Occupational Asthma Reference

Vandenplas O, Jamart J, Delwiche J-P, Evrard G, Larbanois A, Occupational asthma caused by natural rubber latex: outcome according to cessation or reduction of exposure, J Allergy Clin Immunol, 2002;109:125-130,


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Olivier Vandenplas, Universite Mont-Goginne, Yvoir Olivier Vandenplas

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The long-term effects of reducing exposure to latex in subjects with latex-induced asthma remain unknown.

The purpose of this study was to compare the health and socioeconomic outcomes of subjects with latex-induced asthma before and after reduction or cessation of exposure to latex.

Thirty-six subjects with latex-induced asthma as ascertained by specific inhalation challenges were investigated after a median follow-up of 56 months (range, 12 to 92 months). Initial and follow-up visits included use of a detailed questionnaire and measurement of the concentration of histamine causing a 20% fall in FEV(1) (PC(20)). At follow-up, information on employment, financial status, and quality of life was collected.

At follow-up, 16 subjects were no longer exposed to latex, whereas 20 subjects had reduced exposure. In the subjects who avoided exposure, asthma severity decreased from a median score of 8.5 to 3.5 (P =.001) and the median histamine PC(20) value increased from 0.4 mg/mL to 2.3 mg/mL (P =.002). In the subjects who reduced their exposure, asthma-severity score improved from 6.5 to 2.5 (P <.001) and PC(20) values rose from 0.5 mg/mL to 2.4 mg/mL (P <.001). Cessation of exposure to latex was associated with asthma-related work disability (69%) and loss of income (62%) more frequently than was reduction of exposure (35% and 30%, respectively).

Reduction of exposure to latex should be considered a reasonably safe alternative that is associated with fewer socioeconomic consequences than removal from exposure.

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This article purports to show that reduced exposure is as good as complete removal from latex. The first assessment was done after substantial reduction in exposure having not worn latex gloves for months or years, but remained exposed to latex in the air from coworkers. At follow-up the reduced exposure group were exposed to less than 20 latex gloves used in their department/week or only sterile low allergen gloves were used. There were no air measurements made. None of the comparisons tested differences between the reduced exposure and no exposure groups. There are no redsults for the initial latex IgE levels, or changes at follow-up. The reduced exposure group took a mean 112 minutes of exposure in the initial challenge, vs 60 mins for the complete removal group, who were initially and at follow-up on more treatment, suggesting that the reduced exposure group were less severe at presentation.
It is not safe to conclude from this paper that reduced exposure to latex is as good as no exposure.

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