Correspondence

Latex/Allergy

To the Editor:The two papers1,2 and the Editorial3appearing in the February 2000 issueof the Annals prompted us to report ourpersonal experience with latex (NRL)allergy in non–risk groups, i.e. occu-pationally unexposed subjects sent toour outpatient allergy clinic to rule outallergic diseases.A total of 599 subjects were enrolled.

Over 90% were adults. None was af-fected by spina bifida or had a history ofmultiple surgical or medical procedures.They all underwent skin prick test (SPT)with the most common inhalant aller-gens and/or food allergens depending onthe clinical problem and with a commer-cially available NRL preparation (Stall-ergenes, Antony, France). In a propor-tion of subjects, RAST with inhalantand/or food allergens was also per-formed.Of the 599 subjects, 447 could be

classified as atopics on the basis ofSPT and/or RAST results and clinicalfeatures, the remaining 152 as non-atopics due to the negative results ofthe same parameters. Forty-one out ofthe 447 atopics were found to be NRLSPT positive (9.2%), whereas none ofthe non-atopics tested positive. Of the41 NLR-SPT positive atopics only 3(0.7% of the whole atopic population)complained of minor symptoms whenexposed to NRL gloves (sneezing,itching, mild urticarial lesions of thehands). Systemic reactions were neverobserved in any of the 599 NRLSPTested subjects, thus confirmingthat the test is safe. None of our pa-tients had ever experienced symptomsby NRL cross-reactive food allergens.

Conclusively, in our occupationallyunexposed population, NLR sensitiza-tion, as detected by SPT, seems to beconfined to atopic individuals in whomit is not a rare phenomenon. NRL al-lergy however, is often asymptomaticand, when clinically overt, symptomsare generally mild. Although we be-lieve that atopics should be screenedfor NRL allergy in order to preventpossible major complications, our re-sults are in line with what affirmed inthe Editorial by Bubak3: NRL is just anallergen and not some mystical entity.

DANIELA ZAULI, MDGAIA DELEONARDI, MDALBERTO GRASSI, MDFRANCESCO B. BIANCHI, MDDepartment of Internal Medicine,Cardioangiology, Hepatology

University of Bologna, Italy

REFERENCES1. Ownby DR, Williams PB, Magera B. Ablinded evaluation of two commercialin vitro tests for detection of latex-specific IgE antibodies. Ann AllergyAsthma Immunol 2000;84:193–196.

2. Saxon A, Ownby D, Huard T, et al.Prevalence of IgE to natural rubber la-tex in unselected blood donors and per-formance characteristics of AlaSTATtesting. Ann Allergy Asthma Immunol2000;84:199–206.

3. Bubak ME. Allergy to natural rubberlatex. Ann Allergy Asthma Immunol2000;84:175.

Response:The letter by Dr. Zauli et al confirmsprevious observations that a very largepercent (100% in their hands) of sub-jects who test positive on screening forIgE to natural rubber latex (NRL) areatopic individuals. That the vast major-

ity of their positive subjects (38 of 41)were asymptomatic upon exposure toNRL again confirms reports that manypeople with IgE to NRL detected byskin testing or by in vitro testing do notreact clinically. These data likely re-flect the fact that atopic individualshave a broad array of cross-reactingantibodies which bind to NRL latexbut which did not have clinical rele-vance. Such atopic individuals proba-bly were not primarily sensitized toNRL but to some cross-reacting foodor inhalant allergen.The authors’ suggestion that all

atopic individuals be screened for NRLIgE sensitization “in order to preventpossible major complications” is con-troversial. The issue is that since thevast majority of individuals detectedby such screening are not clinicallyreactive, what is the overall value ofthe information? Does one subject�90% of “positive” individuals to un-necessary life style changes and pre-cautions with their attendant expenses?This issue has been addressed by otherresearchers who came to the conclu-sion that the benefit from screening allatopics was not worth the “risk” orcosts involved1. It is certainly an areathat is open to debate today.I whole heartedly agree with the au-

thors’ final comment: “NRL is just anallergen and not some mystical entity”.

ANDREW SAXON, MDUCLA School of MedicineLos Angeles, CA

REFERENCE1. Porri F, Lemiere C, Birnbaum J, et al.Prevalence of latex sensitization in sub-jects attending health screening: impli-cations for a perioperative screening.Clin Exper Allergy, 1997;27:413–417.

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