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Original Article |
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Tolerance and
effects on skin
reactivity to latex
of sublingual rush
immunotherapy with a
latex extract |
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A. Cisteró Bahima1, J. Sastre2, E.
Enrique1, M. Fernández2, R. Alonso1, S. Quirce2, B.
Gandarias3, S. Parmiani4, P.Rico3 |
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1 Institut Universitari Dexeus,
Barcelona, Spain; 2 Fundación Jiménez Díaz, Madrid, Spain;
3 ALK-Abelló, S.A., Madrid, Spain; 4
ALK-Abelló, S.p.A.,
Milan, Italy |
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J Invest Allergol Clin Immunol
2004; Vol. 14(1): 17-25 |
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Abstract |
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Background.
Specific
immunotherapy could
be a therapeutic
tool for the
increasing problem
of sensitisation to
Natural Rubber Latex
(NRL).
Objective. To
investigate the
tolerability of SLIT
for Latex and its
effects on skin
reactivity.
Methods.
Twenty-six patients
(mean age 35.5 years)
with an average
history of 7.5 years
of cutaneous
symptoms plus
respiratory symptoms
(23/26) due to NRL
were studied. All
underwent rush
sublingual therapy
(4 days) with a
standardized NRL
extract followed by
a 9-week maintenance
treatment. Local and
systemic adverse
reactions were
monitored throughout
the treatment. Skin
reactivity to NRL
extract was
evaluated before,
during and at the
end of the treatment
by latex glove-use
test, rubbing test
and skin prick test.
Results. All
patients reached the
maintenance dose.
Out of 1044
administered doses,
257 (24.6%) produced
adverse reactions
from which 21.4%
were local. Only
10.1% of cases
required treatment,
mainly with
antihistamines alone
(5.8%), with 2-agonists
alone (0.8%) or
associated to
antihistamines and/or
corticosteroids
(2.7%). One patient
was precautionary
treated twice with
adrenaline but
completed the
treatment without
further problems.
The glove-use test
improved
significantly after
5 days and 10 weeks
of treatment
(p=0.003, p=0.0004
respectively),
whereas the rubbing
test improved
significantly only
after 10 weeks of
treatment. Doctor’s
assessments
confirmed the
results obtained
with the glove-use
test (p=0.003 after
5 days, and p= 0.004
after 10 weeks) but
not those obtained
with the rubbing
test. No change was
detected for SPTs.
Conclusion.
SLIT for NRL allergy
is able to modify
skin reactivity to
NRL in days as
assessed with
methods reproducing
HCWs normal exposure
to the allergen.
Tolerance of SLIT is
better than
tolerance reported
for injective
therapy with NRL,
but the build up
phase should be
administered under
medical surveillance
until sufficient
experience has been
accumulated. The
long-term effect of
the treatment
deserves further
investigation.
Keywords:
adverse reactions;
allergy; natural
rubber latex; skin
reactivity;
sublingual
immunotherapy. |
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