Sussman G L, Liss G M, Deal K, Brown S, Cividino M, Siu S, Beezhold D H, Smith G, Swanson M C, Yunginger J, Douglas A, Holness D L, Lebert P, Keith P, Waserman S, Turjanmaa K
Section of Allergy, Wellesley Hospital, University of Toronto, Ontario, Canada.
J Allergy Clin Immunol. 1998 Feb;101(2 Pt 1):171-8. doi: 10.1016/s0091-6749(98)70381-1.
Although there are several reports of the prevalence of latex sensitization among health care workers, the incidence of sensitization is unknown.
The objective of this study was to estimate the incidence of sensitization among latex glove users at a hospital in Hamilton, Ontario, Canada.
Workers with negative results to the skin test at baseline were followed prospectively over 1 year, some wearing powdered gloves and others using powder-free gloves. They were reevaluated in 1995 with a questionnaire and skin prick test (SPT) sensitivity to latex reagents, three common inhalants, and six foods. A conversion was defined as a (new) latex SPT with wheal diameter at least 4 mm greater than saline control. Glove extracts were assayed for antigenic protein, and air samples were obtained to estimate exposure to airborne latex protein.
During powdered glove use, personal exposures ranged from 5 to 616 ng/m3, whereas during powder-free glove use, all but two results for air samples were below the limit of detection (about 0.1 ng/m3). During the study period, the protein concentration in the powdered gloves, initially mean 557 microg/gm of sample, declined at a rate of 295 microg/gm per year (p < 0.0001). Of the 1075 SPT-negative participants at baseline, 479 were working in eligible wards, and of these, 435 (91%) participated in follow-up, 227 using powder-free gloves and 208 using powdered gloves. We identified four conversions, two (1.0%) in the powdered glove group and two (0.9%) in the powder-free group. The two participants using powdered gloves were the only converters who were symptomatic. The significance of skin test conversions identified in the powder-free group, both asymptomatic patients, is unclear. The limitations of the study are discussed, including the limited power, the declines in latex protein concentrations, and the possibility of information (observer) bias.
To our knowledge, this represents the first reported estimate (about 1%) of incidence of sensitization in hospital personnel using latex gloves.
尽管有几篇关于医护人员中乳胶致敏率的报道，但致敏的发生率尚不清楚。
本研究的目的是估计加拿大安大略省汉密尔顿一家医院中乳胶手套使用者的致敏发生率。
对基线皮肤试验结果为阴性的工作人员进行为期1年的前瞻性随访，一些人佩戴含粉手套，另一些人使用无粉手套。1995年，通过问卷调查和对乳胶试剂、三种常见吸入物及六种食物的皮肤点刺试验（SPT）对他们进行重新评估。将硬结直径比生理盐水对照至少大4毫米的（新）乳胶SPT定义为转变。对手套提取物进行抗原蛋白检测，并采集空气样本以估计空气中乳胶蛋白的暴露情况。
使用含粉手套期间，个人暴露范围为5至616纳克/立方米，而使用无粉手套期间，除两个空气样本结果外，其余均低于检测限（约0.1纳克/立方米）。在研究期间，含粉手套中的蛋白浓度最初平均为每克样本557微克，以每年295微克/克的速度下降（p<0.0001）。在基线时1075名SPT阴性参与者中，479人在符合条件的病房工作，其中435人（91%）参与了随访，227人使用无粉手套，208人使用含粉手套。我们确定了4例转变，含粉手套组2例（1.0%），无粉手套组2例（0.9%）。使用含粉手套的两名参与者是仅有的有症状的转变者。无粉手套组中两名无症状患者的皮肤试验转变的意义尚不清楚。讨论了该研究的局限性，包括检验效能有限、乳胶蛋白浓度下降以及信息（观察者）偏倚的可能性。
据我们所知，这是首次报道的使用乳胶手套的医院工作人员致敏发生率估计值（约1%）。
