天然橡胶乳胶所致职业性哮喘。特异性吸入激发试验及病情演变。

Acero S, Alvarez M J, García B E, Echechipía S, Olaguibel J M, Tabar A I

Sección Alergología, Hospital Virgen del Camino, Pamplona, Spain.

J Investig Allergol Clin Immunol. 2003;13(3):155-61.

BACKGROUND

Natural rubber latex (NRL) is the most frequent cause of occupational respiratory problems in hospital workers.

OBJECTIVE

To describe the diagnostic methodology, including the specific inhalation challenge (SIC), used on patients diagnosed as having occupational asthma due to NRL in our Allergy Department during a 6-year period from 1989 to 1995.

METHODS

In 19 patients diagnosed as having occupational asthma due to NRL, clinical severity was assessed with a combined score for symptoms and medication use. Skin prick tests with aeroallergens, latex, papain, kiwi and chestnut, total IgE, serum-specific latex IgE, respiratory function study, methacholine test, specific conjunctival test, and SIC test with latex were done.

RESULTS

All but three patients worked in hospitals. All presented urticaria and rhinoconjunctivitis, and six also suffered anaphylaxis, usually preceded by asthma. Clinical fruit allergy was present in eight patients. The latency period was variable (0.25-27 years). The intensity of symptoms was low to moderate. Specific IgE, skin prick, and conjunctival tests to latex were positive in all cases. SICs were done in 12 patients. All of them presented isolated immediate reactions. No adverse reactions were observed. Duration of follow-up ranged from 1 to 7 years. Twenty-six percent of the patients kept their job, 26% changed jobs but remained in health care, and 48% switched to jobs unrelated to health care. Only 16% were free of symptoms without treatment, while 32% needed bronchodilators and 52% needed inhaled steroids. The specific bronchial challenge test was safe, but it did not predict the course of the illness. Duration of exposure and intensity of symptoms did correlate with prognosis, however.

CONCLUSIONS

NRL acts as a common aerollergen. Minor symptoms often precede occupational asthma. The SIC test was safe in the hands of trained technicians. Occupational asthma due to NRL seems to have a poor prognosis.

背景

天然橡胶乳胶（NRL）是医院工作人员职业性呼吸问题最常见的病因。

目的

描述1989年至1995年6年间在我们过敏科被诊断为因NRL导致职业性哮喘的患者所采用的诊断方法，包括特异性吸入激发试验（SIC）。

方法

对19例被诊断为因NRL导致职业性哮喘的患者，用症状和药物使用综合评分评估临床严重程度。进行了气传变应原、乳胶、木瓜蛋白酶、猕猴桃和栗子的皮肤点刺试验、总IgE、血清特异性乳胶IgE、呼吸功能研究、乙酰甲胆碱试验、特异性结膜试验以及乳胶的SIC试验。

结果

除3例患者外，所有患者都在医院工作。所有患者均出现荨麻疹和鼻结膜炎，6例还发生过敏反应，通常先于哮喘出现。8例患者存在临床水果过敏。潜伏期各不相同（0.25 - 27年）。症状强度为轻度至中度。所有病例中乳胶特异性IgE、皮肤点刺和结膜试验均为阳性。12例患者进行了SIC试验。所有患者均出现孤立的速发反应。未观察到不良反应。随访时间为1至7年。26%的患者保住了工作，26%换了工作但仍从事医疗保健工作，48%转而从事与医疗保健无关的工作。仅16%的患者未经治疗无症状，32%的患者需要支气管扩张剂，52%的患者需要吸入性类固醇。特异性支气管激发试验是安全的，但它不能预测疾病进程。然而，接触时间和症状强度与预后相关。