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Answer
Latex hypersensitivity: Weaving bond can contain natural
rubber latex (NRL), an antioxidant, a preservative, and
color. Contents of bond removers include water, adepsine
oil, carbomer, surfactants, vitamin E, aloe vera,
panthenol, propyl and methyl paraben, and fragrance.
In this patient, skin-prick tests reveal a 4+ reaction
to the weaving bond and histamine control and a negative
response to the hair bond remover and glycerin control.
Three volunteer subjects had negative results to
skin-prick testing with the weaving bond. On further
evaluation, a serum latex immunoglobulin E (IgE)
radioallergosorbent test (RAST) demonstrated a 938%
response (class 4, very high level) in this patient.
Latex, or NRL, is secreted from the rubber tree
Hevea brasiliensis. An estimated 5-15% of the
population have IgE-mediated sensitivity to NRL. In
particular, the prevalence of sensitization is high
among healthcare workers; this rate is related to both
their frequent use of latex gloves and their high
workplace exposure to ambient latex allergen. Because
powder-free latex gloves can significantly decrease
ambient levels of this allergen, their widespread use is
now recommended.
Individuals
allergic to latex should avoid latex exposure, wear a
MedicAlert bracelet, and carry an EpiPen. Patients with
latex allergy can find educational materials at the Web
site of the
American Latex Allergy Association. This site also
features latex-free products used in hospitals, on crash
carts, in schools, in dentists' offices, and in everyday
life by consumers.
For more information on latex allergy and anaphylaxis,
see the eMedicine articles
Latex Allergy and
Anaphylaxis.
Bibliography
- Gainer JV, Nadeau JH, Ryder D, Brown NJ. Increased sensitivity to bradykinin among African Americans. J Allergy Clin Immunol. 1996;98:283-7.
- Karim MY, Masood A. Fresh-frozen plasma as a treatment for life-threatening ACE-inhibitor angioedema. J Allergy Clin Immunol. 2002;109(2):370-1.
- Kyrmizakis D, Papadakis CE, Fountoulakis EJ, Liolios AD, Skoulas JG. Tongue angioedema after long-term use of ACE inhibitors. Am J Otolaryngol. 1996;98(2):283-7.
- Vleeming W, van Amsterdam JG, Stricker BH, de Wildt DJ. ACE inhibitor-induced angioedema. Incidence, prevention and management. Drug Saf.1998;18(3):171-88.
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BACKGROUND
A 37-year-old woman who works as a secretary in a medical and dental
clinic is referred for an allergy evaluation. She reports an
episode that occurred 3 months ago while she was having her
hair styled by a hairdresser. The relaxer, shampoo, and
conditioner treatments had been applied without adverse
effect. The hairdresser was placing hair extensions and was
beginning to apply weaving bond and lotion to remove the
hair bond. Within 5 minutes, the patient began feeling
flushed, lightheaded, and short of breath. She developed a
cough, neck urticaria, and a sensation of swelling in her
throat.
The event had occurred about 3 hours after the patient ate
lunch. Her lunch contained shrimp, which she has since
ingested without adverse effect. She was in her usual state
of health on that day and denies having taken medications
besides Synthroid (levothyroxine sodium) for hypothyroidism.
The hairdresser was not using latex gloves during the hair
appointment.
The patient denies having had swelling of her lip or tongue,
peripheral angioedema, a change in vocal quality, and GI
symptoms. She was taken to the emergency department, where
she became hypotensive, lost consciousness, and was
successfully treated with epinephrine and steroids. |
Hint
The woman reports a history of immediate localized pruritus
but no systemic symptoms when she uses household gloves
while performing cleaning chores at home.
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Author:
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Michael S. Tankersley, MD,
FAAAAI |
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Chief, Department of Allergy,
Asthma and Immunology, Third Medical Group, Elmendorf Air Force Base
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eMedicine Editor:
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John Leung, MD
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Program Director of Emergency Medicine, Associate Professor, Departments of Internal Medicine and Emergency Medicine, University of Virginia School of Medicine
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