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AND THE
ANSWER IS . . .
Discussion
Allergy to NRL is a significant problem in healthcare personnel with evidence
of sensitivity in up to 15% of hospital-based nurses. The major sources of airborne
NRL allergens are powdered rubber gloves. Therefore, most of the hospital personnel
who become sensitized in environments where sterile powdered NRL gloves are
donned and removed (operating and post-op suites, rooms for sterile procedures).
A careful study of airborne NRL allergen levels has shown the highest levels
in such environments with much lower (frequently undetectable) levels in other
hospital sections, particularly administrative areas. Thus many individuals
allergic to NRL can be switched to jobs in these 'low NRL allergen' areas of
the hospital. It should be noted that NRL allergen is exposed in 'dipped' products
such as gloves but not in 'hard rubber' products such as stoppers.
The diagnosis of allergy to NRL can be made by one of the FDA-approved in vitro
anti-NRL IgE antibody tests in about 80-90% of cases. A prick skin test using
an ammoniated latex extract, while not yet FDA approved, can detect NRL allergy
in some individuals with negative anti-NRL IgE antibody tests. Occasionally
this type of allergy can be detected in individuals with negative in vitro/skin
tests by a provocative challenge testing.
Allergies to certain foods such as bananas, kiwis, chestnuts, avocados are
clinically manifest in about 25-50% but not all of those allergic to NRL. Cross-sensitivity
tips between these foods and NRL allergens may be found in a higher percentage
of cases, some of whom tolerate ingestion of these foods.
Attempts to develop a safe immunotherapy program for NRL program have been
made for some time with variable results. However, at present, there is not
yet an approved NRL immunotherapy protocol.
References
1. Clin Infect Dis 2004;38:252-6
2. Immunol Allergy Clin North Am 2003;23:205-19
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