Latex Antigens: Identification and Use in Clinical and Experimental Studies, Including Crossreactivity with Food and Pollen Allergens

doi:10.1016/S1081-1206(10)63135-3

Annals of Allergy, Asthma & Immunology

Volume 81, Issue 5, November 1998, Pages 388-398

https://doi.org/10.1016/S1081-1206(10)63135-3 Get rights and content

Learning objectives

The purpose of this review is to introduce the reader to the range of latex allergens that have been identified by polypeptide sequencing. This knowledge is important for the assessment of clinical latex hypersensitivity, including crossreactivity with food and aeroallergens.

Data sources

MEDLINE search and relevant publications and reviews from the English medical literature since 1989.

Results

Of the more than 150 polypeptides in natural latex rubber, 35 or more can act as allergens and are recognized by IgE antibodies in the sera of latex-sensitive subjects. Complete or partial amino acid sequence data have now been obtained for 20 or more allergens, and have facilitated cloning of genes and development of allergen-specific antibodies. In latex-sensitive adults, hevein (Hev b6), rubber elongation factor (Hev b1) and Hev b5 are reported as major allergens, while in children with spina bifida, latex particle proteins are important allergens. Although incomplete, the data for finished latex products indicate that the number as well as diversity of latex antigens are limited compared with the allergen profile of natural rubber latex. Latex allergen sequence data allows epitope mapping, which establishes the molecular basis for understanding crossreactivity between latex, food, and aeroallergens.

Conclusion

The identification of latex allergens is paving the way for studying the molecular basis of immunoreactivity to these proteins, including crossreactivity with food and other allergens. The development of reagents to detect and measure anigen-specific responses will increase diagnostic specificity of allergic reactions to latex products.

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Cited by (34)

Latex immunotherapy: State of the art
2012, Annals of Allergy, Asthma and Immunology
Citation Excerpt :
Latex allergy has thus become a relevant health problem for the general population and an occupational hazard for health-related professions.3 The risk of sensitization is higher for housekeeping personnel, gardeners, hairdressers, and especially for health care workers or patients undergoing multiple surgeries, such as children with spina bifida or other congenital malformations (eg, of the urinary tract).1 Liss et al4 performed an epidemiological study on a large number of health care workers (HCW), and found a prevalence of latex positivity of 12.1%, without significant differences among professional categories (physicians, nurses, laboratory workers, therapists, and technicians).
Latex allergy remains a significant problem, expecially among certain professional categories, and specific immunotherapy has been suggested as a suitable therapeutic option. The objective of the this article is to review the available literature on clinical trials of specific immunotherapy in latex allergy.
Literature databases (PubMed, Embase, Google Scholar) were searched for latex immunotherapy clinical trials.
Clinical trials (either open or randomized controlled) using subcutaneous or sublingual immunotherapy with latex extracts were selected. Only articles published in English in peer-reviewed journals were considered. Case reports quoted in the clinical trials were also described, when pertinent.
Eleven clinical trials (3 with subcutaneous and 8 with sublingual immunotherapy) were identified. Two of the 3 randomized trials of subcutaneous immunotherapy reported some benefit in adults but a remarkable occurrence of side effects. Concerning sublingual immunotherapy (SLIT), there were 6 randomized placebo-controlled (1 in children), 1 randomized open, and 1 open trials. All but 1 trial reported positive results, and the safety profile was overall superior to injection immunotherapy. The overall quality of the study was moderate, and the number of subjects studied was low.
Although guidelines do not consider allergy to latex as an accepted indication to desensitization, SLIT can be offered, in addition to symptomatic treatment, to selected patients, when avoidance measures are not feasible or effective.
Food allergy: A practice parameter
2006, Annals of Allergy, Asthma and Immunology
Isolated hevein-like domains, but not 31-kd endochitinases, are responsible for IgE-mediated in vitro and in vivo reactions in latex-fruit syndrome
2005, Journal of Allergy and Clinical Immunology
Individuals with natural rubber latex allergy often have immediate reactions to plant-derived foods and fresh fruits, such as avocado and banana. IgE of these patients has been shown to bind endochitinases containing an N-terminal hevein-like domain (HLD). However, evidence on 31-kd endochitinase-induced reactions in vivo is lacking.
We sought to assess the clinical significance of 31-kd endochitinases and isolated HLDs in latex-fruit syndrome.
The 31-kd endochitinases and corresponding HLDs were purified or produced from avocado, banana, latex, and wheat germ. Skin prick test reactivities against purified proteins were examined in 15 patients with natural rubber latex allergy. The binding efficiency of IgE to purified proteins was studied by using an inhibition ELISA. Experimentally resolved or modeled structures of the proteins were compared to clarify the molecular basis of clinical reactions.
Eleven (73%) patients had skin prick test reactions to isolated HLDs of avocado and banana, but only 1 (7%) patient reacted to their corresponding 31-kd endochitinases. HLDs from avocado and banana inhibited binding of IgE to prohevein (Hev b 6.01) in 59% and 38% of patients, respectively, whereas corresponding percentages for 31-kd endochitinases were 17% and 20%, respectively. Isolated HLDs of wheat germ agglutinin and 18-kd wheat germ agglutinin did not significantly inhibit IgE binding to hevein.
The isolated HLD molecules alone, but not when linked to endochitinases, seem to be responsible for IgE-mediated clinical reactions in latex-fruit syndrome. Careful selection of relevant allergens in their proper molecular form is therefore crucial in forming a reliable diagnosis of latex-fruit syndrome.
Hevein-specific recombinant IgE antibodies from human single-chain antibody phage display libraries
2003, Journal of Immunological Methods
IgE antibodies distinctively recognising allergenic epitopes would be ideal reagents in immunodiagnostics to detect and quantify allergens, as well as for the development of allergy diagnostics and therapeutics. We have isolated recombinant human IgE antibodies specific for the major latex allergen, hevein, from antibody phage display libraries using a green fluorescent protein (GFP)–hevein fusion as a selection antigen. Human IgE phage display libraries were constructed by combining the IgE heavy chain genes to kappa and lambda light-chain genes which were isolated from lymphocytes of a latex allergic patient. The screening of antibody libraries resulted in the enrichment of two hevein-binding scFvs designated as 1A4 and 1C2. Both antibodies showed specific binding to the hevein that could be inhibited by both the recombinant GFP–hevein and native hevein isolated from latex examination gloves. The scFvs were prone to aggregate and, thus, for further characterisation, they were converted to Fab fragments with human IgG1 or IgE isotype. Similar hevein-binding properties of the 1A4 and 1C2 Fab fragments and human IgE serum pool, conventionally used in the detection of latex allergens, demonstrate the potential utility of these recombinant antibodies for the analysis of latex allergen.
Síndrome látex-frutas
2002, Allergologia et Immunopathologia
Durante la última década, la alergia al látex mediada por IgE ha sido reconocida como un problema médico de enorme trascendencia. Al mismo tiempo, numerosos estudios se han centrado en la reactividad cruzada entre alimentos y aeroalergenos. Recientemente, se ha postulado la existencia de un síndrome látex-frutas, al evidenciarse una asociación clínica significativa entre ambas reacciones alérgicas
Diversos trabajos han demostrado que entre un 20 y un 60% de los pacientes alérgicos a látex presentan reacciones medidas por IgE a una amplia variedad de alimentos, principalmente frutas como el plátano, el aguacate, la castaña y el kiwi. Las manifestaciones clínicas de estas reacciones pueden variar desde el síndrome de alergia oral hasta reacciones anafilácticas graves. Estas últimas no son infrecuentes, lo que pone de manifiesto la relevancia clínica del síndrome látex-frutas
El diagnóstico de la hipersensibilidad a alimentos asociada con alergia al látex, se basa en la historia clínica de reacciones adversas inmediatas en relación con su ingestión, sugestivas de ser mediadas por IgE. La prueba cutánea mediante prick con el alimento fresco muestra una concordancia del 80% con el diagnóstico clínico, siendo la mejor prueba de que disponemos en la actualidad para comprobar la sensibilización a alimentos de origen vegetal. Una vez confirmado el diagnóstico, el paciente debe realizar una dieta exenta de los alimentos a los que sea alérgico
Recientemente, se han logrado caracterizar algunos de los alergenos comunes responsables de las reacciones cruzadas entre el látex y las frutas. Estos panalergenos han resultado ser quitinasas de clase I, que al poseer un dominio heveína N-terminal, reaccionan de forma cruzada con el alergeno principal del látex, Hev b 6
During the last decade, latex IgE-mediated allergy has been recognized as a very important medical problem. At the same time, many studies have dealt with allergic cross-reactions between aeroallergens and foods. In this context, there is clear evidence now on the existence of significant clinical association between latex and fruit allergies. Therefore, a latex- fruit syndrome has been postulated
Several studies have demonstrated that from 20% to 60% of latex-allergic patients show IgE-mediated reactions to a wide variety of foods, mainly fruits. Although implicated foods vary among the studies, banana, avocado, chestnut and kiwi are the most frequently involved. Clinical manifestations of these reactions may vary from oral allergy syndrome to severe anaphylactic reactions, which are not uncommon, thus remarking the clinical relevance of this syndrome
The diagnosis of food hypersensitivities associated to latex allergy is based on the clinical history of immediate adverse reactions, suggestive of an IgE-mediated sensitivity. Prick by prick test with the fresh foods implicated in the reactions shows an 80% concordance with the clinical diagnosis, and therefore it seems to be the best diagnostic test available nowadays in order to confirm the suspicion of latex-fruit allergy. Once the diagnosis is achieved, a diet free of the offending fruits is mandatory
Recently, some of the common allergens responsible for the cross-reactions among latex and the fruits most commonly implicated in the syndrome have been identified. Class I chitinases, with an N-terminal hevein like domain, which cross-react with the major latex allergen hevein, seem to be the panallergens responsible for the latex-fruit syndrome
Allergenic proteins of natural rubber latex
2002, Methods
As the living cytoplasm of laticiferous cells, Hevea brasiliensis latex is a rich blend of organic substances that include a mélange of proteins. A small number of these proteins have given rise to the problem of latex allergy. The salient characteristics of H. brasiliensis latex allergens that are recognized by the International Union of Immunological Societies (IUIS) are reviewed. These are the proteins associated with the rubber particles, the cytosolic C-serum proteins and the B-serum proteins that originate mainly from the lutoids. Procedures for the isolation and purification of latex allergens are discussed, from latex collection in the field to various preparative approaches adopted in the laboratory. As interest in recombinant latex allergens increases, there is a need to validate recombinant proteins to ascertain equivalence with their native counterparts when used in immunological studies, diagnostics, and immunotherapy.

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: Supported by an unrestricted grant from Zeneca Pharmaceuticals

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REVIEW ARTICLELatex Antigens: Identification and Use in Clinical and Experimental Studies, Including Crossreactivity with Food and Pollen Allergens

Learning objectives

Data sources

Results

Conclusion

J Allergy Clin Immunol

J Biol Chem

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Biol Chem

J Biol Chem

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy and Clin Immunol

J Allergy Clin Immunol

J Allergy and Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma, and Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Latex allergy

J Allergy Clin Immunol

Allergic reactions to natural rubber

Ann Allergy

Latex allergens

Clin Exp Allergy

Prevalence of latex-specific IgE antibodies in atopic and nonatopic children with type I diabetes

Diabetes Care

Prevalence of latex-specific IgE antibodies in patients being evaluated for allergy

Ann Allergy Asthma Immunol

REVIEW ARTICLE
Latex Antigens: Identification and Use in Clinical and Experimental Studies, Including Crossreactivity with Food and Pollen Allergens