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| Block 5: Epidemiology Exercise |
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CASE STUDIES ON LATEX ALLERGY:
PART B:
Here follow 4 abstracts found in the medical literature. In each case, describe the study design:
ABSTRACT #1:
A midwife initially suffered hives, nasal congestion, and conjunctivitis. Within a year, she developed asthma, and 2 years later she went into shock after a routine gynecological examination during which latex gloves were used. The midwife also suffered respiratory distress in latex-containing environments when she had no direct contact with latex products. She was unable to continue working.
ABSTRACT #2:
An intensive care nurse with a history of runny nose, itchy eyes, asthma, eczema, and contact dermatitis experienced four severe allergic reactions to latex. The first reaction began with asthma severe enough to require treatment in an emergency room. The second and third reactions were similar to the first. The fourth and most severe reaction occurred when she put on latex gloves at work. She went into severe shock and was successfully treated in an emergency room.
ABSTRACT #3:
From March 1990 through January 1991, eleven patients at one children's hospital (Hospital A) had onset of anaphylactic reactions (ARs) within 30 minutes following the start of general anesthesia; no patient had had a surgical incision at the time of their reaction. Eight of these patients required admission to the intensive care unit for supportive care. To determine the potential source of the problem, an epidemiologic investigation was conducted at hospital A. An AR was defined as hypotension (greater than or equal to 30 mm Hg fall in systolic blood pressure from the preinduction blood pressure) and at least one of the following during a general anesthesia procedure: rash, angioedema, stridor, wheezing, or bronchospasm. All eleven patients were aged 3-14 years (mean: 6.9 years). 32 patients who had successfully undergone general anesthesia for similar indications as the original eleven patients at hospital A from March 1990 through January 1991 were identified and served as the comparison group. The two groups were similar with respect to age, sex, race, day of surgery, anesthesiology personnel, preoperative medications, type of anesthesia induction, anesthetic gas, surgical procedure, and receipt of intraoperative antimicrobials. AR-patients were, however, more likely to have a history of allergy (OR (odds ratio) = 4.8; 95% confidence interval (CI)=1.1-23.3), asthma (OR=7.6; 95% CI=1.0-61.7), or multiple surgical procedures (p=0.04). Before their ARs, all patients had been exposed to the anesthesia circuitry and had intravenous catheters in place. Of the entire group of 43, 10 of the AR-patients and 4 of the comparison group were found to have skin, radioallergosorbent, and/or enzyme-linked immunosorbent assay tests suggesting latex allergy (OR=70.00; 95% CI=6.97-703.29).
ABSTRACT #4:
4. Exposure to natural rubber latex has been recognized as a cause of occupational asthma (OA). In a Cape Town factory manufacturing rubber products, all workers were enrolled into a study and employee records were studied to create a 10-year retrospective record of exposure to latex. Six of the 47 workers were found to have worked the latex line for the period under study. 2 of the latex workers and 13 of the silicone workers were found to have OA (asthma plus latex allergenicity). These findings are still being analysed.
General Introduction to Occupational Health: Occupational Hygiene, Epidemiology & Biostatistics by Prof Jonny Myers is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 South Africa License