Toxicological Reviews

, Volume 23, Issue 2, pp 123–134 | Cite as

Toxicological and Immunological Aspects of Occupational Latex Allergy

  • Syed M. Ahmed
  • Tar-Ching Aw
  • Anil Adisesh
Review Article


Latex allergy continues to be an important occupational health problem as latex products are used increasingly worldwide, particularly in healthcare. Although there are few epidemiological studies on the incidence of latex allergy, there has been an increase in the number of case reports over the last 10 years and, based on skin-prick tests, estimates of prevalence of latex allergy in healthcare workers range from 2% to 17%. The allergic health effects arise either from the latex proteins, generally causing a type I immediate hypersensitivity reaction, or from the chemicals added to latex during processing, causing a type IV delayed hypersensitivity reaction. Clinical manifestations of latex allergy depend on the route of exposure and occur by direct contact either with skin or mucosa, or by inhalation. The diagnosis of latex allergy is based on the history, skin tests, serological tests and challenge tests. Thirteen latex allergens have been identified and isolated so far from natural rubber latex. They differ in their potential to elicit immunological responses in individuals allergic to latex and thus have been designated as major or minor allergens. In latex gloves, cornstarch powder used as a donning agent carries latex proteins, thereby increasing inhalational and mucosal exposure to latex proteins. There also appears to be a positive correlation between protein content and allergenicity of gloves. The use of powder-free, low-protein gloves is effective in reducing symptoms and markers of sensitisation. Alternatives to latex gloves, such as nitrile or vinyl gloves are available but may be inferior in respect to manual dexterity and biological impermeability.


Natural Rubber Spina Bifida Natural Rubber Latex Latex Glove Latex Allergy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

The authors wish to thank Dr Ira Madan of East Kent Hospitals NHS Trust, Kent, and Dr Paul Cullinan of the Brompton Hospital, London, UK, for providing information and advice for the preparation of this manuscript.


  1. 1.
    Sussman GL, Beezhold DH, Liss G. Latex allergy: historical perspective. Methods 2002. 27(1): 3–9PubMedGoogle Scholar
  2. 2.
    US Food and Drug Administration. Surgeon’s and patient examination gloves: reclassification and medical glove guidance manual availability: proposed rule and notice. Fed Regist 1999; 64: 41709–43Google Scholar
  3. 3.
    Grilli E. The world rubber economy. Baltimore (MD): John Hopkins University Press, 1980Google Scholar
  4. 4.
    Shaw D. A brief natural history of rubber latex allergy [online]. Available from URL: [Accessed 2004 Nov 5]
  5. 5.
    Turjanmaa K. Diagnosis of latex allergy. Allergy 2001; 56(9): 810–2PubMedGoogle Scholar
  6. 6.
    Lagier F, Vervloet D, Lhermet I, et al. Prevalence of latex allergy in operating room nurses. J Allergy Clin Immunol 1992; 90 (3 Pt 1): 319–22PubMedGoogle Scholar
  7. 7.
    Brown RH, Schauble JF, Hamilton RG. Prevalence of latex allergy among anesthesiologists: identification of sensitized but asymptomatic individuals. Anesthesiology 1998; 89(2): 292–9PubMedGoogle Scholar
  8. 8.
    Cullinan P, Brown R, Field A, et al. Latex allergy: a position paper of the British Society of Allergy and Clinical Immunology. Clin Exp Allergy 2003; 33(11): 1484–99PubMedGoogle Scholar
  9. 9.
    Archambault S, Malo JL, Infante-Rivard C, et al. Incidence of sensitization, symptoms, and probable occupational rhinoconjunctivitis and asthma in apprentices starting exposure to latex. J Allergy Clin Immunol 2001; 107(5): 921–3PubMedGoogle Scholar
  10. 10.
    Gautrin D, Ghezzo H, Infante-Rivard C, et al. Incidence and determinants of IgE-mediated sensitization in apprentices: a prospective study. Am J Respir Crit Care Med 2000; 162 (4 Pt 1): 1222–8PubMedGoogle Scholar
  11. 11.
    Sussman GL, Liss GM, Deal K, et al. Incidence of latex sensitization among latex glove users. J Allergy Clin Immunol 1998; 101 (2 Pt 1): 171–8PubMedGoogle Scholar
  12. 12.
    Merrett TG, Merrett J, Kekwick R. The prevalence of immunoglobulin E antibodies to the proteins of rubber (Hevea brasiliensis) latex and grass (Phleum pratense) pollen in sera of British blood donors. Clin Exp Allergy 1999; 29(11): 1572–8PubMedGoogle Scholar
  13. 13.
    Saxon A, Ownby D, Huard T, et al. Prevalence of IgE to natural rubber latex in unselected blood donors and performance characteristics of AlaSTAT testing. Ann Allergy Asthma Immunol 2000; 84(2): 199–206PubMedGoogle Scholar
  14. 14.
    Senna GE, Crocco I, Roata C, et al. Prevalence of latex-specific IgE in blood donors: an Italian survey. Allergy 1999; 54(1): 80–1PubMedGoogle Scholar
  15. 15.
    Kose S, Mandiracioglu A. Prevalence of latex sensitization in healthy blood donors in Izmir, Turkey. Asian Pac J Allergy Immunol 2003; 21(4): 273–5PubMedGoogle Scholar
  16. 16.
    Porri F, Lemiere C, Birnbaum J, et al. Prevalence of latex sensitization in subjects attending health screening: implications for a perioperative screening. Clin Exp Allergy 1997; 27(4): 413–7PubMedGoogle Scholar
  17. 17.
    Turjanmaa K, Makinen-Kiljunen S, Reunala T, et al. Natural rubber latex allergy: the European experience. Immunol Allergy Clin North Am 1995; 15: 71–88Google Scholar
  18. 18.
    Gautrin D, Infante-Rivard C, Dao TV, et al. Specific IgE-dependent sensitization, atopy, and bronchial hyperresponsiveness in apprentices starting exposure to protein-derived agents. Am J Respir Crit Care Med 1997; 155(6): 1841–7PubMedGoogle Scholar
  19. 19.
    Bernardini R, Novembre E, Ingargiola A, et al. Prevalence and risk factors of latex sensitization in an unselected pediatric population. J Allergy Clin Immunol 1998; 101(5): 621–5PubMedGoogle Scholar
  20. 20.
    Liss GM, Sussman GL. Latex sensitization: occupational versus general population prevalence rates. Am J Ind Med 1999; 35(2): 196–200PubMedGoogle Scholar
  21. 21.
    Turjanmaa K. Incidence of immediate allergy to latex gloves in hospital personnel. Contact Dermatitis 1987; 17(5): 270–5PubMedGoogle Scholar
  22. 22.
    Smedley J, Jury A, Bendall H, et al. Prevalence and risk factors for latex allergy: a cross sectional study in a United Kingdom hospital. Occup Environ Med 1999; 56(12): 833–6PubMedGoogle Scholar
  23. 23.
    Chowdhury MM, Statham BN. Natural rubber latex allergy in a health-care population in Wales. Br J Dermatol 2003; 148(4): 737–40PubMedGoogle Scholar
  24. 24.
    Bernardini R, Novembre E, Lombardi E, et al. Prevalence of and risk factors for latex sensitization in patients with spina bifida. J Urol 1998; 160(5): 1775–8PubMedGoogle Scholar
  25. 25.
    Turjanmaa K, Kanto M, Kautiainen H, et al. Long-term outcome of 160 adult patients with natural rubber latex allergy. J Allergy Clin Immunol 2002; 110(2 Suppl.): S70–4PubMedGoogle Scholar
  26. 26.
    Turjanmaa K, Alenius H, Reunala T, et al. Recent developments in latex allergy. Curr Opin Allergy Clin Immunol 2002; 2(5): 407–12PubMedGoogle Scholar
  27. 27.
    Piskin G, Akyol A, Uzar H, et al. Comparative evaluation of type 1 latex hypersensitivity in patients with chronic urticaria, rubber factory workers and healthy control subjects. Contact Dermatitis 2003; 48(5): 266–71PubMedGoogle Scholar
  28. 28.
    Nettis E, Dambra P, Soccio AL, et al. Latex hypersensitivity: relationship with positive prick test and patch test responses among hairdressers. Allergy 2003; 58(1): 57–61PubMedGoogle Scholar
  29. 29.
    Carrillo T, Blanco C, Quiralte J, et al. Prevalence of latex allergy among greenhouse workers. J Allergy Clin Immunol 1995; 96 (5 Pt 1): 699–701PubMedGoogle Scholar
  30. 30.
    Valks R, Conde-Salazar L, Cuevas M. Allergic contact urticaria from natural rubber latex in healthcare and non-healthcare workers. Contact Dermatitis 2004; 50(4): 222–4PubMedGoogle Scholar
  31. 31.
    Conde-Salazar L, Gatica ME, Barco L, et al. Latex allergy among construction workers. Contact Dermatitis 2002; 47(3): 154–6PubMedGoogle Scholar
  32. 32.
    Garabrant DH, Schweitzer S. Epidemiology of latex sensitization and allergies in health care workers. J Allergy Clin Immunol 2002; 110(2 Suppl.): S82–95PubMedGoogle Scholar
  33. 33.
    Wartenberg D, Buckler G. Invited commentary: assessing latex sensitization using data from NHANES III. Am J Epidemiol 2001; 153(6): 523–6PubMedGoogle Scholar
  34. 34.
    Porter R. The greatest benefit to mankind. London: Harper Collins, 1997Google Scholar
  35. 35.
    Downing J. Dermatitis from rubber gloves. N Engl J Med 1933 JanGoogle Scholar
  36. 36.
    Stern G. Uberempfindlichkeit gegen Kautschuk als Ursache von Urtikaria und Quinekeschem Odem. Klin Wochenschr 1927; 6: 1096–7Google Scholar
  37. 37.
    Nutter AF. Contact urticaria to rubber. Br J Dermatol 1979; 101: 597PubMedGoogle Scholar
  38. 38.
    Czuppon AB, Chen Z, Rennert S, et al. The rubber elongation factor of rubber trees (Hevea brasiliensis) is the major allergen in latex. J Allergy Clin Immunol 1993; 92(5): 690–7PubMedGoogle Scholar
  39. 39.
    Cohen DE, Scheman A, Stewart L, et al. American Academy of Dermatology’s position paper on latex allergy. J Am Acad Dermatol 1998; 39(1): 98–106PubMedGoogle Scholar
  40. 40.
    Slater JE. Latex allergy. J Allergy Clin Immunol 1994; 94 (2 Pt 1): 139–49PubMedGoogle Scholar
  41. 41.
    Seaton A, Cherrie B, Turnbull J. Rubber glove asthma. BMJ (Clin Res Ed) 1988; 296(6621): 531–2Google Scholar
  42. 42.
    Taylor JS, Cassettari J, Wagner W, et al. Contact urticaria and anaphylaxis to latex. J Am Acad Dermatol 1989; 21 (4 Pt 2): 874–7PubMedGoogle Scholar
  43. 43.
    Taylor JS, Praditsuwan P. Latex allergy: review of 44 cases including outcome and frequent association with allergic hand eczema. Arch Dermatol 1996; 132(3): 265–71PubMedGoogle Scholar
  44. 44.
    Dreyfus DH, Fraser B, Randolph CC. Anaphylaxis to latex in patients without identified risk factors for latex allergy. Conn Med 2004; 68(4): 217–22PubMedGoogle Scholar
  45. 45.
    Lieberman P. Anaphylactic reactions during surgical and medical procedures. J Allergy Clin Immunol 2002; 110(2 Suppl.): S64–9PubMedGoogle Scholar
  46. 46.
    Kwittken PL, Sweinberg SK, Campbell DE, et al. Latex hypersensitivity in children: clinical presentation and detection of latex-specific immunoglobulin E. Pediatrics 1995; 95(5): 693–9PubMedGoogle Scholar
  47. 47.
    Rycroft RJG, Menne T, Frosch PJ. Textbook of contact dermatitis. 2nd ed. Berlin: Springer-Verlag, 1995Google Scholar
  48. 48.
    Conde-Salazar L, del-Rio E, Guimaraens D, et al. Type IV allergy to rubber additives: a 10-year study of 686 cases. J Am Acad Dermatol 1993; 29 (2 Pt 1): 176–80PubMedGoogle Scholar
  49. 49.
    Heese A, van Hintzenstern J, Peters KP, et al. Allergic and irritant reactions to rubber gloves in medical health services: spectrum, diagnostic approach, and therapy. J Am Acad Dermatol 1991; 25 (5 Pt 1): 831–9PubMedGoogle Scholar
  50. 50.
    Wilkinson SM, Beck MH. Allergic contact dermatitis from latex rubber. Br J Dermatol 1996; 134(5): 910–4PubMedGoogle Scholar
  51. 51.
    Gottlober P, Gall H, Peter RU. Allergic contact dermatitis from natural latex. Am J Contact Dermatitis 2001; 12(3): 135–8PubMedGoogle Scholar
  52. 52.
    Wakelin SH, Jenkins RE, Rycroft RJ, et al. Patch testing with natural rubber latex. Contact Dermatitis 1999; 40(2): 89–93PubMedGoogle Scholar
  53. 53.
    Shaffrali FC, Gawkrodger DJ. Allergic contact dermatitis from natural rubber latex without immediate hypersensitivity. Contact Dermatitis 1999; 40(6): 325–6PubMedGoogle Scholar
  54. 54.
    Sommer S, Wilkinson SM, Beck MH, et al. Type IV hypersensitivity reactions to natural rubber latex: results of a multicentre study. Br J Dermatol 2002; 146(1): 114–7PubMedGoogle Scholar
  55. 55.
    Hamilton RG, Adkinson Jr NF. Diagnosis of natural rubber latex allergy: multicenter latex skin testing efficacy study. Multicenter Latex Skin Testing Study Task Force. J Allergy Clin Immunol 1998; 102(3): 482–90PubMedGoogle Scholar
  56. 56.
    Ownby DR, Magera B, Williams PB. A blinded, multi-center evaluation of two commercial in vitro tests for latex-specific IgE antibodies. Ann Allergy Asthma Immunol 2000; 84(2): 193–6PubMedGoogle Scholar
  57. 57.
    Turjanmaa K, Palosuo T, Alenius H, et al. Latex allergy diagnosis: in vivo and in vitro standardization of a natural rubber latex extract. Allergy 1997; 52(1): 41–50PubMedGoogle Scholar
  58. 58.
    Kelly KJ, Kurup V, Zacharisen M, et al. Skin and serologic testing in the diagnosis of latex allergy. J Allergy Clin Immunol 1993; 91(6): 1140–5PubMedGoogle Scholar
  59. 59.
    Blanco C, Carrillo T, Ortega N, et al. Comparison of skin-prick test and specific serum IgE determination for the diagnosis of latex allergy. Clin Exp Allergy 1998; 28(8): 971–6PubMedGoogle Scholar
  60. 60.
    Hamilton RG, Biagini RE, Krieg EF. Diagnostic performance of Food and Drug Administration-cleared serologic assays for natural rubber latex-specific IgE antibody. The Multi-Center Latex Skin Testing Study Task Force. J Allergy Clin Immunol 1999; 103 (5 Pt 1): 925–30PubMedGoogle Scholar
  61. 61.
    Vyas A, Pickering CA, Oldham LA, et al. Survey of symptoms, respiratory function, and immunology and their relation to glutaraldehyde and other occupational exposures among endoscopy nursing staff. Occup Environ Med 2000; 57(11): 752–9PubMedGoogle Scholar
  62. 62.
    Turjanmaa K, Alenius H, Makinen-Kiljunen S, et al. Natural rubber latex allergy. Allergy 1996; 51(9): 593–602PubMedGoogle Scholar
  63. 63.
    Valyasevi MA, Maddox DE, Li JT. Systemic reactions to allergy skin tests. Ann Allergy Asthma Immunol 1999; 83(2): 132–6PubMedGoogle Scholar
  64. 64.
    Lezaun A, Marcos C, Martin JA, et al. Contact dermatitis from natural latex. Contact Dermatitis 1992; 27(5): 334–5PubMedGoogle Scholar
  65. 65.
    Alenius H, Turjanmaa K, Palosuo T, et al. Surgical latex glove allergy: characterization of rubber protein allergens by immunoblotting. Int Arch Allergy Appl Immunol 1991; 96(4): 376–80PubMedGoogle Scholar
  66. 66.
    Slater JE, Chhabra SK. Latex antigens. J Allergy Clin Immunol 1992; 89(3): 673–8PubMedGoogle Scholar
  67. 67.
    Slater JE, Trybul DE. Immunodetection of latex antigens. J Allergy Clin Immunol 1994; 93(5): 825–30PubMedGoogle Scholar
  68. 68.
    Yunginger JW, Jones RT, Fransway AF, et al. Extractable latex allergens and proteins in disposable medical gloves and other rubber products. J Allergy Clin Immunol 1994; 93(5): 836–42PubMedGoogle Scholar
  69. 69.
    Warshaw EM. Latex allergy. Skinmed 2003; 2(6): 359–66PubMedGoogle Scholar
  70. 70.
    Alenius H, Kurup V, Kelly K, et al. Latex allergy: frequent occurrence of IgE antibodies to a cluster of 11 latex proteins in patients with spina bifida and histories of anaphylaxis. J Lab Clin Med 1994; 123(5): 712–20PubMedGoogle Scholar
  71. 71.
    Alenius H, Turjanmaa K, Palosuo T. Natural rubber latex allergy. Occup Environ Med 2002; 59(6): 419–24PubMedGoogle Scholar
  72. 72.
    Yagami T, Sato M, Nakamura A, et al. Plant defense-related enzymes as latex antigens. J Allergy Clin Immunol 1998; 101(3): 379–85PubMedGoogle Scholar
  73. 73.
    King TP, Hoffman D, Lowenstein H, et al. Allergen nomenclature. Allergy 1995; 50(9): 765–74PubMedGoogle Scholar
  74. 74.
    Bernstein DI, Biagini RE, Karnani R, et al. In vivo sensitization to purified Hevea brasiliensis proteins in health care workers sensitized to natural rubber latex. J Allergy Clin Immunol 2003; 111(3): 610–6PubMedGoogle Scholar
  75. 75.
    Dennis MS, Light DR. Rubber elongation factor from Hevea brasiliensis: identification, characterization, and role in rubber biosynthesis. J Biol Chem 1989; 264(31): 18608–17PubMedGoogle Scholar
  76. 76.
    Alenius H, Kalkkinen N, Yip E, et al. Significance of rubber elongation factor as a latex allergen. Int Arch Allergy Immunol 1996; 109(4): 362–8PubMedGoogle Scholar
  77. 77.
    Chen Z, Cremer R, Posch A, et al. On the allergenicity of Hev b 1 among health care workers and patients with spina bifida allergic to natural rubber latex. J Allergy Clin Immunol 1997; 100(5): 684–93PubMedGoogle Scholar
  78. 78.
    Yeang HY, Cheong KF, Sunderasan E, et al. The 14.6 kd rubber elongation factor (Hev b 1) and 24 kd (Hev b 3) rubber particle proteins are recognized by IgE from patients with spina bifida and latex allergy. J Allergy Clin Immunol 1996; 98(3): 628–39PubMedGoogle Scholar
  79. 79.
    Kurup VP, Yeang HY, Sussman GL, et al. Detection of immunoglobulin antibodies in the sera of patients using purified latex allergens. Clin Exp Allergy 2000; 30(3): 359–69PubMedGoogle Scholar
  80. 80.
    Yeang HY, Arif SA, Yusof F, et al. Allergenic proteins of natural rubber latex. Methods 2002; 27(1): 32–45PubMedGoogle Scholar
  81. 81.
    Breiteneder H, Scheiner O. Molecular and immunological characteristics of latex allergens. Int Arch Allergy Immunol 1998; 116(2): 83–92PubMedGoogle Scholar
  82. 82.
    Posch A, Chen Z, Raulf-Heimsoth M, et al. Latex allergens. Clin Exp Allergy 1998; 28(2): 134–40PubMedGoogle Scholar
  83. 83.
    Sunderasan E, Hamzah S, Hamid S, et al. Latex B serum b-1,3-glucanase (Hev b II) and a component of the microhelix (Hev b IV) are major latex allergens. J Nat Rubb Res 1995; 10: 82–9Google Scholar
  84. 84.
    Alenius H, Kalkkinen N, Lukka M, et al. Prohevein from the rubber tree (Hevea brasiliensis) is a major latex allergen. Clin Exp Allergy 1995; 25(7): 659–65PubMedGoogle Scholar
  85. 85.
    Raulf-Heimsoth ME, Yeang HY, Sander I, et al. Is ENSP (Hev b 13) the missing latex allergen to fill the gap in the repertoire of isolated allergens for the determination of sensitization profiles [abstract]. J Allergy Clin Immunol 2003; 111: S94Google Scholar
  86. 86.
    Yip L, Hickey V, Wagner B, et al. Skin prick test reactivity to recombinant latex allergens. Int Arch Allergy Immunol 2000; 121(4): 292–9PubMedGoogle Scholar
  87. 87.
    Yeang HY. Natural rubber latex allergens: new developments. Curr Opin Allergy Clin Immunol 2004; 4(2): 99–104PubMedGoogle Scholar
  88. 88.
    Yagami T, Osuna H, Kouno M, et al. Significance of carbohydrate epitopes in a latex allergen with beta-1,3-glucanase activity. Int Arch Allergy Immunol 2002; 129(1): 27–37PubMedGoogle Scholar
  89. 89.
    Akasawa A, Hsieh LS, Lin Y. Serum reactivities to latex proteins (Hevea brasiliensis). J Allergy Clin Immunol 1995; 95(6): 1196–205PubMedGoogle Scholar
  90. 90.
    Alenius H, Palosuo T, Kelly K, et al. IgE reactivity to 14-kD and 27-kD natural rubber proteins in latex-allergic children with spina bifida and other congenital anomalies. Int Arch Allergy Immunol 1993; 102(1): 61–6PubMedGoogle Scholar
  91. 91.
    Alenius H, Kalkkinen N, Lukka M, et al. Purification and partial amino acid sequencing of a 27-kD natural rubber allergen recognized by latex-allergic children with spina bifida. Int Arch Allergy Immunol 1995; 106(3): 258–62PubMedGoogle Scholar
  92. 92.
    Lu LJ, Kurup VP, Hoffman DR, et al. Characterization of a major latex allergen associated with hypersensitivity in spina bifida patients. J Immunol 1995; 155(5): 2721–8PubMedGoogle Scholar
  93. 93.
    Yeang HY, Chow KS, Yusof F, et al. Appraisal of latex glove proteins in the induction of sensitivity to multiple latex allergens. J Investig Allergol Clin Immunol 2000; 10(4): 215–22PubMedGoogle Scholar
  94. 94.
    Akasawa A, Hsieh LS, Martin BM, et al. A novel acidic allergen, Hev b 5, in latex: purification, cloning and characterization. J Biol Chem 1996; 271(41): 25389–93PubMedGoogle Scholar
  95. 95.
    Slater JE, Vedvick T, Arthur-Smith A, et al. Identification, cloning, and sequence of a major allergen (Hev b 5) from natural rubber latex (Hevea brasiliensis). J Biol Chem 1996; 271(41): 25394–9PubMedGoogle Scholar
  96. 96.
    Beezhold DH, Hickey VL, Slater JE, et al. Human IgE-binding epitopes of the latex allergen Hev b 5. J Allergy Clin Immunol 1999; 103(6): 1166–72PubMedGoogle Scholar
  97. 97.
    Chen Z, Rihs HP, Slater JE, et al. The absence of Hev b 5 in capture antigen may cause false-negative results in serologic assays for latex specific IgE antibodies [abstract]. J Allergy Clin Immunol 2000; 105: S83Google Scholar
  98. 98.
    Sutherland MF, Drew A, Rolland JM, et al. Specific monoclonal antibodies and human immunoglobulin E show that Hev b 5 is an abundant allergen in high protein powdered latex gloves. Clin Exp Allergy 2002; 32(4): 583–9PubMedGoogle Scholar
  99. 99.
    Lundberg M, Chen Z, Rihs HP, et al. Recombinant spiked allergen extract. Allergy 2001; 56(8): 794–5PubMedGoogle Scholar
  100. 100.
    Hamilton RG, Rossi CE, Yeang HY, et al. Latex-specific IgE assay sensitivity enhanced using Hev b 5 enriched latex allergosorbent [abstract]. J Allergy Clin Immunol 2003 2003; 111: S174Google Scholar
  101. 101.
    Rozynek P, Posch A, Baur X. Cloning, expression and characterization of the major latex allergen prohevein. Clin Exp Allergy 1998; 28(11): 1418–26PubMedGoogle Scholar
  102. 102.
    Alenius H, Kalkkinen N, Reunala T, et al. The main IgE-binding epitope of a major latex allergen, prohevein, is present in its N-terminal 43-amino acid fragment, hevein. J Immunol 1996; 156(4): 1618–25PubMedGoogle Scholar
  103. 103.
    Banerjee B, Wang X, Kelly KJ, et al. IgE from latex-allergic patients binds to cloned and expressed B cell epitopes of prohevein. J Immunol 1997; 159(11): 5724–32PubMedGoogle Scholar
  104. 104.
    Chen Z, Posch A, Lohaus C, et al. Isolation and identification of hevein major IgE-binding polypeptide in Hevea latex. J Allergy Clin Immunol 1997; 99: 402–9PubMedGoogle Scholar
  105. 105.
    Karisola P, Mikkola J, Kalkkinen N, et al. Construction of hevein (Hev b 6.02) with reduced allergenicity for immunotherapy of latex allergy by comutation of six amino acid residues on the conformational IgE epitopes. J Immunol 2004; 172(4): 2621–8PubMedGoogle Scholar
  106. 106.
    Beezhold DH, Sussman GL, Kostyal DA, et al. Identification of a 46-kD latex protein allergen in health care workers. Clin Exp Immunol 1994; 98(3): 408–13PubMedGoogle Scholar
  107. 107.
    Seppala U, Palosuo T, Seppala U, et al. IgE reactivity to patatin-like latex allergen, Hev b 7, and to patatin of potato tuber, Sol 11, in adults and children allergic to natural rubber latex. Allergy 2000; 55(3): 266–73PubMedGoogle Scholar
  108. 108.
    Sowka S, Wagner S, Krebitz M, et al. cDNA cloning of the 43-kDa latex allergen Hev b 7 with sequence similarity to patatins and its expression in the yeast Pichia pastoris. Eur J Biochem 1998; 255(1): 213–9PubMedGoogle Scholar
  109. 109.
    Ganglberger E, Radauer C, Wagner S, et al. Hev b 8, the Hevea brasiliensis latex profilin, is a cross-reactive allergen of latex, plant foods and pollen. Int Arch Allergy Immunol 2001; 125(3): 216–27PubMedGoogle Scholar
  110. 110.
    Rihs HP, Chen Z, Rozynek P, et al. PCR-based cloning, isolation, and IgE-binding properties of recombinant latex profilin (rHev b 8). Allergy 2000; 55(8): 712–7PubMedGoogle Scholar
  111. 111.
    Vallier P, Balland S, Harf R, et al. Identification of profilin as an IgE-binding component in latex from Hevea brasiliensis: clinical implications. Clin Exp Allergy 1995; 25(4): 332–9PubMedGoogle Scholar
  112. 112.
    Wagner S, Breiteneder H, Simon-Nobbe B, et al. Hev b 9, an enolase and a new cross-reactive allergen from Hevea latex and molds. Purification, characterization, cloning and expression. Eur J Biochem 2000; 267(24): 7006–14PubMedGoogle Scholar
  113. 113.
    Baum JA, Scandalios JG. Isolation and characterization of the cytosolic and mitochondrial Superoxide dismutases of maize. Arch Biochem Biophys 1981; 206(2): 249–64PubMedGoogle Scholar
  114. 114.
    Miao Z, Gaynor JJ. Molecular cloning, characterization and expression of Mnsuperoxide dismutase from the rubber tree (Hevea brasiliensis). Plant Mol Biol 1993; 23(2): 267–77PubMedGoogle Scholar
  115. 115.
    Wagner S, Sowka S, Mayer C, et al. Identification of a Hevea brasiliensis latex manganese Superoxide dismutase (Hev b 10) as a cross-reactive allergen. Int Arch Allergy Immunol 2001; 125(2): 120–7PubMedGoogle Scholar
  116. 116.
    O’Riordain G, Radauer C, Hoffmann-Sommergruber K, et al. Cloning and molecular characterization of the Hevea brasiliensis allergen Hev b 11, a class I chitinase. Clin Exp Allergy 2002; 32(3): 455–62PubMedGoogle Scholar
  117. 117.
    Rihs HP, Dumont B, Rozynek P, et al. Molecular cloning, purification, and IgE-binding of a recombinant class I chitinase from Hevea brasiliensis leaves (rHev b 11.0102). Allergy 2003; 58(3): 246–51PubMedGoogle Scholar
  118. 118.
    Beezhold DH, Hickey VL, Kostyal DA, et al. Lipid transfer protein from Hevea brasiliensis (Hev b 12), a cross-reactive latex protein. Ann Allergy Asthma Immunol 2003; 90(4): 439–45PubMedGoogle Scholar
  119. 119.
    Arif SA, Hamilton RG, Yusof F, et al. Isolation and characterization of the early nodule-specific protein homologue (Hev b 13), an allergenic lipolytic esterase from Hevea brasiliensis latex. J Biol Chem 2004; 279(23): 23933–41PubMedGoogle Scholar
  120. 120.
    Barbara J, Santais MC, Levy DA, et al. Immunoadjuvant properties of glove cornstarch powder in latex-induced hypersensitivity. Clin Exp Allergy 2003; 33(1): 106–12PubMedGoogle Scholar
  121. 121.
    Edlich RF, Woodard CR, Pine SA, et al. Hazards of powder on surgical and examination gloves: a collective review. J Long Term Eff Med Implants 2001; 11(1–2): 15–27PubMedGoogle Scholar
  122. 122.
    Crippa M, Belleri L, Mistrello G, et al. Prevention of latex allergy among health care workers: evaluation of the extractable latex protein content in different types of medical gloves. Am J Ind Med 2003; 44(1): 24–31PubMedGoogle Scholar
  123. 123.
    Palosuo T, Makinen-Kiljunen S, Alenius H, et al. Measurement of natural rubber latex allergen levels in medical gloves by allergen-specific IgE-ELISA inhibition, RAST inhibition, and skin prick test. Allergy 1998; 53(1): 59–67PubMedGoogle Scholar
  124. 124.
    M’Raihi L, Charpin D, Pons A, et al. Cross-reactivity between latex and banana. J Allergy Clin Immunol 1991; 87 (1 Pt 1): 129–30PubMedGoogle Scholar
  125. 125.
    Blanco C, Carrillo T, Castillo R, et al. Latex allergy: clinical features and cross-reactivity with fruits. Ann Allergy 1994; 73(4): 309–14PubMedGoogle Scholar
  126. 126.
    Wagner S, Breiteneder H. The latex-fruit syndrome. Biochem Soc Trans 2002; 30 (Pt 6): 935–40PubMedGoogle Scholar
  127. 127.
    Baur X. I are we closer to developing threshold limit values for allergens in the workplace? Ann Allergy Asthma Immunol 2003; 90 (5 Suppl. 2): 11–8PubMedGoogle Scholar
  128. 128.
    Tarlo SM, Sussman GL, Holness DL. Latex sensitivity in dental students and staff: a cross-sectional study. J Allergy Clin Immunol 1997; 99(3): 396–401PubMedGoogle Scholar
  129. 129.
    Levy DA, Charpin D, Pecquet C, et al. Allergy to latex. Allergy 1992; 47(6): 579–87PubMedGoogle Scholar
  130. 130.
    Sri-Akajunt N, Sadhra S, Jones M, et al. Natural rubber latex aeroallergen exposure in rubber plantation workers and glove manufacturers in Thailand and health care workers in a UK hospital. Ann Occup Hyg 2000; 44(2): 79–88PubMedGoogle Scholar
  131. 131.
    Heilman DK, Jones RT, Swanson MC, et al. A prospective, controlled study showing that rubber gloves are the major contributor to latex aeroallergen levels in the operating room. J Allergy Clin Immunol 1996; 98(2): 325–30PubMedGoogle Scholar
  132. 132.
    Alenius H, Makinen-Kiljunen S, Turjanmaa K, et al. Allergen and protein content of latex gloves. Ann Allergy 1994; 73(4): 315–20PubMedGoogle Scholar
  133. 133.
    Alenius H, Turjanmaa K, Makinen-Kiljunen S, et al. IgE immune response to rubber proteins in adult patients with latex allergy. J Allergy Clin Immunol 1994; 93(5): 859–63PubMedGoogle Scholar
  134. 134.
    Raulf-Heimsoth M, et al. Development of a monoclonal antibody-based sandwich ELISA for detection of the latex allergen Hev b 1. Int Arch Allergy Immunol 2000; 123(3): 236–41PubMedGoogle Scholar
  135. 135.
    Zeldin RK, Hamilton RG, Adkinson Jr NF. The effect of avoidance on the natural history of rubber latex allergy [abstract]. J Allergy Clin Immunol 1996; 97: 429Google Scholar
  136. 136.
    Vandenplas O, Jamart J, Delwiche JP, et al. Occupational asthma caused by natural rubber latex: outcome according to cessation or reduction of exposure. J Allergy Clin Immunol 2002; 109(1): 125–30PubMedGoogle Scholar
  137. 137.
    Allmers H, Brehler R, Chen Z, et al. Reduction of latex aeroallergens and latex-specific IgE antibodies in sensitized workers after removal of powdered natural rubber latex gloves in a hospital. J Allergy Clin Immunol 1998; 102(5): 841–6PubMedGoogle Scholar
  138. 138.
    Hunt LW, Kelkar P, Reed CE, et al. Management of occupational allergy to natural rubber latex in a medical center: the importance of quantitative latex allergen measurement and objective follow-up. J Allergy Clin Immunol 2002; 110(2 Suppl.): S96–106PubMedGoogle Scholar
  139. 139.
    Rueff F, Schopf P, Putz K, et al. Effect of reduced exposure on natural rubber latex sensitization in health care workers. Ann Allergy Asthma Immunol 2004; 92(5): 530–7PubMedGoogle Scholar
  140. 140.
    Nettis E, Colanardi MC, Ferrannini A. Type I latex allergy in health care workers with latex-induced contact urticaria syndrome: a follow-up study. Allergy 2004; 59(7): 718–23PubMedGoogle Scholar
  141. 141.
    Allmers H, Schmengler J, Skudlik C. Primary prevention of natural rubber latex allergy in the German health care system through education and intervention. J Allergy Clin Immunol 2002; 110(2): 318–23PubMedGoogle Scholar
  142. 142.
    Medical Device Agency. Latex sensitisation in a health care setting [MDA DB9601]. London: Department of Health, 1996Google Scholar
  143. 143.
    Korniewicz DM, Kirwin M, Cresci K, et al. Leakage of latex and vinyl exam gloves in high and low risk clinical settings. Am Ind Hyg Assoc J 1993; 54(1): 22–6PubMedGoogle Scholar
  144. 144.
    Kotilainen HR, Brinker JP, Avato JL, et al. Latex and vinyl examination gloves. Quality control procedures and implications for health care workers. Arch Intern Med 1989; 149(12): 2749–53PubMedGoogle Scholar
  145. 145.
    Estlander T, Jolanki R, Kanerva L. Dermatitis and urticaria from rubber and plastic gloves. Contact Dermatitis 1986; 14(1): 20–5PubMedGoogle Scholar
  146. 146.
    Korniewicz DM, El-Masri M, Broyles JM, et al. A laboratory-based study to assess the performance of surgical gloves. AORN J 2003; 77(4): 772–9PubMedGoogle Scholar
  147. 147.
    Tarlo SM, Sussman G, Contala A, et al. Control of airborne latex by use of powder-free latex gloves. J Allergy Clin Immunol 1994; 93(6): 985–9PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Syed M. Ahmed
    • 1
    • 2
  • Tar-Ching Aw
    • 1
    • 2
  • Anil Adisesh
    • 3
  1. 1.Occupational Health DepartmentKent & Canterbury HospitalCanterbury, KentUK
  2. 2.Division of Occupational Health, Kent Institute of Medicine and Health SciencesUniversity of KentCanterburyUK
  3. 3.Health and Safety LaboratoryHealth Effects DivisionHarpur Hill, BuxtonUK

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