Angelika Heese

Allergic and irritant reactions to rubber gloves in medical health services: Spectrum, diagnostic approach, and therapy

Delayed-type allergies account for most reactions to gloves. These have been found in 32 of 39 patients (82%) attending our department with occupationally induced contact dermatitis to gloves. Accelerators, mainly of the thiuram group, antioxidants, vulcanizers, organic pigments, and, presumably, glove powder ingredients are known responsible allergens. In contrast, immediate-type allergies to rubber gloves were less frequent (13 of 39 patients [33%] with occupationally induced glove allergies). They usually present as contact urticaria. Responsible allergens are latex, glove powder, and accelerators. On the basis of the numerous glove-related allergens, a comprehensive schedule of diagnostic tests is proposed. In addition, we introduce a new classification of hypoallergenic gloves according to their basic materials and ingredients and thus provide a guideline for individual therapy.

Frequency, spectrum and occupational relevance of type IV allergies to rubber chemicals

3851 consecutive patients patch tested between January 1985 and March 1990 have been analysed for rubber allergies. The incidence of rubber allergy was 3.8% (n=145) In 80/145 patients (55%). the source of rubber sensitization was occupational, 67 of whom (84%) had acquired allergy from wearing rubber gloves a work. Most of them (36%) were employed in the health services. The most commonly positive rubber‐mix in this group was thiuram‐mix (72%) Followed by carba‐mix (25%.) 13/80 patients (16%) had occupational rubber allergy from industrial rubber products other than gloves. Patch tests revealed thiuram‐mix (62%) as the most commonly positive rubber‐mix but, in contrast to the group with glove‐induced rubber allergy, black‐rubber‐mix came second (38%) In 47/145 patients (32%) the source of rubber sensitization W8S non‐occupational; in 18/145 (13%) the origin remained unknown.

Immunohistochemical characterization of epithelial cells in human lacrimal glands - I. Normal major and accessory lacrimal glands

Expression patterns of cytokeratins (CKs), actin, lactoferrin (Lf), lysozyme (Ly), vimentin, and S-100 protein were immunohistochemically examined in paraffin sections from eight normal major and accessory lacrimal glands (LGs). Luminal duct cells and a number of secretory cells stained with the antibodies (ABs) KL1 and Pkk1 (CK 7, 8, 17, 18), while basal duct and myoepithelial cells reacted with the AB 34βE12 (CK 5). Myoepithelial cells expressing CK 5 and actin were restricted to acini and intralobular ducts, and their number was greater in major LGs than accessory ones. Lf and Ly were found in 50%–75% of acini and intralobular ducts. Vimentin was absent in parenchyma of LGs. S-100 protein reaction was observed in a number of acinar and luminal duct cells of major LGs whereas epithelia of accessory LGs remained negative. Distribution patterns of CKs, Lf, and Ly in major and accessory LGs are identical. The difference with respect to the number of myoepithelial cells as well as S-100 protein reactivity between major and accessory LGs reactivity appeared to be relevant to the differences in their secretory mechanisms and local environment.

Frequency of type I allergy to rubber gloves in dental students

Zusammenfassung. In der vorliegenden Studie wurde mittels Fragebogen, Prick-Testungen und Bestimmung spezifischer IgE-Antikörper die Prävalenz einer Typ-I-Allergie gegen Latex bei Zahnmedizinstudenten untersucht. Bei 18 (8,7%) von 206 Studenten zeigten sich positive Prick-Teste auf unterschiedliche Latexmilchen, für die in 11 Fällen eine klinische Relevanz bestand. Unter Berücksichtigung der jeweiligen Gesamtzahl an Studenten pro Semester konnte eine Zunahme der minimalen Prävalenzen einer klinisch relevanten Latexallergie von 2% im 7. Semester auf 10,4% im 10. Semester ermittelt werden. Die Anamnese einer Handschuhintoleranz mit Urtikaria, Erythem und Juckreiz war nur in 50% der Fälle mit dem Vorliegen einer Typ-I-Allergie gegen Latex assoziiert. Als Risikofaktoren erwiesen sich atopische Erkrankungen und Handekzeme unterschiedlicher Genese bei 16 bzw. 5 der 18 Latexallergiker. In der Diagnostik zeigte sich eine hochammoniakalische, akzeleratorfreie Latexmilch als geeignetes Testmedium im Gegensatz zu der weniger sensitiven Bestimmung spezifischer IgE-Antikörper gegen Latex.Abstract. The prevalence of type I allergy against latex was investigated in dental students by questionnaire, prick tests and the determination of specific IgE antibodies. Positive prick tests against different latex fluids were found in 18 (8.7%) of 206 students, with clinical relevance in 11 cases. When the total number of students in each semester was taken into account an increase in the minimal prevalence of clinically relevant latex allergy from 2% in the second semester to 10.4% in the tenth semester was seen. A history of glove intolerance presenting as a wheal-and-flare reaction was associated with a type I allergy against latex in only 50% of the affected subjects. Atopic diseases and hand eczema of different causes proved to be risk factors in 16 and 5 of 18 students with latex allergy, respectively. A high-ammonia accelerator-free latex fluid proved to be a very reliable test medium compared to the less sensitive determination of specific IgE antibodies to latex.

Immunohistochemical characterization of epithelial cells in human lacrimal glands. II. Inflammatory and neoplastic lesions of lacrimal glands.

The distribution of cytokeratins (CK), actin, lactoferrin (Lf), lysozyme (Ly), vimentin and S-100 protein was immunohistochemically investigated in paraffin-embedded specimens of five inflammatory and five neoplastic lesions of lacrimal glands (LGs). Atrophic acini in dacryoadenitis reacted with antibodies (ABs) KL1 and Pkk1 (CK 7, 8, 17, 18) in a manner similar to ducts. Apart from myoepithelial cells and some luminal-duct cells, the remaining epithelia in dacryoadenitis were negative with AB 34βE12 (CK 5). The number of AB HHF35 (actin)-positive myoepithelial cells was not altered in dacryoadenitis. Epithelia in dacryoadenitis reacted weakly but consistently with Lf while revealing weak and inconsistent staining for Ly. Vimentin was negative in epithelial cells in dacryoadenitis except in one case. S-100 protein was detected only in epithelia of inflammatory major LGs. Epimyoepithelial islands in lymphoepithelial proliferation reacted variably for CKs, Lf, Ly and vimentin and remained negative for actin and S-100. In pleomorphic adenomas, neoplastic cells showing duct-like differentiation (luminal) reacted consistently with CK 7, 8, 17, 18 and S-100 protein and inconsistently with CK 5, Lf and Ly but remained negative for actin and vimentin. Other neoplastic cells (ovoid/peripheral cells) stained consistently for CK 5, vimentin and S-100 protein and focally for CK 7, 8, 17, 18, actin, Lf and Ly. Spindle-form neoplastic cells found in the stroma exhibited vimentin and S-100 protein and, less frequently, actin. Determination of these antigens in pleomorphic LG adenomas may help to evaluate their prognosis.