| Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist Judith Green-McKenzie and Debra Hudes* University of Pennsylvania Medical Center, Division of Occupational and Environmental Medicine, Philadelphia, Pennsylvania, USA
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Unversity of Pennsylvania Medical Center
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Abstract
Context: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice. Case Presentation: A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time. Discussion: The patient's presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work. Relevance to Clinical or Professional Practice: The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work. Key Words: formaldehyde, health care worker, latex allergy, occupational asthma, pathology, xylene. Environ Health Perspect 113:888-893 (2005) . doi:10.1289/ehp.7830 available via http://dx.doi.org/ [Online 31 March 2005]
Address correspondence to J. Green-McKenzie, 3400 Spruce St., Division of Occupational and Environmental Medicine, Ground Silverstein, Philadelphia, PA 19104-4283. Telephone: (215) 662-4439. Fax: (215) 349-5100. E-mail: jmckenzi@mail.med.upenn.edu *Current address: Division of Occupational Medicine, Temple University Hospital, Philadelphia, PA. This article is based on an oral presentation at the 23rd annual national meeting of the Society of General Internal Medicine, Boston, MA, 4-6 May 2000. The authors declare they have no competing financial interests. Received 1 December 2004 ; accepted 31 March 2005.
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