Latex rush desensitization
Article first published online: 23 SEP 2008
Volume 56, Issue 1, pages 86–87, January 2001
How to Cite
Nucera, E., Schiavino, D., Buonomo, A., Roncallo, C., Del Ninno, M., Milani, A., Pollastrini, E. and Patriarca, G. (2001), Latex rush desensitization. Allergy, 56: 86–87. doi: 10.1034/j.1398-9995.2001.00904.x
- Issue published online: 23 SEP 2008
- Article first published online: 23 SEP 2008
- Accepted for publication 21 August 2000
Allergic reactions to natural rubber latex (NRL) have been reported with increasing frequency since the first description by Nutter in 1979 (1). The main therapy is to avoid the exposure to latex, but this is difficult because of the ubiquity of latex products.
To our knowledge, just one clinical report dealing with desensitization to latex is available in the literature. However, the desensitizing treatment, performed subcutaneously with an aqueous latex extract in a patient with allergy to NRL, resulted in serious side-effects (anaphylactic reaction requiring the use of epinephrine) (2).
Therefore, we employed an alternative method of desensitization in a 23-year-old female medical student. She had a history of local erythematous papular rash, asthma, and rhinitis when wearing latex gloves.
A complete allergologic evaluation (including specific skin prick and patch tests; measurement of specific IgE; and contact, mucous, and sublingual challenge tests) was carried out. Skin prick tests with a 1-cm2 piece of surgical latex glove material (prick by prick method) and a standard latex skin test reagent (0.5 mg/ml; ALK Abelló, Madrid, Spain), and specific anti-NRL IgE immunoassay (Pharmacia UniCAP, Uppsala, Sweden) were positive.
The patch tests using the standard latex preparation of the prick tests and a 1-cm2 piece of surgical latex material were negative.
To confirm the diagnosis of allergy to latex, we performed specific challenge tests. The contact glove-challenge test was performed with the patient wearing a latex glove on a hand until symptoms appeared, the mucous challenge was performed with the patient holding a latex glove finger in her mouth until the occurrence of symptoms, and the sublingual challenge was performed by putting under the patient's tongue increasing doses of latex for 3 min every 20 min until symptoms appeared. The contact glove-challenge test (rhinitis, asthma, and local erythematous papular rash with pruritus after 20 min), the mucous challenge test (local erythema with some itchy wheals and itching of throat after 10 min), and the sublingual challenge test (submaxillary erythema with pruritus, nausea, and dysphagia after 20 min with one drop of a solution containing 25 µg of latex diluted 1:10) were all positive. These findings are consistent with the occurrence of IgE-mediated allergy to latex.
We decided to attempt a rush sublingual desensitization to NRL. In this protocol, the patient put under her tongue increasing doses of latex extract (ALK Abelló) for 3 min every 20 min and then spit them out.
After obtaining informed consent, the desensitization was begun with an initial dose of a solution containing 25 µg of latex diluted 1:10. On day 1, the patient received a cumulative dose of 28×10−10μg of latex, on day 2 she received 2.8 µg, and on day 3 the desensitization protocol was successfully completed, reaching the cumulative dose of 500 µg of latex with no side-effects.
After the rush desensitization, the contact and the mucous challenges were negative: the patient could wear latex gloves for 6 h and hold a latex glove-finger in her mouth for 1 h without symptoms. Desensitization was maintained with five drops of a solution containing 500 µg/ml of latex once a day.
Although this study has been carried out only in one patient, it provides evidence that a successful therapeutic approach to latex allergy is possible with a sublingual desensitizing treatment. However, further studies are necessary to confirm these results.
A successful use of sublingual immunotherapy.