[Stepwise diagnosis of respiratory latex allergy]

Latex proteins bound to the powder of latex gloves are potent aeroallergens which can cause severe immediate-type allergic reactions of the upper and lower respiratory tract. To evaluate the clinical relevance of positive skin prick tests or IgE antibodies to latex we developed a sequence of provocation tests for the diagnosis of latex induced rhinitis or asthma. 14 patients are presented, 11 working in the medical field. All had positive skin prick test to latex milk and specific IgE-antibodies to a latex glove extract, six were atopic. 14 reported symptoms of the upper respiratory tract, 11 dyspnea related to latex contact. Nasal provocation with a suspension of powder from latex gloves or a glove extract could prove latex rhinitis in all cases by rhinomanometry. Bronchial obstruction was seen in four cases with one severe asthma attack in this test. The workplace-related provocation test with latex gloves was less sensitive for latex-asthma (3/9 positive) than the direct bronchial provocation test with a latex glove extract (6/7 positive), the three latex allergic patients without a history of dyspnea remaining negative in both. Provocation tests are highly sensitive for latex allergy of the respiratory tract and therefore of special importance in the diagnostic procedure.