Latex Allergy Desensitization by Exposure Protocol..(Part 1)

Abstract.

Doctors Offer Allergy Alternatives. Some Patients Turn To Drops Over Shots.

Many allergy sufferers are using alternatives to allergy shots for relief from the spring-time ailment.

Two clinical reports dealing with subcutaneous desensitization to latex are available, but these treatments were reported to have significant side effects. To investigate an alternative method for latex desensitization, we present five cases of immunoglobulin E-mediated latex allergy in which a specific desensitization was successfully performed by means of an original exposure protocol.

"I had extreme congestion in the morning and I had three to four sinus infections a year," said allergy sufferer John Durdan.

Five female patients with proven latex allergy underwent an original contact desensitization by wearing latex gloves daily, progressively increasing exposure to latex. All patients reached a final latex exposure time of 60 min in both hands.

In the past, Durdan said he used to get weekly shots for relief from his allergies. Durdan said that now he uses an alternative, and puts drops under his tongue daily.

The desensitization protocol was completely successful in all patients. Twelve months after the beginning of the desensitization program, all the treated subjects were able to wear latex gloves daily without any clinical manifestations.

"I do it twice a day -- two drops in the morning, one in the afternoon. It's just great," he said.

This study provides evidence that a successful contact desensitization to latex is possible with no side effects. The adopted exposure protocol seems to be completely safe and effective. However, further studies in larger groups of subjects are necessary to fully confirm these preliminary results.p>

Allergists claim that the drops are safer than weekly shots and more convenient. Patients can treat their allergies in the comfort of their own homes.

Implications: We present five patients with latex allergy who underwent desensitization by a new cutaneous exposure protocol. This study provides evidence that a safe therapeutic approach to latex allergy is possible.

"You call up and order the drops over the phone, pay by credit card, and it comes in the mail," Durdan said.

Introduction.

Latex, the content of lactifier cells of the rubber tree (Hevea brasiliensis), used as the raw material for natural rubber, induces immediate and delayed hypersensitivity reactions. Symptoms include contact urticaria, rhinitis, conjunctivitis, asthma, urticarial rash, angioedema, and anaphylactic shock.p>

Allergists said that the drops help patients build an immunity instead of masking symptoms like antihistamines do... [read more]

The first cases of allergy to natural rubber latex (NRL) were described in 1979–1980. Subsequently, allergic reactions to latex proteins have been reported with increasing frequency because of the worldwide use of latex-containing items, such as medical equipment, household and professional gloves, condoms, balls and balloons, footwear, baby pacifiers, carpets, and sport equipment. Although anyone may be susceptible to sensitization, children with spina bifida, health care workers, and patients undergoing repeated surgical procedures or internal examinations are at more frequent risk than the general population.p>

Allergy Desensitization — Fast and Safe Homeopathic care.

Desensitization helps you live more comfortable and safely with your allergy or sensitivity. It takes about 45 minutes using the Miller method of rapid oral dosing with a homeopathic series of preparations of the substances. The preparations are made in-house from the testing materials. The drops under the tongue carry increasing amounts of the allergen challenge into the bloodstream to safely condition the body to tolerate that substance.

An allergic cross-reaction between latex and various foods (most often banana, avocado, kiwi, and chestnut) has been observed. The main cross-reacting allergens may be represented by specific latex proteins (such as hevamines, heveins, proheveins, patatins, and profilins) contained in several plants and fruits.p>

Latex may also cross-react with pollens: a history of pollinosis with positive allergological test to ragweed and grass pollens has been often reported in patients clinically allergic to latex. Until now, the principal therapeutic approach to latex allergy was to avoid the exposure to latex (which is, however, particularly difficult because of the ubiquity of latex products).p>

There has never been a harsh reaction to this procedure. Up to three reactors can be treated in one visit. Avoid the allergens strictly for at least 2 days after desensitization. Take as few medications as possible. Children usually take one treatment, and adults sometimes need two treatments to achieve a comfortable tolerance in about 80% of cases. Booster treatments are recommended as needed and at one year from the first. Many treatments are durable for years.

Just two recent reports are available in the literature dealing with the subcutaneous desensitizing treatment with latex extracts in patients with allergy to latex. In the reported cases, the desensitization was partially successful, but during the protocol many patients experienced important anaphylactic reactions requiring medical treatment. To investigate the possibility of safer alternative methods for desensitization, we present five cases of desensitization to latex, successfully performed by means of an original contact exposure protocol.

The fees are partly reimbursed by extended health care plans, and are income tax deductible.

Methods.

The desensitization protocol was approved by our hospital’s ethics review board, and all patients gave fully informed written consent to the treatment.

Common Questions regarding desensitization:

When can I eat or drink again?

You can have something to eat or drink after 30 minutes.

Nine health care workers with proved immunoglobulin (Ig) E-mediated (Type I) latex allergy were consecutively followed up as outpatients of the Department of Allergology of Policlinico A. Gemelli, Rome. The admission criteria included a history of cutaneous reaction, systemic reaction, or both after contact with latex items, with positive prick test and IgE radioallergosorbent test (RAST) with latex extracts.p>

When can I start eating the foods that I have allergies to and have been desensitized for?

Wait at least 48 hours before reintroducing the food and avoid the inhalants that you have been desensitized to.

Complete allergological evaluation tests (including specific prick tests, measurement of total and specific IgE, and contact and mucosal provocation tests) were performed in all patients. Prick tests were performed with a 1-cm2 piece of surgical latex glove material (the prick-by-prick method, in which a puncture device is pushed into the skin through a piece of surgical latex glove; the gloves were manufactured by Triflex Allegiance Health Care Co., McGaw Park, IL) and a standard latex skin test reagent (500 mg/L; ALK Abellò, Madrid, Spain) at increasing concentrations (5, 50, and 500 mg/L). A wheal larger than 4 mm in diameter was considered as a positive response.p>

What if I have been desensitized to three items, can I eat them all after 48 hours?

No, you should reintroduce these foods very slowly and only after the 48 hour time frame. Start with one allergen after 48 hours, and the next day add another one etc and finally after 4 days you can have all three items again.

Cornstarch may be used as a latex glove powder. Although it has been repeatedly demonstrated to be inert, a prick test with corn was also assessed in all investigated subjects to exclude corn allergy. The patch tests were performed by using the standard latex preparation used for the prick tests and an 1-cm2 piece of surgical glove latex material. Because some patients presented cross-reactions with food allergens, prick tests with the specific food allergens were also performed.p>

What if I react the first time I eat the foods for which I have been desensitized?

You can be given a booster within 3-5 days after the first desensitization if necessary.

Any reaction was checked 72 h after the patch had been placed, assessing positivity according to the North American Contact Dermatitis Group criteria: negative reaction (0); macular erythema (?); erythema, infiltration, and possibly papules (1+); erythematous papules, vesicles, or both (2+); and spreading blisters, crust with ulceration, or both (3+). Total and specific antinatural rubber latex IgE were measured by means of fluorescent enzyme immunoassay (Pharmacia UniCAP System, Uppsala, Sweden). In vitro detection of specific antinatural rubber latex IgG4 antibodies was obtained with a latex-specific fluorescent enzyme immunoassay (Pharmacia CAP FEIA, Uppsala, Sweden).p>

Can I take antihistamines or allergy medication?

Take as few medications as possible.

To confirm the diagnosis of allergy to latex, a specific contact provocation test (asking the patients to wear a latex glove on one hand until any symptoms appeared) and a mucous challenge (asking the patients to hold a latex-gloved finger in their mouth for an hour and recording the occurrence of any symptoms) were performed in all subjects.

Booster treatments are recommended as needed and at 6 months to one year from the first. Many treatments are durable for years. Please feel free to contact us if you are unsure or have further questions... [read more]

After the preliminary allergological examination, a desensitization treatment was proposed to all subjects.p>

Four patients refused to undergo any desensitization treatment; they were four women aged from 24 to 40 yr. Therefore, these subjects were requested merely to avoid contacts with latex-containing items, and they were followed up for at least 1 yr as a control group.

The adopted original protocol for contact latex desensitization, with a duration of 12 mo, is described in detail in Table 2. It consists of a progressively increasing exposure to latex, obtained by wearing latex gloves daily for increasing periods. Allegiance Triflex latex gloves were used. The starting exposure time was 10 s once a day in one hand only (right hand). The scheduled exposure time was incremented every second or third day, reaching a 10-min exposure twice a day (right hand only) at the end of the fifth month. Thereafter, a progressively increasing left hand exposure was started (Months 6 to 8), maintaining a 10-min exposure twice a day on the right hand. In such a way, a 10-min exposure in both hands was achieved at the end of the eighth month. During Months 9 to 12, latex exposures (on both hands simultaneously) were increased, reaching a final exposure of 1 h twice a day at the end of the 12-mo treatment. After the desensitizing treatment, a maintenance latex exposure of at least 60 min in both hands three times a week was recommended. A complete allergological evaluation was reassessed at the end of the specific latex desensitization treatment (treated patients) or after a 12-mo follow-up period (control subjects).

When Trouble Hits Those Holes in Your Head. (Part 2)

Sinusitis refers to inflammation of the sinuses, which is generally caused by an infection (viral, bacterial, or fungal). The sinuses are air-filled spaces around the forehead, cheeks, and eyes that are lined with mucous membranes. Healthy sinuses are sterile (meaning that they contain no bacteria or other organisms) and open, allowing mucus to drain and air to circulate in the nasal passages. When inflamed, the sinuses become blocked with mucus and can become infected. Each year, over 30 million people (adults and children alike) get sinusitis in the United States at some point. Sinusitis can be acute (lasting anywhere from 2 to 8 weeks) or chronic, with symptoms lingering even longer than that.

Each sinus cavity has an opening into the nose to allow a free exchange of air and mucus. But if something causes swelling within the nose, air can be trapped inside a sinus cavity, along with pus and other secretions, causing increased pressure on the wall of the sinus. Or the congestion can create a vacuum in a sinus cavity. Either causes pain when air can no longer pass freely in and out of a sinus cavity.

Typical symptoms of sinusitis depend on which cavity or cavities are involved. These are some of the symptoms:

• A headache upon awakening.
  
  
• Pain when the forehead is touched.
  
  
• An ache in the upper teeth or jaw or a cheek that is tender to the touch.
  
  
• Swollen eyelids and tissues around the eyes and pain between the eyes.
  
  
• Loss of smell, stuffy nose and tenderness on the sides of the nose.
  
  
• Earaches, neck pain and a deep aching on the top of the head.
  
  

Sinusitis typically follows an upper respiratory infection (for example, the common cold) or an allergic reaction (like hay fever, also called allergic rhinitis). These can cause inflammation and swelling that prevents the sinuses from draining properly. This makes the sinuses a great place for organisms like bacteria, viruses, and fungus to live and grow rapidly.

There are three ways to characterize sinus attacks: acute, lasting three weeks or less; chronic, three to eight weeks and, perhaps, months or years; and recurrent, referring to several acute attacks a year.

It is reasonable to conclude that you have acute sinusitis when a cold becomes worse after a week or persists for more than two weeks, especially if it is accompanied by a purulent nasal discharge that fills paper tissue after tissue.

Your health care provider can generally make the diagnosis of sinusitis from your history (that is, asking you a series of specific, appropriate questions) and by examining you, with a focus on the sinuses and upper respiratory system. The simplest way to test for sinusitis is by percussing (tapping) or pressing over your sinuses (that is, on the forehead and cheekbones). If those areas are tender, there is likely to be inflammation and there may be an infection. Transillumination (shining a light through the sinuses) is another simple method that your doctor may use to test for sinus inflammation; if the light does not shine through, this indicates congestion.

Chronic sinusitis, on the other hand, is most likely a result of an airborne allergy to substances like mold, dust and pollen that cause chronic allergic rhinitis (nasal inflammation).

Seeking Treatments.

The treatment for sinusitis is best determined by its likely cause. With or without antibiotics, most cases of acute sinusitis clear up in two weeks.

An acute attack, at the outset, is best treated symptomatically.

If the diagnosis is not entirely clear, if an acute infection recurs, or if your symptoms have been ongoing (chronic), then additional tests that your doctor may consider include an xray, CT scan, or magnetic resonance imaging (MRI). Sometimes, a referral to a specialist (known as an Ear Nose and Throat (ENT) doctor [also called an otolaryngologist]) is necessary. This specialist may perform a rhinoscopy (also called nasal endoscopy) using a fiber optic scope to look at your sinuses or a sinus puncture to test for different organisms that may be causing your sinusitis.

The most important action is drinking lots and lots of liquids, which help thin secretions in the nose and sinuses and promote drainage. Hot soup and spicy foods help, as well. You can also use a saline nose spray or even a nasal saline wash (each is sold over the counter), as many times a day as needed to loosen secretions. And each is harmless.

Humidifying the air also helps, as long as you prevent mold growth. The preferred method is to wet a washcloth with hot water, or heat a wet cloth in the microwave for about two minutes. Hold it over the nose and mouth and breathe the warm moist air.

The goals of treatment for sinusitis are to alleviate symptoms by reducing inflammation and to cure the infection. The latter requires the use of antibiotics (see Medications) to get rid of bacteria and other organisms. To lessen inflammation, on the other hand, there are many possible methods ranging from using a humidifier (see section entitled Lifestyle) to surgical drainage. Several dietary supplements and herbs may help prevent colds, shorten the duration of your cold or flu, or work together with antibiotics to treat your infection and support your immune system. How well many of these substances work can be very individual; talk to your doctor about safety and appropriateness.

Another approach is to use a portable battery-operated humidifier that delivers moist air through a mask over the nose and mouth. If you use a humidifier or vaporizer, you must thoroughly clean the equipment every day and refill it each time with clean water to prevent the growth of allergenic molds.

During a sinus attack, avoid alcoholic beverages, which increase nasal and sinus swelling. Flying can also make things worse. If you're using an oral or a nasal decongestant, limit treatment to three days, lest you create a rebound reaction that worsens the inflammation.

In addition, like many individuals, you may experience a significant improvement in sinusitis symptoms from acupuncture or homeopathy, especially if your symptoms are chronic.

If inflammation seems chronic and persists despite 10 days' antibiotic therapy, consider consulting an allergist to find the cause. While self-treatments described above can reduce symptoms, significant relief can result from the use of a prescribed nasal steroid that is inhaled.

Humming can also help by increasing air flow to the sinuses, as can nasal strips that widen the nasal passages. But there is no scientific evidence - only testimonials - to support the benefit of colloidal silver nose drops.