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PubMed2001

Hevein, an allergenic lectin from rubber latex, activates human neutrophils' oxidative burst.

Hevein is an N-acetyl-D-glucosamine (GlcNAc) specific lectin that has been hypothesized to participate in the IgE-mediated allergic reactions in patients with latex allergy. In this work we assessed the specificity and biological effect of hevein purified from rubber latex on human leukocytes, using epifluorescence microscopy and flow cytometry. Purified human granulocytes were stimulated in vitro with hevein, and production of oxidative radicals was measured by reduction of nitroblue tetrazolium formazan. Histochemical staining and flow cytometry showed that hevein recognizes specifically monocytes (CD14+) and neutrophils (CD16+), but not lymphoid cells. Hevein induced oxidative response in purified granulocytes; this effect was 1.3-1.5-fold higher than the effect observed with the lectin WGA (wheat germ agglutinin), or other lectins with different sugar specificity. The induced reactions and cellular recognition by hevein were inhibited with GlcNAc and its oligomers; as well as by glycoproteins containing tri-and tetra-antennary N-glycosydically linked glycans. Our findings suggest that neutrophils are the main target for latex hevein; this lectin induces production of oxidative radicals, which seem to play an important role in tissue damage during latex allergy.

Antimicrobial Cationic Peptides↗
PubMed2000

IgE reactivity to patatin-like latex allergen, Hev b 7, and to patatin of potato tuber, Sol t 1, in adults and children allergic to natural rubber latex.

BACKGROUND: Patients allergic to natural rubber latex (NRL) frequently show positive skin prick tests (SPT) and hypersensitivity reactions to various fruits, such as avocado, banana, and kiwi, as well as to vegetables such as potato. METHODS: Hev b 7 was purified from NRL "C-serum" and Sol t 1 from potato extract, and they were detected by immunoblotting. IgE antibodies to Hev b 7 and Sol t 1 were measured with ELISA in sera from 35 adults and 35 children allergic to NRL. ELISA inhibition and immunoblotting were used to study allergen cross-reactivity. The in vivo reactivity of Hev b 7 and Sol t 1 were demonstrated in the SPT. RESULTS: Seventeen (49%) of the 35 NRL-allergic adults had IgE antibodies to Hev b 7, in contrast to only one of the 35 NRL-allergic children. Fifteen (43%) of the NRL-allergic adults and 29 (83%) of the NRL-allergic children had IgE antibodies to Sol t 1. Ten (29%) of the adult sera showed IgE binding to both Sol t 1 and Hev b 7, and crosswise inhibition tests with pooled sera revealed marked cross-reactivity. In the SPT, both natural Hev b 7 and Sol t 1 were able to produce a wheal and flare reaction. CONCLUSIONS: One-half of the NRL-allergic adults, but only one of the NRL-allergic children, had IgE antibodies to natural Hev b 7. These results suggest that Hev b 7 is an important NRL allergen for adults, but not for children. Elucidation of the clinical importance of the observed cross-reactivity between Hev b 7 and Sol t 1 requires further studies.

Adolescent↗
PubMed2000

The use of protective gloves and the prevalence of hand eczema, skin complaints and allergy to natural rubber latex among dental personnel in the county of Uppsala, Sweden.

During the past decade, there has been an increasing problem with acrylate allergy and natural rubber latex (NRL) allergy among dental personnel. The aim of the present study was to evaluate the prevalence of these problems among dentists, dental nurses and dental hygienists in Uppsala county, Sweden. The study was based on a self-administered questionnaire sent to 690 persons with 527 responders (76%). The most common skin problem was dry skin, fissures and/or itching on the hands. Of the 72 persons (13.6%) reporting to have suffered from hand eczema during the past 12 months, 41 were patch tested with the TRUE Test standard series and the Swedish dental screening series. In the patch tested group, 9.8% reacted to 1 or more of the acrylates. In addition, 389 persons were tested for NRL allergy with the Pharmacia Upjohn CAP-RAST test, and of these, we found 7.2% to be positive. The prevalence of self-reported hand eczema and the number of positive CAP-RAST tests differed between the 3 occupations, with higher figures for the dentists. There was also a correlation between atopic eczema and hand eczema. Of those reporting skin symptoms, 67.7% connected them to the place of work and 28.8% related them to the use of gloves.

Acrylates↗
PubMed2003

Effects of autoclave sterilization on properties of dental rubber dam as related to its use as barrier membrane in guided tissue regeneration.

BACKGROUND AND OBJECTIVE: Dental rubber dams (RDs) were used as barrier membranes in guided tissue regeneration for the treatment of periodontal intraosseous defects with acceptable clinical results. The aim of the present study was to investigate the effects of autoclave sterilization on properties of RD as related to its use as a barrier membrane in guided tissue regeneration. METHODS: RDs were sterilized by either an autoclave, gamma irradiation, or chemical agents and then co-cultured with human gingival fibroblasts. The cell responses to sterilized RDs were investigated by inverted phase contrast microscopy, scanning electron microscopy (SEM) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) technique. The surface alterations of the autoclaved RDs were observed under SEM. The tensile strength, tear strength and elongation at break of the autoclaved RDs were tested by a universal testing machine. RESULTS: The results from cell culture, microscopic and MTT studies showed that RDs sterilized by autoclave and gamma irradiation did not deteriorate gingival fibroblasts and provided surfaces suitable for cell attachment, whereas chemical-sterilized RDs were toxic to these cells. Ultrastructurally, surface changes from the non-autoclaved RDs, including some melted areas, small pores and folds were observed on the autoclaved RD surface. The tensile strength and tear strength of the autoclaved RDs were significantly lower than those of the non-autoclaved RDs (p = 0.042, p < 0.001, respectively). In contrast, the elongation at break of the autoclaved RDs was higher than that of the non-autoclaved RDs (p < 0.001). CONCLUSION: These results suggest that the autoclave sterilization deteriorated the physical properties of RDs even though they seemed to be compatible to the cultured human cells. Therefore, the sterilization method should be taken into consideration when RDs are utilized as barrier membranes.

Analysis of Variance↗
PubMed1998

Rubber dam.

In a busy dental practice the many advantages of the routine use of dental dam for day-to-day procedures are often not appreciated. Many general dental practitioners (GDPs) are unaware of the simple and rapid techniques for placement that exist and the important role that rubber dam plays in infection control.

Air Microbiology↗
PubMed1993

Direct bond brackets: cotton roll versus rubber dam isolation.

Forty-four brackets were bonded "in vivo" using cotton roll and rubber dam isolation. Maxillary and mandibular premolars, to be extracted for orthodontic reasons, were used in this study. After bonding, the teeth were retained in the mouth for at least 30 days. They were extracted using surgical elevators. After extraction, the teeth were secured in plastic rings using gypsum and kept in water for 7 days until debonding. A Universal Instron Machine was used to produce a shear force at a speed of 0.1 cm/min until each bracket was removed. No statistically significant differences for debonding strength were observed between the two types of isolation, nor between the buccal and palatal surfaces of the teeth. One hundred percent of the failures occurred at the bracket/composite interface.

Acid Etching, Dental↗
PubMed2000

Delivery of an hypoxic gas mixture due to a defective rubber seal of a flowmeter control tube.

The delivery of an hypoxic gas mixture to a patient during general anaesthesia is a rare event due to contemporary standards of monitoring, equipment design and alarm features. An incident is described where a split occurred in a rubber seal round the top of a flowmeter control tube. This resulted in a downstream oxygen leak and the delivery of an hypoxic gas mixture to the patient. The bobbin on the oxygen flowmeter did not accurately reflect the amount of oxygen being delivered. A paramagnetic oxygen analyser and a fuel cell oxygen electrode indicated that the inspired oxygen concentration was lower than intended. The anaesthetic machine was exchanged, and the operation continued uneventfully. The faulty anaesthetic machine subsequently passed a formal pressure test by the hospital engineers and also close examination of the flowmeter control valves. The importance of monitoring equipment and the interpretation of the information that they provide is emphasized.

Adult↗
PubMed2002

In vivo fracture of a new rubber-dam clamp.

AIM: This study was carried out to investigate the reasons for fracture of a new rubber-dam clamp used for the first time. SUMMARY: The fractured surfaces of the broken clamp were studied with optical microscopy. Characteristic surface patterns of tensile fracture were identified. Cracks originated from the groove of letter D mechanically engraved on the inner surface of the clamp bow, and developed with high velocity (unstable crack growth rate) leading to catastrophic fracture. This behaviour was attributed to the residual stresses introduced by the labelling technique due to local thermal alterations. KEY LEARNING POINTS: The labelling technique used to number clamps may be implicated with catastrophic failure. Dentists should be aware that even new clamps can fracture. It is important that clamps are secured to prevent inhalation of metal fragments, should catastrophic failure occur.

Dental Equipment↗
PubMed2002

Socioeconomic profile and nutritional status of children in rubber smallholdings.

This paper will present the socioeconomic profile and nutritional status of children aged 1-6 years in the rubber smallholdings of Peninsula Malaysia. A total of 323 households were involved in this study. The sociodemographic data were obtained through interviews with heads of households using a set of questionnaires. Anthropometric measurements were taken from 506 children aged 1-6 years from these households. The weight and height of the children were compared with the reference values of the National Center for Health Statistics (NCHS) and the nutritional status was classified based on the recommendations of WHO. The average age of the fathers was 39.9+/-8.6 years and 34.4+/-7.0 years for the mothers. The mean household size was 6.67+/-2.27. The majority (49.7%) of the heads of households received 4-6 years of formal education and 7.9% received no formal education. Based on the monthly per capita income, 24.0% were found to be in the hardcore poor category, 38.3% fall into the poor category and 37.7% in the above poverty income group. The prevalence of stunting and underweight among children between the ages of 1-6 years were highest among children from the hardcore poor, followed by the poor category and above the poverty line income group. Wasting was present in all income groups, with a prevalence of 4.2% found among the hardcore poor, 9.4% among the poor group and 8.4% in the above poverty income group. The Pearson Product Moment Correlation showed significant relationships between household total income and height-for-age (r = 0.131, P = 0.05) and weight-for-age (r = 0.127, P = 0.05). There were also significant correlations between monthly per capita income with height-for-age (r = 0.16, P < 0.01) and weight-for-age (r = 0.13, P < 0.05). The acreage of land utilised was correlated with height-for-age (r = 0.11, P < 0.05), weight-for-age (r = 0.17, P < 0.05) and weight-for-height (r = 0.16, P < 0.05). However, stepwise multiple regression analysis indicated that the predictor of height-for-age was monthly per capita income (R2 = 0.03, P < 0.01) and acreage of land utilised was a predictor for weight-for-age (R2 = 0.03, P < 0.01) and weight-for-height (R2 = 0.01, P < 0.01). Because income and acreage of land utilised have been shown to be associated with nutritional status, it is recommended that intervention programs that focus on generation of income and diversification of land utilisation should be undertaken. A multidiscipline approach involving the family, community and government agencies should be applied to any type of intervention program.

Agriculture↗
PubMed2001

Outcomes of a natural rubber latex control program in an Ontario teaching hospital.

BACKGROUND: Allergy to natural rubber latex (NRL) has been frequently reported in health care workers. However, there is little published evidence of the outcome of hospital intervention programs to reduce exposure and detect cases of sensitization early. OBJECTIVE: This study assesses the effects of intervention to reduce NRL allergy in an Ontario teaching hospital with approximately 8000 employees. METHODS: A retrospective review assessed annual numbers of employees visiting the occupational health clinic, allergy clinic, or both for manifestations of NRL allergy compared with the timing of introduction of intervention strategies, such as worker education, voluntary medical surveillance, and hospital conversion to low-protein, powder-free NRL gloves. RESULTS: The number of workers identified with NRL allergy rose annually, from 1 in 1988 to 6 in 1993. When worker education and voluntary medical surveillance were introduced in 1994, a further 25 workers were identified. Nonsterile gloves were changed to low-protein, powder-free NRL gloves in 1995: Diagnoses fell to 8 workers that year, and 2 of the 3 nurses who had been off work because of asthma-anaphylaxis were able to return to work with personal avoidance of NRL products. With a change to lower protein, powder-free NRL sterile gloves in 1997, allergy diagnoses fell to 3, and only 1 new case was identified subsequently up to May 1999. No increased glove costs were incurred as a result of consolidated glove purchases. CONCLUSIONS: This program to reduce NRL allergy in employees was effectively achieved without additional glove costs while reducing expenses from time off work and workers' compensation claims.

Gloves, Protective↗
PubMed2002

The manufacture of gloves from natural rubber latex.

Gloves that will provide a barrier of protection from infectious organisms are an essential feature of medical practice for the protection of both patients and medical personnel. Natural rubber latex has consistently been the most satisfactory raw material for the manufacture of gloves. Certain latex proteins, carried over into the finished product by inadequate manufacturing processes, may pose a risk of provoking allergic reactions in some patients and medical workers. As with any allergy, the risk depends on the route of exposure and dose. Hence, the method of manufacture, including the means used to coat gloves to make donning easy, can influence the eventual exposure of sensitive people to latex allergens. In this article, we describe the several processes in use and their effects on latex protein content.

Allergens↗
PubMed2002

Management of natural rubber latex allergy.

Issues of impairment, compensation, and disability are appropriately directed at health care workers with latex allergy and occupational asthma or anaphylaxis who may not be able to re-enter a work environment with ambient exposure to latex proteins. The following stepwise approach for managing a high-risk health care worker with natural rubber latex (NRL) allergy is recommended: (1) confirm the diagnosis of NRL allergy by using rational, validated methods; (2) justify cessation of further NRL exposure in the workplace; (3) determine whether there is impairment and disability resulting from NRL allergy; (4) advise employer and risk managers regarding the diagnosis and their responsibility to institute effective environmental interventions; (5) if accommodation efforts are unsuccessful, advise the worker to seek workers' compensation benefits and rehabilitation. Objective evidence of residual impairment caused by NRL-induced anaphylaxis or occupational asthma is often absent. Therefore, the physician must determine disability based on how work restrictions resulting from NRL allergy affect the worker's ability to perform current required tasks and duties. According to the Americans with Disabilities Act, the employer must make reasonable accommodations for an impaired employee. Therefore, an employee with NRL allergy and no objective evidence of impairment would not be considered to be disabled after successful interventions, which totally eliminate continued NRL protein exposure and the risks of work-related asthma and anaphylaxis.

Air Pollutants, Occupational↗
PubMed2002

Protein and allergen assays for natural rubber latex products.

The major issues in the efforts to alleviate allergy to natural rubber latex (NRL) proteins are prevention of allergic reactions and decreasing future sensitization. An accurate estimate of the potential allergenicity of NRL products is essential as guidance to manufacturers and users. Development of a reliable in vitro method for the quantitation of NRL allergens has been impeded by (1) limited knowledge of the individual allergens among NRL proteins, (2) variations in the protein profiles among NRL products, and (3) heterogeneity of responses to NRL allergens among sensitized individuals. The current methods include measurement of either the total or the antigenic NRL proteins. Although these methods provide valuable information, all except one have not been validated or standardized. The lack of sensitivity and specificity of this standardized method and poor correlation with the allergenic protein levels have mandated the need for a better assay. In the past year, an immunologic method for the quantitation of all antigenic proteins has been developed as a national standard. The method provides a significant improvement in sensitivity and specificity of NRL protein measurement, but the question of relevance to allergen content remains open. In the last several years, the intensive research aimed at purifying and characterizing individual allergens among NRL proteins resulted in the identification of more than 10 major allergens. On the basis of this knowledge, present efforts are focused on the development of a method for quantitation of relevant allergenic NRL proteins.

Allergens↗
PubMed2002

Starch and natural rubber allergen interaction in the production of latex gloves: a hand-held aerosol.

Starch powders continue to be used as donning agents on natural rubber (NR) gloves. NR aeroallergens are an important aspect of human sensitivity to latex. Asthma, upper airway, and ocular symptoms are associated with these airborne proteins. These bioaerosols feature starch as the carrier. The association of NR allergen and starch is demonstrated in NR glove manufacturing, in laboratory simulation, and as occupational aeroallergens in health care environments. Four aspects of latex allergen affinity for starch powders were examined by using a competitive IgE immunoassay for NR latex. Allergen content was assessed in finished gloves before and after powder process points and related to the allergen content of the raw latex source material. In another manufacturing process, allergen uptake by two different starch powders was quantified. NR allergen affinity for the starches was also determined under laboratory conditions. Finally, NR aeroallergens carried by starch powder in production facilities were measured. This article outlines the sources, mechanisms, and conditions for NR allergens to interact with two different starches. The quantitative airborne allergen data are used to compare and contrast various occupational indices of NR allergen exposure. Powdered NR gloves continue to cause concern; however, the technology used for contemporary glove powder applications may be advanced and improved enough to consistently produce powdered gloves with a low allergen content.

Air Pollutants↗
PubMed2002

Primary prevention of natural rubber latex allergy in the German health care system through education and intervention.

BACKGROUND: The development of occupational asthma and allergic skin reactions caused by natural rubber latex (NRL) allergy are risks for health care workers. There are few published studies to suggest that intervention programs to reduce exposure will lead to primary prevention of sensitization. OBJECTIVE: This study assesses the effects of intervention to reduce the incidence of NRL allergy in personnel working in health care facilities insured by the German statutory accident insurance company for health care workers, Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege, with approximately 3 million insured employees, by switching to powder-free NRL gloves. METHODS: The timing of introduction of intervention strategies, such as education of both physicians and administrators, together with regulations demanding that health care facilities only purchase low-protein, powder-free NRL gloves are reported. We reviewed the annual numbers of reported suspected cases of NRL-caused occupational allergies and the amount and type of gloves used in German acute-care hospitals since 1986. RESULTS: The purchase of powder-free NRL examination gloves exceeded that of powdered gloves for the first time in 1998. This only became true for powder-free NRL sterile gloves 2 years later in 2000. The incidence of suspected occupational NRL allergy cases rose until 1998 and has declined steadily since. There was a 2-year lag between the beginning of the decline in the purchase of powdered NRL examination gloves and the beginning of a decline in suspected NRL-caused occupational asthma cases. CONCLUSIONS: Despite the effect of increased recognition of NRL allergies, education about NRL allergies in health care facilities combined with the introduction of powder-free gloves with reduced protein levels has been associated with a decline in the number of suspected cases of occupational allergies caused by NRL in Germany on a nationwide scale. These results clearly indicate that primary prevention of occupational NRL allergies can be achieved if these straightforward and practical interventions are properly carried out and maintained.

Adult↗
PubMed1976

Respiratory function and symptoms: an environmental-epidemiological study of rubber workers exposed to a phenolformaldehyde type resin.

Rubber workers exposed to a hexamethylenetetramine-resorcinol (HR) adhesive system reported an excess of acute symptoms and significant reductions in expiratory flow rates at low lung volumes. Smokers exhibited greater reductions in flow rates than nonsmokers. The greatest reductions in ventilatory capacity were associated with HR exposure. There was a moderate association of reduced flow rates with respirable particulate in the HR exposed workers only.

Acute Disease↗
PubMed1977

Air sampling and analysis in a rubber vulcanization area.

Results of sampling and analysis of air in a rubber vulcanization area are described. Organic compounds were collected on activated charcoal, desorbed with carbon disulfide and analyzed by gas chromatography. Several previously identified substances were quantitated, including styrene, toluene, ethylbenzene, and several oligomers of 1,3-butadiene. Concentrations ranged from 0.007 to 1.1 ppm.

Air Pollutants↗
PubMedDate not supplied

Studies of respiratory morbidity in rubber workers. Part III. Respiratory morbidity in processing workers.

Respiratory questionnaires and pulmonary function tests were administered to sixty-five men exposed to dust in the processing are from three rubber tire manufacturing plants. Similar tests were done on 189 "control" workers. Compared with the controls, the processing workers had a higher prevalence of chronic productive cough. Overall, the processing group showed a decrease in the ratio of FEV to FVC. The processing workers with more than ten years of exposure showed a significant decrease in the ratio of FEV1.0/FVC, the FEV1.0, the residual FEV1.0, and the flow rates at 50% and 25% of the forced vital capacity. None of the pulmonary function effects could be solely explained on the basis of smoking, age, ethnic, or socioeconomic factors: all were related to the length of exposure. Based on these results we conclude that exposure in the processing area produces pulmonary disease.

Adult↗