Woods J A, Lambert S, Platts-Mills T A, Drake D B, Edlich R F
Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA.
J Emerg Med. 1997 Jan-Feb;15(1):71-85. doi: 10.1016/s0736-4679(96)00256-9.
Latex allergy has reached epidemic proportions in the United States and is increasingly recognized as a significant contributor to morbidity and mortality during medical and surgical procedures. Ultimately, many of the affected patients with recognized latex sensitivity and those who are not yet diagnosed will receive treatment for their allergic reactions to latex in emergency departments. Consequently, emergency physicians must have a comprehensive understanding of the etiology, epidemiology, pathogenesis, treatment, and management of these challenging patients. Groups at high risk include spina bifida cystica patients, health care workers, latex industry workers, specific food-allergy patients, and patients with a history of atopy or multiple surgical procedures. Sensitization to latex antigens is commonly encountered in health care workers wearing latex gloves with high latex allergen concentrations and in workers using powdered latex surgical gloves. Exposure to air-borne allergens and water-soluble IgE reactive latex antigens from natural rubber latex products in sensitized individuals can result in type I (immediate) hypersensitivity reactions. Clinical manifestations include contact urticaria, dermatitis, allergic rhinitis, conjunctivitis, asthma, angioedema, and anaphylaxis. Diagnostic tools include serological assays and skin prick testing. At present, latex avoidance is the only available treatment and is the key to preventing allergic reactions in latex-sensitized individuals. Health care worker sensitization to latex antigens in natural rubber products is becoming an increasing contributor to workers' liability and disability claims. Specific action can be taken to reduce occupational and patient exposure to latex antigens.
在美国，乳胶过敏已呈流行态势，并且越来越被视为医疗和外科手术过程中发病和死亡的一个重要因素。最终，许多已确诊对乳胶敏感的患者以及那些尚未确诊的患者将在急诊科接受针对乳胶过敏反应的治疗。因此，急诊医生必须全面了解这些具有挑战性的患者的病因、流行病学、发病机制、治疗和管理。高危人群包括脊柱裂患者、医护人员、乳胶行业工人、特定食物过敏患者以及有特应性病史或多次手术史的患者。在佩戴乳胶过敏原浓度高的乳胶手套的医护人员以及使用含粉乳胶手术手套的工人中，对乳胶抗原的致敏情况很常见。致敏个体接触来自天然橡胶乳胶产品的空气传播过敏原和水溶性 IgE 反应性乳胶抗原可导致 I 型（速发型）超敏反应。临床表现包括接触性荨麻疹、皮炎、过敏性鼻炎、结膜炎、哮喘、血管性水肿和过敏反应。诊断工具包括血清学检测和皮肤点刺试验。目前，避免接触乳胶是唯一可行的治疗方法，也是预防乳胶致敏个体发生过敏反应的关键。医护人员对天然橡胶产品中乳胶抗原的致敏正日益成为导致工人责任和残疾索赔的一个因素。可以采取具体行动来减少职业和患者对乳胶抗原的接触。
