LATEX ALLERGY - SYMPTOMS AND INDICATIONS FOR TREATMENT

Approximately 1 per cent of the general population, 10 per cent of med ical and paramedical personnel in operating rooms or intensive care un its and 30 to more than 50 per cent of multi-operated children present an immediate allergy to Hevea brasiliensis lates proteins (NLP) : usu ally presenting in the form of contact urticaria, angioneurotic oedema , conjunctivitis, rhinitis and asthma, or more rarely anaphylactic sho ck, particularly intraoperative. The diagnosis of NLP allergy is based on the clinical history, immediate skin tests with one or preferably two NLP extracts and specific IgE assay. A provocation test using a gl ove is sometimes necessary in atypical dermatitis of the hands. Cutane ous sensitisation to the avocado, banana, papaya, chestnut and kiwi fr uit is frequent (approximately 40 to 65 % of casts) in subjects allerg ic to NLP, whether or not they are atopic. In nonatopic subjects, alle rgies to other foods are much rarer than in atopic subjects without NL P allergy. The role of epitopes or profilins common to NLP and to cert ain foods is likely. As specific IgE is able to recognize almost 60 of the 240 NLP proteins, cross-allergy with foods and the definition of major NLP allergens (especially hevein or rubber elongation factor) ar e still controversial. Permanent elimination of NLP from the allergic subject's environment remains the only effective treatment, in the cas e of occupational disease, because of the risk of deterioration of the sensitisation. A placebo-controlled trial of specific immunotherapy t o NLP is underway. Only the use of surgical gloves and examination glo ves not containing NLP will be able to slow the current epidemic whose economic consequences will become obvious over the next few years.