex-allergic patients. rHev b 7 inhibited binding to its counterpart in natural rubber latex extracts. Purified rHev b 7 used at concentrations of 10 micrograms/ml in skin prick tests produced wheal-and-flare reactions of sizes equal to those produced by nHev b 7. Furthermore, we were able to show that rHev b 7 possessed esterase activity. A plant expression system for the production of larger quantities of recombinant latex allergens as an alternative to the preparation from H. brasiliensis sap is discussed.
Allergens↗