Natural rubber latex-related occupational asthma: successful sublingual desensitization.
D. Schiavino, A Buonomo, T De Pasquale, V Pecora, V Sabato, A Colagiovanni, A Rizzi, A Aruanno, L Pascolini, E Nucera.
Allergy Department – Catholic University - Rome
Background: Occupational Asthma (OA) has become the most common work-related lung disease in industrialized countries. The most common triggers are wood dust, grain dust, latex (especially among health care workers associated with use of gloves) or other chemicals (especially diisocyanates). Specific desensitization represents an important therapeutic tool in the management of patients with latex allergy. The aim of the study is to evaluate the safety and effectiveness of sublingual desensitization in patients with latex-induced asthma and its impact on patient capability to reintegrate at the previous work.
Method: We selected 13 patients affected by occupational latex-induced asthma. The diagnosis of NRL allergy was based on a positive allergological work-up, included execution of allergological tests (skin prick test and in vitro laboratory tests) and provocation challenges (glove-wearing, conjunctival, bronchial and sublingual provocation test) to confirm clinical latex allergy. Based on clinical history and positive allergological work-up, we decided to carry on a rush sublingual desensitization with latex, performed in 4 days with increasing doses of latex extract under patient's tongue until the highest dose of 500 µg of undiluted latex solution. A maintenance therapy (10 drops of undiluted solution three times a week) was recommended. After 1-year treatment challenges were repeated and those with negative bronchial test underwent a 8-hour work place challenge in an operating room. Patients with all negative challenges were reintegrated at the previous work and followed up for 1 year for the occurrence of modification of respiratory parameters.
Results: The treatment was tolerated by all patients and in 12 out of 13 bronchial challenge turned negative. They did not experience symptoms or modification of respiratory parameters during the workplace challenge and 10 were reintegrated at the previous work, being followed up for 1 year.
Conclusion: Sublingual immunotherapy with NRL has proven to be safe and efficacious for the management of patients affected by NRL-related occupational asthma. Our results are really encouraging even though they should be confirmed by further large case-controlled studies.