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Update in Allergy and Immunology
- Anthony Montanaro, MD; and
- Stephen A. Tilles, MD
- From Oregon Health Sciences University, Portland, Oregon.
- Latex allergy
- Allergy and immunology
- Trimethoprim—sulfamethoxazole combination
- Food hypersensitivity
- Asthma
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
The medical literature addressed many different topics in the field of allergy and immunology in the past year. For this Update, we focus on topics that are particularly relevant to internal medicine: latex allergy, trimethoprim–sulfamethoxazole (TMP-SMX) allergy, environmental controls for persons with allergies, food allergy, use of inhaled corticosteroids, use of monoclonal anti-IgE antibody, asthma, and allergic rhinitis.
Latex Allergy
Although latex allergy has become an increasingly important allergic disorder in U.S. society, it presents a difficult diagnostic problem in both primary and specialty care. One of the major difficulties in diagnosing latex allergy has been the lack of a standardized skin testing reagent.
Study Supports the Efficacy of Nonammoniated Latex Skin Test Reagent for Confirmatory Puncture Skin Tests
In testing for latex allergy, allergists have relied on extracts of unknown potency or have performed skin tests by directly puncturing uncharacterized powdered latex gloves. Reliable in vitro testing is available for latex-specific IgE, but the diagnostic sensitivity and specificity of these assays are generally regarded as being lower than those of puncture skin tests. To document the safety and diagnostic sensitivity of a nonammoniated latex extract, Hamilton and colleagues studied 358 adults. The study participants were divided into three groups on the basis of their clinical history: those who reported no history of allergy to latex (n = 180), those who reported an unequivocal allergy to latex (n = 124), or those in whom latex hypersensitivity had been restricted to contact dermatitis (n = 54). The participants underwent serologic testing for the presence of latex-specific IgE and skin testing. The latter was performed by using a nonammonium latex allergen preparation at an initial concentration of 100 µg/mL; this was increased to 1 mg/mL if results were negative at the lower concentration. Appropriate positive and negative controls were …
