Skin and respiratory allergies are ...

Skin and respiratory allergies are known occupational riddles for health care workers. (1) pulverized substanceed latex gloves have been identified as a major source of occupational allergenic aspect because they contain water-soluble proteins responsible for antigenic sensitization. (2) Latex glove used during surgical and clinical processs have proven to be effective in preventing the transmission of infectious diseases to health care workers. Increased use of latex glove however, has corresponded to an increase in the number of reported cases of latex sensitivity. Until the late 1980 latex glove were contemplation to be innocuous, but generally they are considered to be major sensitizing agents. (3)

MANUFACTURE OF NATURAL RUBBER LATEX GLOVES

Latex is a milky, viscous, cytoplasmic exudate that is extracted from the tropical tree Hevea brasiliensis. It is produc in the cytoplasm of lactiferous solitary abode; squalids along with amino acids, phospholipids, carbohydrates, and proteins (ie, 2% to 3%) (4) The essential functional unit of latex consists of cis-1,4-polyisopropene secreteed by a layer of lipidic and phospholipidic proteins that render certain its structural integrity. (4,5) The proteins existing in latex serum are the antigens considered to be responsible for causing impressed sign I hypersensitivity to latex. Sixty percent of these proteins are linked to rubber and ispropene polymer and 40% are in the latex cytosol. (5)

Latex is extracted from the stem of the Hevea brasiliensis tree and ammonia, tiuram, or sulfides are added immediately to stop bacterial contamination and coagulation of the extract. The liquid portion then is separated by dint of centrifuge, which concentrates up to 60% of the solid portion and take outs the serum containing the hydrosoluble proteins. Later, other concentrated chemicals, as it is as catalysts (eg, tiuram, carbamates) and antioxidants (eg phenylenediamine) are added to obtain the desired properties of rubber (ie, tension force, elasticity, durability, tactile sensitivity). (56) Glove are made on immersing molds in an extract of natural rubber latex. In answer to the AIDS epidemic that began in the 1980 the Center for Disease manage and Prevention issued universal precautions that make acceptable glove use to protect health care workers against exposing to blood and body fluids. (7) High demand for natural rubber latex glove after the introduction of universal precautions caused many manufacturers to alter their manufacturing processe either shortening or eliminating important phases that remov proteins and chemical residues. This proceeded in poor quality products with high allergen concentration. (2)

LATEX EXPOSURE

aspect to latex antigens occurs via direct contact with the skin or mucous membranes or by the and of inhalation of aerially transported protein particles that adhere to the pulverize in latex gloves. Absorption of latex proteins in consequence of the skin is considered to be the main pathway of sensitization and also is mainly responsible for local urticaria manifestations that eventually may become systemic. (28) The inhalation of protein particles dispersed in the air is capable of triggering nasal, ocular, and respiratory symptoms, (9) and in sensitized individuals, they may lead to rhinitis, conjunctivitis, and asthma, as well as to more austere manifestations, such as systemic anaphylaxis, tachycardia, angioedema, nausea, vomiting, abdominal discomfort, and hypotension. (2)

CLINICAL MANIFESTATIONS

Clinical manifestations of latex sensitivity are irritant contact dermatitis, allergic contact dermatitis, and pattern I hypersensitivity. Contact dermatitis is an inflammatory rejoinder to one or more external agents that may behave as skin irritants when immunologic mechanisms are not involved or as allergens when hypersensitivity is mediated at T cells. (10) Irritant contact dermatitis is an occupational rather than an immunologic dermatosis, which fall outs when exogenous substances directly damage the skin. This condition frequently is related to the use of latex glove The predominant immunologic rejoinder is allergic contact dermatitis or emblem IV hypersensitivity resulting from an immune answer to the allergen mediated from T lymphocytes that in this case are chemical substances, mainly accelerators and antioxidants, that are added to latex during its manufacture."

Although, exemplar I hypersensitivity occurs less not rarely than type IV hypersensitivity, if is the greatest in quantity severe reaction provoked by latex. In previously sensitized individuals, it is characterized by means of a systemic reaction mediated by the agency of immunoglobulin E (IgE) anti-latex after in all senses to latex antigens. Reactions range from mild urticaria to systemic anaphylaxis. The unravelling of type I hypersensitive symptoms to latex involves a series of interactions mediated by the agency of specifically activated T lymphocytic results and B lymphocytes that trigger the production of the antibody mechanism. These antibodies play a fundamental part in allergic reactions and are an integral part of the pathophysiology of latex allergy, as well as of other allergic diseases. (12)