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Dermatitides
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Allison Perz, Tara Jennings, Robert Duffy, Warren Heymann
Management: Identification and avoidance of the offending agent is the most important step in managing contact dermatitis. This can be quite difficult, as patients may be sensitized to common household chemicals, so counseling is of the utmost importance. Patients with occupational exposure can try to use protective clothing; however, a change in role or occupation may be required. Topical corticosteroids are appropriate treatment. Occasionally, oral antihistamines are needed. There are barrier creams, such as silicone, that may act as preventatives. Avoiding contact with the culprit, such as nickel in silver or low-karat gold or latex in gloves or underwear, is important. A latex allergy, when severe, can be life-ruining.
Introduction to dermatological diagnosis
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
This identifies an immediate hypersensitivity reaction in asthma, hay fever or allergic urticaria (contact urticaria to fragrances is done by short contact patch testing). It is not of any use in the diagnosis of atopic eczema or idiopathic urticaria. It is useful in identifying natural rubber latex allergy.
Latex Allergy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Ronald D DeGuzman, Pudupakkam K Vedanthan
Skin testing is considered the most sensitive test for confirming the diagnosis of latex allergy. Skin testing is the primary confirmatory test in Europe and Canada and is available commercially with ammoniated and non-ammoniated latex extracts (Bernadini et al. 2008). In the United States, FDA-approved latex skin tests are not available and thus serologic testing for latex specific IgE has become the most widely accepted confirmatory test (Hamilton 2002). This in vitro test, however, has suboptimal diagnostic predictive value with highly variable reported sensitivities between 50 to 100% (Lieberman et al. 2010). Provocative testing methods, to include glove use tests, inhalational challenge and nasal provocation, have been reported by a number of investigators. Due to concerns with safety, reproducibility and interpretation of these testing methods, provocation testing has not been recommended by some experts for routine clinical use (Hamilton 2002).
Comparison of surgical gloves: perforation, satisfaction and manual dexterity
Published in International Journal of Occupational Safety and Ergonomics, 2022
Tulay Basak, Gul Sahin, Ayla Demirtas
Until a few years ago, latex surgical gloves were preferred because of their flexibility and manual dexterity [10]. But latex allergy associated with the use of gloves is an increasing health problem [7]. Latex allergies are reported to affect 8.8% of nurses [11]. These reactions are usually unpredictable because a mild sensitization can worsen to anaphylactic shock after multiple or continuous exposure [12]. For this reason, it is recommended to limit the use of latex gloves in surgical sites [12]. However, powder-free latex gloves are more expensive than powdered ones. It has been noted that these gloves are relatively inexpensive when considering the health problems they are exposed to and the compensation paid to workers [13–15]. The US Food and Drug Administration banned the sale of powdered surgical gloves in the USA in January 2017, due to evidence for substantial risk of illness or injury to individuals exposed to the powdered gloves [16]. Nevertheless, as in our country, the use of powdered latex gloves continues in developing countries [17]. Also, Carey et al. [18] found that the rate of usage of latex gloves in nurses was 61.0% and the rate of using powdered latex gloves was 22.8% in a study on the frequency of using latex gloves while working in health care in Australia. The purpose of this study was to assess the effectiveness of two different surgical gloves (powdered latex surgical gloves and powder and latex free surgical gloves) for glove perforation frequency, problems and satisfaction with glove usage and manual dexterity levels during surgical operations that include scrub nurses.
Hevea latex-associated allergies: piecing together the puzzle of the latex IgE reactivity profile
Published in Expert Review of Molecular Diagnostics, 2020
Didier G. Ebo, Chris H. Bridts, Hans-Peter Rihs
In general, clinical practice, many physicians rely upon quantification of latex-sIgE antibodies as a primary measure to confirm or discard their clinical suspicion of an IgE-mediated latex allergy. However, the correct diagnosis of latex allergy via quantification of latex-sIgE can pose significant difficulties. On several occasions, it has been demonstrated that latex-sIgE results are not absolutely predictive for the clinical outcome. Results of latex-sIgE can be false-negative [11–13] or, much more frequently, false positive, that is, clinically irrelevant [11–16]. The consequences of false-negative results are obvious, as these entail a risk for life-threatening anaphylaxis upon subsequent exposure. However, over-diagnosis by false-positive results can also have dramatic consequences. For example, during diagnostic work-up of perioperative anaphylaxis, clinical irrelevant results could erroneously lead to the diagnosis of IgE-mediated latex allergy and premature stopping of further testing for the true culprit. Besides, identification of clinically irrelevant latex-sensitization should prevent unnecessary and generally expensive latex avoidance measures. Hence, there is need for additional reliable confirmatory tests.
Rocuronium anaphylaxis in a 7-year-old boy during the induction of anesthesia
Published in Immunological Medicine, 2018
Yoshiko Morimoto, Sakiko Satake, Aguri Kamitani, Manabu Yamada, Mutsumi Saitou, Yuki Torii, Rokuro Shiba, Chika Hadase, Toru Yamamoto
Clinical signs and symptoms of anesthetic anaphylaxis usually start about 10 min after intravenous administration of the responsible agent [1]. Among anesthetic drugs, NMBA has the highest frequency of inducing perioperative anaphylaxis [2]. In contrast, anaphylaxis from latex and antiseptics exhibits a more delayed onset and generally occurs during maintenance of anesthesia or recovery. β-Lactams including cefazolin sodium are able to elicit perioperative anaphylactic reactions usually in an IgE dependent manner. Since, the patient had no known allergies to antibiotics, it was difficult to suspect that he was with IgE-mediated β-lactam allergy. In patients allergic to latex, bronchospasm may also be observed early following arrival in the operating theatre. Considering that latex allergy can readily be established by quantification of specific IgE in most patients [1], it was less likely that our patient was hypersensitive to latex, as IgE against latex in his peripheral blood was negative. To determine the responsible drugs, we performed skin tests 76 d after surgery, and identified rocuronium as the culprit.