Gottlöber P, Gall H, Peter R U
Department of Dermatology, University of Ulm, Ulm, Germany.
Am J Contact Dermat. 2001 Sep;12(3):135-8.
Reports on natural latex allergy have increased steadily during the last 10 years. Latex allergy generally refers to a type 1 reaction to natural rubber latex (NRL) proteins with clinical manifestations ranging from contact urticaria to asthma and anaphylaxis. Previous United States studies on NRL allergy largely have been reported by allergists with little detailed information on hand eczema, contact allergy, or on outcome. The present study was performed from March 1998 to November 1999 with the aim of finding out the prevalence of type IV hypersensitivity to latex in patients with suspected rubber allergy.
A total of 167 patients with hand eczema and contact with rubber products underwent patch testing with the standard screening and rubber components (test series Deutsche Kontaktallergiegruppe), and NRL pure provided by Regent (liquid high ammonia 0.7% NRL, accelerator, and preservative-free latex) between March 1998 and November 1999. The charts of all NRL positive patients are reported with the results of history, prick, patch tests, total IgE, specific IgE to latex (FEIA) test and follow-up data (after 6 months).
Four patients (3 men) showed positive patch test results to NRL. One of these patients also reacted to the rubber chemical tetraethylthiuram monosulfide, and another one of these patients revealed a type 1 reaction to NRL, diagnosed by positive reaction to prick test. The other 3 patients with patch test reactions to NRL had negative reactions to prick tests to NRL extracts after 20 minutes. All 4 patients had a positive delayed prick test reaction to NRL. Latex FEIA test result was negative in all 4 patients. The contact eczema healed after elimination of the latex gloves and medical latex devices in all patients. Furthermore, 10 of the 167 patch testing patients (6%) were positive for tetramethylthiuram monosulfide 1%.
In the present study with 167 patients, the prevalence of type IV hypersensitivity to latex was 2.4%. We recommend that the patch test with NRL as well as with rubber additives should be performed in patients of suspected contact dermatitis caused by rubber products.
在过去10年中，关于天然乳胶过敏的报告稳步增加。乳胶过敏通常是指对天然橡胶乳胶（NRL）蛋白的1型反应，临床表现从接触性荨麻疹到哮喘和过敏反应不等。美国先前关于NRL过敏的研究大多由过敏症专科医生报告，关于手部湿疹、接触性过敏或结局的详细信息很少。本研究于1998年3月至1999年11月进行，目的是找出疑似橡胶过敏患者中对乳胶IV型超敏反应的患病率。
1998年3月至1999年11月期间，共有167例手部湿疹且接触橡胶制品的患者接受了标准筛查和橡胶成分（德国接触性过敏组测试系列）的斑贴试验，以及Regent提供的NRL纯品（液体高氨0.7% NRL、促进剂和无防腐剂乳胶）的斑贴试验。报告了所有NRL阳性患者的病史、点刺试验、斑贴试验、总IgE、乳胶特异性IgE（FEIA）试验结果及随访数据（6个月后）。
4例患者（3名男性）对NRL的斑贴试验结果呈阳性。其中1例患者对橡胶化学物质一硫化四乙基秋兰姆也有反应，另1例患者对NRL呈1型反应，通过点刺试验阳性确诊。其他3例对NRL斑贴试验有反应的患者在20分钟后对NRL提取物的点刺试验呈阴性。所有4例患者对NRL的延迟点刺试验反应均为阳性。所有4例患者的乳胶FEIA试验结果均为阴性。所有患者在去除乳胶手套和医用乳胶器械后，接触性湿疹均愈合。此外，167例斑贴试验患者中有10例（6%）对1%一硫化四甲基秋兰姆呈阳性。
在本研究的167例患者中，对乳胶IV型超敏反应的患病率为2.4%。我们建议，对于疑似由橡胶制品引起的接触性皮炎患者，应进行NRL以及橡胶添加剂的斑贴试验。
