Sensitivity to rubber chemicals and latex among hemodialysis patients.

test. A history of atopic disease was reported by 6 subjects patients undergoing long-term hemodialysis. (7.2%), pruritus by 35 (42.2%) and dermatitis by 22 (26.5%). Sixteen patients (19.3%), exhibited positive patch tests to PATIENTS AND METHODS rubber antigens (Table I). For 9 of them, the rubber allergy We enrolled 154 consecutive hemodialysis patients (66 women and 88 was considered clinically relevant, as these patients had previmen). The median time of dialysis was 53O 44 months, with a range ously had episodes of allergic contact dermatitis following of 1± 205 months. Skin-prick tests were performed with a standardized exposure to the rubber allergens. However, it was not possible commercial extract of non-ammoniated latex (StallergeA nes, Paris, to assess whether the sensitivity to the rubber chemicals was France) and with glove extracts prepared as previously reported (3). Brie y, twenty 1 cm2 (400mg total weight) freshly cut glove pieces induced by hemodialysis or prior to treatment. The most (Le Petit, Gradate, Como, Italy) were incubated for 30min in 5ml of common sensitizers were thiuram mix (12 cases) and carba sterile 0.9% NaCl saline solution. The incubation uid was used as a mix (5 cases) We did not ® nd any signi® cant diŒerences stock solution for prick testing. Histamine hydrochloride (10mg/ml) concerning age, sex, durationof hemodialysis, history of atopy, and 0.9% NaCl saline solution served as positive and negative controls, respectively. Wheals of 3 mm or greater were regarded as positive in prior or current pruritus among patients with either positive the absence of a reaction to saline. A glove user test was performed or negative patch tests (Table I ). Statistical analysis showed, as follows: a ® ngertip was cut from a surgical glove, dampened with however, a signi® cant association between positive patch water, and placed on one ® nger for 15± 30min. If the reaction was test results and the presence of prior or current dermatitis negative, the whole glove was worn for the same amount of time. One ( p 5 0.004). vinyl glove was used as control. Urticaria on the ® nger/hand exposed to latex was regarded as a positive reaction. Only 83 patients accepted to undergo the patch test. These tests were performed with a series of 32 rubber additives (4). The allergens were applied in Finn Chambers DISCUSSION with Scampor tape to each patient’s back. Readings were taken after 2 and 4 days. The reactions were scored in accordance with the Recent data have demonstrated that non-atopic hemodialysis recommendations of the International Contact Dermatitis Research patients, despite continued exposure, are not at risk of developGroup. Any drug that could have interfered with the allergic tests was ing latex allergy (6). Moreover, allergic contact dermatitis due stopped at least 2 weeks prior to testing. Laboratory evaluation to substances used in manufacturing hemodialysis devices is included measurement of total IgE level by the PRIST (Pharmacia, Uppsala, Sweden) and serum-speci® c IgE to latex by a uorescence rarely reported (7). However, we observed a positive patch enzyme-linked immunoassay (CAP-FEIA system; Pharmacia). The test in 16 patients (19.3%), and 9 reactions were considered threshold of positivity for the CAP test was set at 0.35kU/l. Atopy clinically relevant. Most of the sensitizations were towards was assessed by a careful clinical history of atopic dermatitis and/or allergens normally employed in the European standard patchseasonal or perennial rhinitis or asthma, and by increased IgE levels. test series. Therefore, contact allergy can be a relevant clinical Informed consent was given by subjects prior to participation in the study. problem in hemodialysis patients. Statistical analysis of data was performed by two-tailed chi-squared The exposure to rubber products can vary according to test and Fisher exact test when necessary. Mean values of continuous method of dialysis. Furthermore, the allergenicity can vary variables were compared using Student’s t-test. Probability ( p) values from one product to another based on the allergen content less than 0.05 were considered signi® cant. (7, 8).