Association between sensitization to natural rubber latex and papain.

Several studies have documented clinical and immunologic cross-reactivity between natural rubber latex (NRL) and a variety of fruits, mainly banana, avocado, and kiwi?, 2 We fortuitously observed that a nurse with NRL allergy also showed skin reactivity to papain, although she had had no known exposure to this enzyme, which is extracted from the latex of the papaya tree (Carica papaya): Papain is widely used in the food industry (meat tenderizer, beer clearing agent), as well as in pharmaceuticals (local treatment of necrotic ulcers, digestive aid, cleaning agent for contact lenses, chemonucleolysis) and cosmetic products? -5 The latex of C. papaya and commerCial preparations of papain contain a number of characterized enzymes, including cysteine proteinases (papain itself, chymopapain, caricain, and endoproteinase Gly-C; molecular weight, 23 to 24 kd) and chitinase (molecular weight, 28 kd). 6 Papain has been documented as causing IgE-mediated allergic reactions after domestic and occupational exposure. 34 Quarre et al. 7 recently reported an association between allergy to NRL and papain in a subject with occupational exposure to both allergens. The purpose of this study was to assess the prevalence of sensitization to papain among health care workers with and without NRL allergy. METHODS Subjects