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1Crest Oral-B at dentalcare.com Continuing Education Course,
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Online Course:
www.dentalcare.com/en-US/dental-education/continuing-education/ce81/ce81.aspx
Disclaimer: Participants must always be aware of the hazards of
using limited knowledge in integrating new techniques or procedures
into their practice. Only sound evidence-based dentistry should be
used in patient therapy.
This course is based on a review of the literature and presents
the etiology and epidemiology of adverse reactions to latex
products, clinical manifestations of adverse reactions to latex
products, and strategies for the prevention and treatment of
adverse reactions to latex products.
Conflict of Interest Disclosure Statement Dr. Huber reports no
conflicts of interest associated with this course. Dr. Terzhalmy
has done consulting work for Procter & Gamble and is a member
of the dentalcare.com
Advisory Board.
ADA CERPThe Procter & Gamble Company is an ADA CERP
Recognized Provider.
ADA CERP is a service of the American Dental Association to
assist dental professionals in identifying quality providers of
continuing dental education. ADA CERP does not approve or endorse
individual courses or instructors, nor does it imply acceptance of
credit hours by boards of dentistry.
Concerns or complaints about a CE provider may be directed to
the provider or to ADA CERP at: http://www.ada.org/cerp
Approved PACE Program ProviderThe Procter & Gamble Company
is designated as an Approved PACE Program Provider by the Academy
of General Dentistry. The formal continuing education programs of
this program provider are accepted by AGD for Fellowship,
Mastership, and Membership Maintenance Credit. Approval does not
imply acceptance by a state or provincial board of dentistry or AGD
endorsement. The current term of approval extends from 8/1/2013 to
7/31/2017. Provider ID# 211886
Michaell A. Huber, DDS; Gza T. Terzhalmy, DDS, MAContinuing
Education Units: 2 hours
Adverse Reactions to Latex Products: Preventive and Therapeutic
Strategies for Oral Healthcare Settings
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OverviewEvidence-based infection control/exposure control
practices are evolutionary in nature. Elements of historical note
were first recorded with the suggestions of Lister for guidelines
on aseptic procedures.1 Others, like Semmelweis, promoted the
practice of hand washing by medical students and physicians prior
to leaving autopsy suites and before entering the labor and
delivery areas of hospitals.2 Halstead is credited with being the
first to use surgical gloves in a clinical setting.3 While the use
of latex surgical gloves became routine by the end of World War I,
it wasnt until the adoption of universal precautions by the Centers
for Disease Control and Prevention in 1987 that the use of gloves
was officially expanded to cover virtually all aspects of patient
care.4 Since then the ubiquitous use of latex gloves and other
latex products in healthcare has resulted in a parallel increase in
latex-associated adverse reactions. To provide for a safe
environment for both oral healthcare workers (OHCWs) and patients
alike, clinicians must understand the basis for latex-related
adverse reactions, recognize associated signs and symptoms, and
initiate appropriate preventive and therapeutic strategies. The
recommendations for preventing or minimizing latex-related adverse
reactions in the oral healthcare setting are based on current
knowledge and a common sense approach to the problem.
Learning ObjectivesUpon completion of this course, the dental
professional should be able to: Discuss the etiology and
epidemiology of adverse reactions to latex products. Recognize the
clinical manifestations of irritant contact dermatitis, allergic
contact dermatitis, and
immediate allergic reactions. Discuss diagnostic issues related
to adverse reactions to latex products. Establish strategies for
the prevention of adverse reactions to latex products. Implement
strategies for the treatment of adverse reactions to latex
products.
Course Contents Etiology and Epidemiology Clinical
Manifestations
Irritant Contact Dermatitis Allergic Contact Dermatitis
Immediate Allergic Reactions Urticaria Angioedema Allergic
Rhinoconjunctivitis and Asthma Anaphylaxis
Diagnosis Medical History Laboratory Testing Skin-patch Testing
Skin-puncture Testing (SPT) Radioallergosorbent Test (RAST) Glove
Provocation Testing (GPT)
Preventive Strategies for the Oral Healthcare Setting
Treatment Strategies Conclusion Course Test Preview References
About the Authors
Etiology and Epidemiology Latex is a product of the Brazilian
Hevea brazilienses rubber tree harvested mainly in Malaysia,
Indonesia, and Thailand.5-6 A milky sap flows in lactifers under
the surface of the bark, which is collected by making diagonal cuts
in the bark of the tree. Once collected, ammonia is added to the
sap to prevent autocoagulation and bacterial contamination of the
latex.5,7,9 There are two types of ammonia-latex concentrates: high
ammonia-latex concentrate (0.7% ammonia by weight) and low
ammonia-latex concentrate (0.2-0.3% ammonia by weight). While the
higher ammonia concentration is more effective in stabilizing the
latex, it also increases the incidence of irritant contact
dermatitis.7,10
Natural rubber latex contains cis-1,4-polyisoprene (the major
component), proteins, lipids, carbohydrates, and numerous inorganic
constituents such as potassium, manganese, copper, zinc, and
iron.11 Over 250 proteins have been identified in latex and,
depending on the source; the overall protein content varies
from
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1-1.8%. These proteins are involved in numerous processes of
biosynthesis and defensive, structural, and housekeeping
functions.9 While about 30-60 latex proteins are believed to be
responsible for virtually all of the immediate hypersensitivity
reactions (Gell and Coombs Type I), only 13 of these proteins have
been classified and labeled by the International Nomenclature
Committee of Allergens.5,11,12
Gloves are produced by one of two processes: coagulant dipping
or straight dipping.8 In coagulant dipping a destabilizing chemical
is deposited on the formers, while in straight dipping no
destabilizing agent is used. After dipping, the latex product on
the former is washed (leached) to remove residual chemicals and
proteins. In order to enhance elasticity, strength, and stability
it is then subjected to the process of vulcanization (heating in
the presence of sulfur). To reduce the time and temperature
required for vulcanization, numerous accelerators and promoters
(thiurams, mercaptobenzothiazoles, and carbamates) are added. After
vulcanization, post-cure leaching further removes residual
chemicals and proteins. Residual chemicals are primarily
responsible for allergic contact dermatitis associated with latex
glove use (Gell and Coombs Type IV).7,9,10,13-15
If the gloves are destined to be free of donning powder, another
washing followed by chlorination and further washing is undertaken
to reduce the inherent tackiness of latex.8 Alternatively, donning
powder may be added by dipping the gloves into slurry prior to
removal from the
formers. Donning powder (typically cornstarch) is recognized as
a major vector for the development of latex sensitivity.8,14,16-26
Free extractable proteins not removed during the glove
manufacturing process may be adsorbed by the cornstarch. During the
donning, use and removal of these gloves, the cornstarch-protein
complexes come in direct contact with skin and mucosal surfaces or
become suspended in the air (aeroallergens) for up to six hours.27
Following direct contact, mucosal surfaces appear to absorb latex
proteins much more readily than intact skin and exposure to
aeroallergens is considered the predominant method of inducing
latex sensitization in healthcare workers.18.19,25,28 While an
allergy to cornstarch is rare, evidence exists that it may act as
an immunoadjuvant further increasing the risk of latex-induced
allergic reactions.7,18,29
Improvements in the manufacturing of latex gloves includes the
use of enzymatic processes to breakdown raw latex proteins;
increased centrifugation of the raw latex liquid to separate out
more latex proteins; refined leaching protocols; and chemical
deproteinization during the leaching process.8 In addition the use
of oat starch in lieu of cornstarch as a donning powder appears to
be associated with reduced aeroallergen formation.25 An increasing
number of latex-free alternatives are also becoming available;
however, residual chemicals associated with the manufacturing of
non-latex gloves may also induce delayed hypersensitivity
reactions.8
The incidence of latex allergy in the general population is 1 to
2 percent.30 Patients with spina bifida, because of repeated
exposure of mucous membranes to latex during various
medical/surgical procedures, are at highest risk of latex allergy
with a prevalence rate that ranges from 20 to 67 percent.30
Healthcare workers have the second highest risk of developing latex
allergy with sensitization rates that are three times higher than
in the general population.30,31,32 Healthcare workers who are
exposed to latex products on a regular basis are at higher risk
than those who are not routinely exposed.7 There is also a positive
correlation between the risk of latex allergy and the length of
employment in healthcare.33 Finally, exposure to powdered gloves
appears to be associated with symptoms of asthma, allergic
rhinitis, conjunctivitis, and angioedema.7,30,32
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Clinical ManifestationsAdverse reactions following exposure to
latex products may be categorized as: (1) irritant contact
dermatitis, (2) allergic contact dermatitis, or (3) immediate
hypersensitivity reactions (urticaria, angioedema, allergic
rhinitis, asthma, or anaphylaxis).5,7,10,14,34
Irritant Contact DermatitisThe most common reaction to latex
products, specifically to latex gloves, is irritant contact
dermatitis (ICD). ICD, characterized by dry, cracked, itchy,
irritated areas of the skin (usually of the hands) is not an
allergy. The time of onset is gradual (over several days) and may
result from abrasion and maceration from wearing gloves constantly,
repeated hand washing and drying, incomplete hand drying, the use
of cleaners and sanitizers, exposure to powder added to gloves, and
exposure to other workplace products and chemicals.5,7,10,35 These
signs and symptoms are similar to those associated with allergic
contact dermatitis, which can only be ruled out by allergy testing.
In one study, only 9 percent of healthcare workers who reported
symptoms of allergic contact dermatitis actually had a latex
allergy; the remainders had ICD.36 In a study of dental students,
of the 10 percent who reported reactions to latex, only 1 percent
had confirmed diagnosis of latex sensitization.31 Other studies
suggest that 80 percent of the cases of hand dermatitis are a
result of ICD.34,37 It is important to note that ICD increases the
potential for allergic sensitization.9,20,30,35-40
Allergic Contact DermatitisAllergic contact dermatitis (ACD) is
a delayed hypersensitivity reaction (Gell and Coombs Type IV)
caused primarily by the accelerators, promoters, and antioxidants
that are added to
natural rubber latex during harvesting, processing, or
manufacturing.5,7,9,10,13,15,24,35,39 Many of these processing
chemicals are also utilized in the manufacturing of nitrile and
neoprene gloves.15 ACD is a T cell-mediated immune response. It is
characterized by a papular, pruritic rash; redness; and itching,
which usually begin 24 to 48 hours after contact with offending
products and may progress to oozing vesicles and blisters and
spread to areas of skin untouched by latex15,41,42 (Figure 1). The
reaction is similar to those caused by nickel and poison ivy. A
skin rash may be the first sign of allergy to latex and more
serious reactions could occur with continued exposure. Since the
clinical signs and symptoms of ACD are similar to ICD, it is
necessary to confirm the allergic nature of the reaction in order
to avoid further sensitization. The most frequently cited allergen
for glove-related ACD is the accelerator thiuram.5,43 ACD can
develop upon re-exposure to an antigen many years after initial
exposure.7
Immediate Allergic ReactionsThe risk of progression from ACD to
more serious reactions is unknown, but at least some patients
initially develop ACD; then urticaria; then allergic rhinitis,
sneezing, scratchy throat, conjunctivitis, angioedema, wheezing,
asthma (coughing, difficulty breathing); and, rarely, anaphylaxis.
Immediate allergic reactions are all IgE mediated.24,34
UrticariaUrticaria (local or generalized) is the most common
presentation of a type I hypersensitivity reaction to latex (Figure
2). It likely reflects an IgE-mediated immediate hypersensitivity
reaction in response to contact with latex proteins, although not
all cases are associated with detectable latex-specific IgE
antibodies. Symptoms usually occur within 10 to
Figure 1. Allergic contact dermatitis characterized by rash,
redness, and itching, which began about 24 hours after dental
treatment under a rubber dam.
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proteins) on the mucosal surfaces of the eyes and upper
respiratory tract initiate the IgE-mediated allergic response. If
sufficient aeroallergens penetrate below the level of the glottis,
the allergic response progresses to include asthma.22 An estimated
2.5% of healthcare workers are susceptible to asthma induced by
exposure to latex aeroallergens.21
AnaphylaxisAnaphylaxis is the most severe manifestation of a
type I hypersensitivity reaction. Latex proteins interact with IgE
antibodies found on tissue mast cells and peripheral blood
basophiles. A massive release of histamine and other mediators
initially results in weakness, dizziness, and cutaneous symptoms
such as flushing and urticaria. Anaphylaxis progresses rapidly and
sequentially to include laryngeal edema (resulting in stridor),
bronchospasm (resulting in wheezing); followed by hypotension,
tachycardia, and vascular collapse as a result of decreased
systemic vascular resistance (Figure 4).45 While anaphylaxis is
seldom the first sign of latex allergy, latex exposure is estimated
to account for 12 to 40 percent of anaphylactic reactions that
occur during adult surgery.30,46,47 In oral healthcare settings,
anaphylactic reactions to latex products have been reported to
occur with
15 minutes of direct contact and is characterized by itching,
redness, and wheal and flare reaction at the site of contact.
Urticaria may represent a transitional stage in the progression
from ACD to immediate hypersensitivity. Reactions that occur within
60 minutes of exposure to a latex product are highly suggestive of
IgE-mediated allergy, while delayed or persistent urticaria is
suggestive of delayed hypersensitivity.44
AngioedemaAngioedema may be a feature of urticaria. It is
characterized by episodes of localized, well-circumscribed,
nonpitting swelling commonly affecting the lips (Figure 3), face,
limbs, trunk, abdominal viscera, and larynx. When edema affects the
larynx, upper airway obstruction can be severe and life
threatening. Involvement of the gastrointestinal tract is
associated with severe pain.
Allergic Rhinoconjunctivitis and AsthmaNasal congestion,
sneezing, rhinorrhea, watery eyes, and an itching sensation of the
oropharyngeal mucosa are clinical symptoms of a type I
hypersensitive reaction known as allergic rhinoconjunctivitis.22 It
is generally accepted that deposits of aeroallergens (in this case
latex
Figure 2. Acute urticaria characterized by pruritic, red wheals
that range from 1.5 to 3.0 cm in diameter, which began about an
hour after exposure to latex gloves.
Figure 3. Angioedema characterized by localized,
well-circumscribed, non-pitted swelling affecting the lips.
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known to have allergens that cross-react with latex.30,36
Many latex proteins, collectively called pathogenesis-related
(PR) proteins, serve to protect the rubber tree from a variety of
environmental threats such as infections (fungal, bacterial, and
viral), wounding, and chemical insults.50 These same proteins are
also expressed in numerous other plant species.51,52 For example,
the latex protein -1,3-glucanase shares high association with the
-1-3-glucanase proteins found in avocado, banana, chestnut, and
kiwi. Other latex PR proteins share moderate association with
analogous proteins in apple, carrot, celery, melon, papaya, tomato,
and potato. Low or undetermined association exists between still
other latex PR proteins and many other fruits and vegetables, e.g.,
turnip and zucchini.53 It is estimated that a patient with a
history of fruit allergy has an 11% risk of concurrent latex
allergy.59 Conversely, up to 50% of patients with latex allergy are
hypersensitive to some plant-derived foods.5,30,54
Laboratory TestingThere is no standardized testing protocol for
diagnosing latex allergy and screening for latex allergy in the
general population has not been found useful and is not
indicated.7,55 However, testing may be helpful in high-risk
patients (e.g., patients with a high number of previous surgical
procedures, a history of atopy, and a history of adverse reaction
to latex).28,47,56
Skin-patch TestingSkin-patch testing is a sensitive test for
diagnosing type IV delayed hypersensitivity reactions to rubber
additives (e.g., chemical accelerators,
exposure to gloves, dental rubber dams, and exposure to
latex-related aeroallergens.7 Rapid detection of signs and symptoms
with immediate intervention is necessary to prevent serious
complications and death.10,48
DiagnosisThe diagnostic algorithm for latex allergy entails
obtaining a thorough medical history, skin-patch testing for
diagnosing type IV delayed hypersensitivity, i.e., allergic contact
dermatitis; serum IgE measurement to confirm suspected severe latex
allergy, i.e., type I immediate hypersensitivity; and glove
provocation testing when the patients clinical history is
incongruent with IgE results.7,29,49
Medical HistoryObtaining a complete medical history is the first
step in diagnosing latex allergy. OHCWs and patients who relate a
history of papular, pruritic rash of the skin; rhinitis;
conjunctivitis; urticaria (local or generalized); angioedema; and
coughing, shortness of breath, or wheezing; and/or a drop in blood
pressure following exposure to latex should be suspected of latex
allergy. As noted earlier, certain patient populations (i.e., those
with neural tubal defects and occupational exposure) are at higher
risk for latex allergies than the general population. Other risk
factors include a history of atopy (persons predisposed to multiple
allergies such as those with a familial history of hay fever,
asthma, dry skin, or eczema), multiple surgeries, previous hand
dermatitis of any kind, and allergies to foods
Figure 4. Anaphylactic reactions to latex allergens in the oral
healthcare setting characterized by angioedema of the lips and
oropharynx associated with stridor, wheezing, hypotension, and
tachycardia.
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CA, USA], ImmunoCAP [Phadia AB, Portage, MI, USA], CLA
Allergen-Specific IgE Assay [Hitachi Chemical Diagnostics, Mountain
View, CA, USA], and HY TECH-288 [Hycor Biomedical Incorporated,
Garden Grove, CA, USA] licensed by the FDA. Their sensitivity and
selectivity is variable, ranging from 50 to 90 percent and 80 to 87
percent, respectively.30
Glove Provocation Testing (GPT)GPT is useful when the patients
clinical history is inconsistent with IgE results.30 During the
test, the patient wears one finger of a latex glove while the
physician watches for a reaction. If there is no urticarial
reaction after 15 minutes, the exposed surface area is increased.
The test concludes when an urticarial response is identified (i.e.,
a positive provocation test), or when the patient is able to wear
the full glove for 15 minutes with no reaction (i.e., a negative
provocation test).7,30 Because of variations of latex content in
gloves, this test has varied sensitivity and could be unsafe in
highly sensitized persons.7
Preventive Strategies for the Oral Healthcare SettingTo prevent
cross-contamination, oral healthcare workers must perform proper
hand hygiene (work practice controls) and wear gloves (engineering
controls) during the treatment of all patients and when cleaning
and disinfecting instruments, dental units, and environmental
surfaces.58,59 Sterile surgical gloves are used during surgery.
Non-sterile examination gloves are used for routine examinations,
restorative procedures, and preventive care and thick utility
gloves are used during cleaning procedures. Most available glove
types contain latex proteins in variable amounts, as well as
processing chemicals that are responsible for precipitating type I
or type IV allergic reactions, respectively.
The proteins responsible for latex allergies fasten to the
powder (cornstarch) used as a donning lubricant in some gloves.
While cornstarch is an extremely rare sensitizing agent, when
powdered gloves are used, more latex proteins reach the host.
During donning, use, and removal, the water-soluble
cornstarch/latex protein particles become airborne. These aerosols
can be inhaled and absorbed systemically, causing conjunctivitis,
rhinitis, and asthma. Work areas,
antioxidants) and helps to differentiate ACD from ICD. It is
performed by applying allergen samples to intact skin and covering
them with a dressing. The patient is checked for skin reaction at
30 minutes, 24 hours, and 48 hours.7,30 Swelling, redness, or
blistering characterize a positive test. If the test is negative,
the site is reexamined again at 72 and 96 hours because weak
reactions may appear later. A refinement of the technique, the thin
layer rapid use epicutaneous (TRUE) test (Allerderm, Petaluma, CA,
USA), has been licensed by the FDA and is available commercially.
The TRUE test consists of a pre-prepared testing strip containing
24 of the most common contact allergens, including four rubber
screening mixes and mercaptobenzothiazole.9
Skin-puncture Testing (SPT)The skin-puncture test (SPT) is the
most sensitive testing method for diagnosing type I immediate
hypersensitivity reactions.30,36,55,57 A minute quantity of
allergen, sufficient to react with IgE antibodies fixed in
cutaneous mast cells, is introduced into the epidermis at a single
point. After 15 minutes, a wheal formation equal to or larger than
half the control signifies a positive response.30 However, SPT
should only be performed at medical centers with staff experienced
and equipped to manage severe IgE-mediated immediate
hypersensitivity reactions and an FDA-approved latex skin-puncture
testing reagent is not available in the United States.30,42
Radioallergosorbent Test (RAST)The radioallergosorbent test
(RAST), a quantitative measurement of allergen-specific IgE
antibodies, is considered to be the safest testing method for
confirming suspected severe latex allergy because there is no risk
of anaphylaxis.30 There are a number of assays (e.g., Alastat
[Diagnostic Products Corporation, Los Angeles,
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by following the recommendations of the National Institute for
Occupational Safety and Health (Figure 5).28
Treatment StrategiesOnce an individual becomes allergic to
latex, special precautions are needed to prevent exposure at home,
at work, and during medical and dental care. They should also be
aware of common natural rubber latex products, as well as foods
with cross-reactive proteins.30 Pretreatment with antihistamines,
corticosteroids, and bronchodilators do not predictably prevent
latex or other IgE-mediated anaphylactic reactions, consequently,
complete latex avoidance is the most effective approach to this
problem.26 While symptoms of latex allergy resolve quickly with
avoidance, elevated IgE levels can remain detectable for more than
5 years after exposure, suggesting the importance of long-term
avoidance.65 OHCWs and patients with a history of type I
hypersensitivity to latex should wear a Medic Alert bracelet and
carry epinephrine for emergency use.39 Strategies for the
management of emerging
where only powder-free gloves are used, show low or undetectable
levels of allergy-causing latex proteins.4,9,21,23,24 Consequently,
low-protein, powder-free gloves; or latex-free gloves provide a
primary prevention of latex allergy.32,60-62
The amount of latex exposure to produce sensitization or
symptoms of an allergic reaction is unknown. However, reductions in
exposure to latex products have been reported to be associated with
decreased sensitization and symptoms.19,24,36,44,63 Table 1
contains some of the products used in dentistry that contain latex
and a list of alternative products.52 Practitioners should
routinely check with their suppliers to stay current on the
availability of latex-free substitutes. The cost of latex
alternatives and non-latex gloves has been analyzed, and it was
found to be less expensive when compared to the disability and
liability costs associated with exposure to latex products.6,64
Allergic reactions to latex products in the healthcare setting
can be minimized or prevented
Table 1. Dental products that frequently contain latex and
alternatives.52
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Reductions in exposure to latex products have been reported to
be associated with decreased sensitization and symptoms,
consequently, a reasonable reduction of latex products in the oral
healthcare setting should be considered for the protection of both
OHCWs and the patient. Low-protein, powder-free gloves, or
latex-free gloves provide a primary prevention of latex
allergy.
adverse reactions to latex are presented in Figure 6.66,67
ConclusionAdverse reactions to latex products in the oral
healthcare setting can result in potentially serious health
problems; however, such adverse reactions can be minimized or
prevented.
Figure 5. Strategies for the prevention of adverse reactions to
latex products.
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Figure 6. Strategies for the treatment of allergic reactions to
latex products.
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Course Test PreviewTo receive Continuing Education credit for
this course, you must complete the online test. Please go to:
www.dentalcare.com/en-us/dental-education/continuing-education/ce81/ce81-test.aspx
1. Naturally occurring proteins found in latex are believed to
be responsible for inducing what type of allergic reaction?a. Type
Ib. Type IIc. Type IIId. Type IV
2. The process in which latex is heated in the presence of
sulfur is termed:a. Leachingb. Vulcanizationc. Autocoagulationd.
Chlorination
3. The most commonly used donning powder is ____________.a.
talcumb. baby powderc. cornstarchd. oat starch
4. During the donning process, donning powder may become
suspended in the air for up to __________.a. 10 minutesb. 1 hourc.
6 hoursd. 24 hours
5. Residual chemicals associated with the manufacturing of
non-latex gloves may also induce delayed hypersensitivity
reactions.a. Trueb. False
6. The most common form of adverse reaction to latex glove use
is ____________.a. irritant contact dermatitisb. allergic contact
dermatitisc. immediate hypersensitivity reaction
7. Factors contributing to irritant contact dermatitis
include:a. Frequent hand washingb. Constant wearing of glovesc.
Exposure to donning powderd. All of the above.
8. Allergic contact dermatitis is ____________.a. delaying
hypersensitivity reactionb. caused by latex proteinsc. caused by
accelerators, promoters and antioxidants added during glove
manufacturingd. A and C
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9. One of your assistants develops a hand rash while working in
the office. She relates that the rash only occurs when she wears
brand X, but not brand Y. She is most likely describing what type
of adverse reaction?a. Irritant contact dermatitisb. Allergic
contact dermatitisc. Immediate hypersensitivity reaction
10. The most common presentation of a type I hypersensitivity
reaction is:a. Asthmab. Angioedemac. Urticariad. Allergic
rhinitis
11. Type I hypersensitivity reactions are mediated by:a. IgAb.
IgDc. IgEd. IgM
12. The most serious manifestation of a type I hypersensitivity
reaction is:a. Anaphylaxisb. Asthmac. Angioedemad. Allergic
rhinitis
13. The diagnostic algorithm for latex allergy include
_______________.a. obtaining a thorough medical historyb.
skin-patch testing for diagnosing type IV delayed hypersensitivity
and serum IgE measurements
to confirm type I immediate hypersensitivityc. glove provocation
testing when patients clinical history is incongruent with IgE
resultsd. All of the above.
14. Historical clues to a possible latex sensitivity include:a.
Signs and symptoms of an allergic response after exposure to
latexb. Atopyc. Multiple surgical exposuresd. All the above.
15. The risk of latex allergy in an individual with a fruit
allergy is estimated to be ______.a. 1%b. 11%c. 20%d. 50%
16. Patch testing is diagnostic of a:a. Type I hypersensitivity
reactionb. Type II hypersensitivity reactionc. Type III
hypersensitivity reactiond. Type IV hypersensitivity reaction
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17. To reduce latex exposure, when performing routine
restorative dentistry which of the following is not recommended?a.
Use only properly sized surgical gloves.b. Use reduced protein,
powder-free gloves.c. When possible, use latex-free productsd.
Practice proper hand hygiene
18. When managing a patient who has a confirmed type I
hypersensitivity to latex, which of the following is not
recommended?a. Premedicate the patient with an antihistamine one
hour prior to the appointment.b. Schedule the patient for the first
appointment of the day.c. Schedule the patient for the last
available appointment of the day.d. A and C
19. The most effective medication available to manage allergic
contact dermatitis is ____________.a. Epinephrineb. Benadrylc. A
topical corticosteroidd. An oral H1 receptor antagonist
20. Which of the following medication is most critical for
managing anaphylaxis?a. Epinephrineb. Benadrylc. An inhaled
beta2-adrenergic agonistd. An oral H1 receptor antagonist
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References1. Newsom SWB. Pioneers in infections control Joseph
Lister. J Hosp Infect 2003;55:246-253.2. Trampuz A, Widmer AF. Hand
hygiene: A frequently missed lifesaving opportunity during
patient
care. Mayo Clin Proc 2004;79:109-116.3. Ownby DR. A history of
latex allergy. J Allergy Clin Immunol 2002;110(2 Suppl):S27-S32.4.
Centers for Disease Control and Prevention. Recommendations for
prevention of HIV transmission
in health care setting. MMWR Morb Mortal Wkly Rep
1987;36(suppl):35-185.5. Ahmed SM, AW TC, Adiseh A. Toxicological
and immunological aspects of occupational latex
allergy. Toxicol Rev 2004;23:123-134.6. Phillips V, Goodrich M,
TJ S. Health Care Worker Disability Due to Latex Allergy and
Asthma:
A Cost Analysis. Am J Public Health 1999;89:1024-1028.7. Woods
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About the Authors
Michaell A. Huber, DDSAssociate ProfessorHead, Oral Medicine
DivisionDepartment of Dental Diagnostic ScienceThe University of
Texas Health Science Center at San Antonio, Dental School
Dr. Huber is an Associate Professor, Head, Division of Oral
Medicine, Department of Dental Diagnostic Science, the University
of Texas Health Science Center at San Antonio, Dental School, San
Antonio, Texas.
Dr. Huber received his DDS from the University of Texas Health
Science Center at San Antonio Dental School, San Antonio, Texas in
1980 and a Certificate in Oral Medicine from the National Naval
Dental Center, Bethesda, Maryland in 1988. He is certified by the
American Board of Oral Medicine as an
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17Crest Oral-B at dentalcare.com Continuing Education Course,
Revised January 31, 2014
officer of the Dental Corps, United States Navy. Dr. Hubers
assignments included numerous ships and shore stations and served
as Chairman, Department of Oral Medicine and Maxillofacial
Radiology and Director, Graduate Program in Oral Medicine, National
Naval Dental Center, Bethesda, Maryland. In addition he served as
Specialty Leader for Oral Medicine to the Surgeon General of the
United States Navy, Washington, DC; and Force Dental Officer, Naval
Air Force Atlantic, Norfolk, Virginia. He has many professional
affiliations and over the past 24 years, he has held a variety of
positions in professional organizations.
Since joining the faculty in 2002, Dr. Huber has been teaching
both pre-doctoral and graduate dental students at the University of
Texas Health Science Center Dental School, San Antonio, Texas, and
is the Director of the schools Oral Medicine Tertiary Care Clinic.
He is currently serving as the Public Affairs Chairman for the
American Academy of Oral Medicine. Dr. Huber has accepted
invitations to lecture before many local, state, and national
professional organizations. He has been published in numerous
journals including: Oral Surgery, Oral Medicine, Oral Pathology,
Oral Radiology and Endodontology; Dental Clinics of North America,
Journal of the American Dental Association, and Quintessence
International.
Email: [email protected]
Gza T. Terzhalmy, DDS, MAProfessor and Dean EmeritusSchool of
Dental MedicineCase Western Reserve University
Dr. Terzhalmy is Professor and Dean Emeritus, School of Dental
Medicine, Case Western Reserve University. In addition, he is a
Consultant, Naval Postgraduate Dental School, National Naval
Medical Center; and Civilian National Consultant for Dental
Pharmacotherapeutics, Department of the Air Force.
Dr. Terzhalmy earned a B.S. degree from John Carroll University;
a D.D.S. degree from Case Western Reserve University; an M.A. in
Higher Education and Human Development from The George Washington
University; and a Certificate in Oral Medicine from the National
Naval Dental Center. Dr. Terzhalmy is certified by the American
Board of Oral Medicine and the American Board of Oral and
Maxillofacial Radiology (Life).
Dr. Terzhalmy has many professional affiliations and over the
past 40 years, has held more than 30 positions in professional
societies. He has served as editor or contributing editor for
several publications, co-authored or contributed chapters for
several books and has had over 200 papers and abstracts published.
Dr. Terzhalmy has accepted invitations to lecture before many
local, state, national, and international professional
societies.
Email: [email protected]