What is the link between avo on rye and latex allergy? - Medical Academic
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What is the link between avo on rye and latex allergy?

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Natural rubber latex is intracellular cytosol secreted from rubber tree, Hevea brasiliensis (Hev b)​. Due to its excellent elastic properties it is widely used in medical devices​ and everyday products. 

Latex allergy was first diagnosed in 1927, in Germany​. People at risk of latex allergies due to exposure include: 

  • Healthcare workers​ 
  • Hospital theatre staff​ 
  • Patients needing recurrent surgeries​ 
  • Hairdressers​ 
  • Cleaning staff​. 

There is a prevalence of latex allergy in 4% of the public. The allergy is mostly an immediate IgE-mediated allergic response​. Type IV allergic reactions cause skin reactions 24-48 hours after exposure​. Currently, 15 allergens have been characterised and listed by the World Health Organization​, causing: 

  • Skin rash​ 
  • Urticaria​ 
  • Angio-oedema​ 
  • Rhinitis​ 
  • Wheezing​ 
  • Conjunctivitis​ 
  • Systemic:​ 
  • Cardiovascular collapse​ 
  • Anaphylaxis – often intraoperative​. 

The route of sensitisation is mostly airborne allergens​. Corn starch is used in powered latex gloves, which creates latex protein aerosolisation​. Power-free glove usage prevented the future increase in prevalence in the 1990s​. 

Diagnosis is based on history​, atopy​, other atopic manifestations​, other sensitisations​ and occupation exposure​. It is done through careful interpretation and allergy testing​ 

To treat latex allergy, the following is used: 

  • Avoidance​ 
  • Treat other allergic conditions including asthma well​ 
  • Antihistamines (second generation) 
  • EpiPen/ adrenalin​ 
  • Medic Alert bracelet​ 
  • Specific immunotherapy​. 

Latex fruit syndrome 

In infants and young children, food allergy usually precedes aeroallergen hypersensitivity ​(primary sensitisation to ingested antigens). The opposite is frequently observed in adults​.  

Panallergens provide common epitopes for IgE antibodies to bind​ to. In pollen-food syndrome, the Birch tree in Europe and the most common elicitor of allergies​. There is cross-reaction with several foods​. Apple, kiwi, peach, pear, apricot, cherry, strawberry, and hazel nuts are most affected. Allergies are mostly seen in those with food allergies related to birch pollen sensitisation. 

Latex-fruit syndrome was first described in a latex-allergic patient in 1991. It is found in avocado, banana, kiwifruit and papaya, among others. In 1994, Blanco et al found that 50% of latex-allergic patients had hypersensitivity to fruits​. 

Avocado allergy 

The main allergen found in avocado is called Pers a 1. This is a chitinase, which is a plant-derived enzyme made by plants naturally to act as a defence against fungal attacks. 

In a study, Pers a 1 induced positive skin reactivity responses in seven of eight patients with latex-fruit allergy and in another study, it was recognised by 15 out of 20 avocado- and/or latex-allergic patients. 

Component testing 

Differentiate between the primary and cross-reactive allergy​. Latex positivity (k82) can also be explained by IgE antibodies against cross-reactive carbohydrate determinants (CCDs) and can be detected with MUFX3​. 

Comprehensive sensitisation profiling helps differentiate between primary and cross-sensitivity allergy. 

Latex allergen components and cross-reactivity 

The rule in primary allergy with allergen components​ is: Rule out primary allergy with cross-reactive components​. 

Latex sensitisation can also be explained by CCDs (MUFX3)​. 

Test using the algorithm for suspected latex allergy: ImmunoCAP ​whole allergen and ImmunoCAP allergen components​.