Full text of DOI:10.1034/j.1398-9995.2002.1n3503.x

References
Latex allergy was diagnozed and
counselling was given on avoidance of
latex and associated foods. At follow-up,
strict latex avoidance had been introduced
both at home and in her workplace. There
had been a significant improvement in her
asthma, with a reduction in the use of
rescue medication and nocturnal
Risks of latex avoidance
1. NEUGUT AI, GHATAK AT, MILLER RL.
Anaphylaxis in the United States: an
investigation into its epidemiology. Arch
Intern Med 2001;161:15–21.
G. P. Spickett*, L. J. Wright
2. SUSSMAN GL, BEEZHOLD DH. Allergy to latex
rubber. Ann Intern Med 1995;122:43–46.
3. EBO D. Ige-Mediated Allergy from Natural
Rubber Latex. UCB Institute of Allergy,
2000.
Key words: allergen avoidance; anaphylaxis;
natural rubber latex.
symptoms. The abdominal symptoms had
ceased. The clinical impression was that
most of her chronic symptoms were owing
to low-level environmental latex exposure.
Specific IgE to latex was not detected in the
bloodbutskin-pricktestwithALK-Abello
skin-prick test solution was positive at 10
Hep strength, confirming latex
. ANAPHYLAXIS to latex is now well
recognized and is on the increase. A recent
estimateintheUSAindicatesthatthereare
220 latex-induced anaphylactic reactions
per year (1). An earlier study of reports to
the Food & Drug Administration
TARC in allergic disease
identified more than 1100 cases of latex
anaphylaxis, with 15 deaths (2). We
describe the onset of anaphylaxis to latex
developing in a patient with longstanding
but undiagnozed latex allergy causing
wheeze and angiedema only after latex
avoidance measures were introduced.
The patient was a 34-year-old female
who worked as a bank clerk. She was
referred with allergic problems of asthma
and rhinitis. She also complained of
vomiting after certain foods. All the
symptoms were of long standing. The
referral from the
sensitization.
Anaphylaxis to latex was not a feature
of the clinical presentation until after
latex avoidance was instituted. Two
severe episodes have occurred, one
triggered by kissing her daughter, who
had been blowing up balloons at school
and the second by the introduction of a
large number of latex stress balls into her
workplace. On both occasions, there was
immediate onset of laryngeal edema,
acute respiratory distress, hypotension
and on one occasion loss of
N. Sugawara*, T. Yamashita, Y. Ote, M. Miura,
N. Terada, M. Kurosawa
Key words: allergic diseases; plasma TARC level;
thymus and activation-regulated chemokine (TARC).
. THYMUS activation-regulated
chemokine (TARC/CCL17) is a member
of CC chemokine that is transiently
expressed in phytohemagglutinin-
stimulated peripheral blood
consciousness. Both responded to
administration of epinephrine in the
community with an auto-injection device
[Epipen].
primary care
physician did
Re-exposure can give
mononuclear cells (PBMC) and
constitutively and selectively in the
thymus (1). Recently it has been
reported that
severe reactions.
not mention
latex allergy.
This case illustrates that strict allergen
avoidance may make reactions on
subsequent allergen exposure more
severe, and may indicate that continuous
low level environmental exposure may
produce an incomplete tolerance. All
published information on severe IgE-
mediated latex allergy indicates that
avoidance is the cornerstone of further
reactions (3), but this case indicates that
this advice may actually lead to fewer but
more severe reactions. This may have
implications for advice to allergic patients
on allergen avoidance.
However, a careful history identified
reactions to latex-containing clothing,
condoms, gloves and during dental and
gynaecological procedures, characterized
mainly by wheeze. There was no history of
anaphylaxis to latex. She was intolerant of
avocado pears, potatoes and tomatoes,
with symptoms of immediate nausea and
vomiting. She had seasonal rhinitis
beginning in March, suggestive of birch
pollen allergy and tended to avoid stone
fruits. such as apples and pears. She had a
previous severe reaction while taking
ibuprofen, although this was after an
operation when she had a latex drain
inserted into her leg. She was using
salmeterol, high dose inhaled
the TARC
receptor CCR4
is selectively
Thymus and activating-
regulated chemokine
may be a useful marker
for disease.
expressed in T
helper (Th2)
cells and that
serum TARC
level is associated with disease activity in
atopic dermatitis (2,3). This is the first
report describing plasma TARC levels in
patients with bronchial asthma and
allergic rhinitis.
Plasma TARC concentration was
measured by ELISA (R&D systems,
MN, USA) in 50 healthy
*Regional Department of Immunology
Royal Victoria Infirmary
Newcastle upon Tyne NE1 4LP
UK
volunteers who previously
showed no allergic symptoms, 30
patients with atopic dermatitis, 64
patients with bronchial asthma, and 22
patients with allergic rhinitis. In this
study patients treated with drugs were
excluded. The mean concentration of
TARC in healthy volunteers was
31.9 pg/ml (SD14.8); significantly higher
than in non-allergic volunteers, and than
beclomethasone and salbutamol inhalers,
nasal triamcinolone. Asthma control was
poor, with significant nocturnal wheeze.
She was said to have irritable bowel
syndrome. She had recurrent tonsillitis.
Examinationrevealedverylargetonsilsfor
herage, thepeakexpiratory flow was490 l/
min. There were no other abnormalities on
physical examination.
Tel.+44-91-2824281
Fax:+44-91-2275071
E-mail: gavin.spickett@nuth.northy.nhs.uk
Accepted for publication 25 September 2001
Allergy 2002: 57:180
Copyright # Munksgaard 2002
ISSN 0105-4538
180

patients with atopic dermatitis
Accepted for publication 30 August 2001
Allergy 2002: 57:180–181
IgE to Bet v 1/Bet v 2 in UAS
(p,0.001), bronchial asthma (p,0.001),
and allergic rhinitis (p,0.001): 325 pg/
ml (287), 271 pg/ml (264), and 147 pg/
ml (101), respectively,. (Fig. 1). IgE
levels and numbers of peripheral
eosinophils were not necessarily
Copyright # Munksgaard 2002
ISSN 0105-4538
M. De Amici*, R. Moratti, S. Quaglini, M. A Vignini,
M. Mosca
correlated with the TARC level.
Though Th2 cytokines such as IL-4,
IL-5 and IL-13 play important roles in
allergic diseases it is difficult to
Key words: food allergen; hypersensitivity;
References
recombinant birch pollen.
1. IMAI T, YOSHIDA T, BABA M. et al.
Molecular cloning of a novel T cell-
directed CC chemokine expressed in
thymus by signal sequence trap using
Epstein-Barr virus vector. J Biol Chem
1996;271:21514–21521.
. SOME patients with birch pollen
allergic hypersensitivity also refer
symptoms of the ‘oral allergy syndrome’
when they eat fresh fruit, certain
vegetables and hazelnuts (1–4). Cross-
reactivity between apples and birch
pollen occurs not only at the serologic
level but also at the cellular level (4). In
order to evaluate the relationship
between specific IgE levels for Bet v 1/
Bet v 2 with 11 types of food (apple,
celery, carrot, hazelnut, tomato, potato,
cucumber, peanut orange, kiwi and
turkey meat) serum IgE levels were
determined by FEIA (Pharmacia,
Upjohn) in 33 patients with specific IgE
to birch pollen.
efficiently detect them, because of the
poor sensitivity of assays of peripheral
blood. We measured these three
plasma cytokines but even IL-13,
which is the easiest of the three to
detect, was detected in only 54 of
the 116 patients, while TARC was
detected in all patients. In our study,
following prednisolone treatment in 6
patients with bronchial asthma, the
plasma TARC levels decreased to those
of the healthy volunteers (pre/post:
237/35.6 pg/ml, p,0.005).
2. IMAI T, NAGIRA M, TAKAGI S et al.
Selective recruitment of CCR4-bearing
Th2 cells toward antigen-presenting cells
by the CC chemokines thymus and
activation-regulated chemokine and
macrophage-derived chemokine. Int
Immunol 1999;11:81–88.
3. KAKINUMA T, NAKAMURA K et al.
Thymus and activation-regulated
chemokine in. atopic dermatitis: Serum
thymus and activation-regulated
chemokine level is closely related with
disease activity. J Allergy Clin Immunol
2001;107:535–541.
These results suggest that the
measurement of plasma TARC may be
a new useful diagnostic marker not only
of atopic dermatitis but also bronchial
asthma and allergic rhinitis.
Twenty patients (61%) were positive
for Bet v 1,
four patients
Positivity to apple is
(12%) for
Bet v 2, and six
patients (18%)
*Naoto Sugawara
the best predictor.
R & D
for both allergens. Twelve out of the 30
patients (40%) sensitized to recombinant
allergens reported symptoms of the ‘oral
allergy syndrome’.
Mitsubishi Kagaku Bio-Clinical Laboratories,
Inc.
3-30-1 Shimura
Itabashi-ku
Tokyo 174–8555
Japan
A significant correlation (Spearman’s
rank test) was identified between Bet v 1
IgE and apple IgE (r=0.37, P=0.03).
Significant positive correlations
(P,0.01) were also found for Bet v 2
IgE and 10 of the 11 foods (not for
turkey meat).
As shown in Table .1, all patients
with IgE specific only for Bet v 2 also
had IgE for the same three foods (apple,
peanut and carrot), while all those with
IgE for both Bet v 1 and Bet v 2 had
IgE for the same five foods (apple,
peanut, carrot, tomato and potato).
Specific IgE was observed most
frequently for apple and was present in
93% (28/30) of the patients sensitized to
either or both recombinant birch
pollens.
Symptoms of the ‘oral allergy
syndrome’ were reported by 35% (7/20)
of the patients positive for Bet v 1
Figure 1. Comparison with plasma TARC level in healthy volunteers (NORMAL) and the patients with
atopic dermatitis (AD), bronchial asthma (BA) and allergic rhinitis (AR).
181