#8 Contact Dermatitis & Latex Allergies Flashcards
Irritant contact dermatitis ?
1) Common in dentistry
2) Physical irruption of the skin
3) NOT an allergic reaction
4) compromises healthy skin
What are irritant reactions?
-S/S?
- A form of dermatitis caused by contact w/ a substance that physically or chemically damages the skin
- Not an immunologic response
- Dryness, fissuring, redness of hands
What is Irritation Dermatitis characterized by?
- Dryness
- Fissuring
- Redness
What is Irritation Dermatitis aggravated by?
1) Glove powder
2) frequent washing of hands
3) contact w/ disinfectant chemicals
What is the sensitizing dose?
1) Initial immune response to allergen
2) No symptoms manifested from this response
3) latent interval required before sensitivity can be expressed
4) Variable # of exposures from sensitization of individual
(SOME people are easily sensitized w/ single exposure)
What is the challenge dose?
1) Exposure to allergen in a sensitized person
2) Results in manifestation of allergic symptoms
3) Challenge occurs w/ much lower allergen concentration
4) severity of symptoms dependent on extent of sensitization
5) Some do not react, or only slightly react, to multiple challenges–leads to diagnosis difficulties
What are the symptoms of Irritation Dermatitis ?
1) Dry
2) Itchy
3) Irritated
4) Cracks and breaks in skin
What is Allergic Contact Dermatitis?
1) Type IV or delayed
2) Can result from exposure to chemicals and rubber
3) usually appears as a RASH several hours or even days AFTER exposure
What are symptoms of Allergic Contact Dermatitis?
1) Rash
2) Usually confined to area of contact but may expand
What is latex hypersensitivity?
1) Latex allergy
2) Potentially life threatening
3) Allergy to proteins in natural rubber latex
4) TYPE I (IMMEDIATE)
What are the symptoms of latex hypersensitivity?
1) Can be serious/severe/ or mild symptoms
2) Can be whole body response
3) onset w/in minutes up to hours
4) Can result in anaphylaxis or death
5) runny nose
6) sneezing
7) itchy eyes/ itchy burning skin
8) scratchy throat
9) hives
10) asthma
11) difficulty breathing
12) wheezing
13) coughing spells
14) cardiovascular
15) GI
HCW Allergies ?
1) Allergies to disinfectants/preservatives > 10%
(glutaraldehyde, phenols, thimerosal)
2) Allergies to methacrylates: > 20% in dentistry
(dental bonding agents)
3) Allergies to NRL proteins: approx 10%
(varies w/ healthcare field)
4) Allergies to thiruams: 7-14%
(latex gloves rubber material, “vulcanizing accelerator)
What are Hypersensitivity Reactions (Allergies) ?
1) Result of normally beneficial immune response acting inappropriately
2) Exaggerated, pathological response to substances, situations, or physical states c/o comparable effect in normal individuals
3) DO NOT occur in all members of the same species
4) Can occur against “just about anything”
For the SKIN what is the clinical manifestation of anaphylaxis?
a) symptoms
b) sign
a) prutitis & facial swelling
b) urticaria & angioedema
For the RESPIRATORY TRACT, what is the clinical manifestation of anaphylaxis?
a) symptoms
b) sign
a) nasal congestion, itching, sneezing, dyspnea, and cough
b) rhinitis, laryngeal stridor, wheezing
For the CARDIOVASCULAR System, what is the clinical manifestation of anaphylaxis?
a) symptoms
b) sign
a) syncope & general weakness
b) hypotension & arrhythmias
For the GI, what is the clinical manifestation of anaphylaxis?
a) symptoms
b) sign
a) abdominal pain, nausea, vomiting, diarrhea (bloody)
b) N/A
For the EYE, what is the clinical manifestation of anaphylaxis?
a) symptoms
b) sign
a) Tearing & itching
b) conjunctivitis
What the Dental examples of Allergic RXNS?
1) Rxn to gutta-percha in HCW w/ diagnosed latex allergy
2) Allergy to mercury in amalgam
3) Allergy metals in dental materials
4) Induced, systemic/local reactions to eugenol
5) Allergenic newer dental material: acrylic resin, resin composite
6) Type I Rxns to mouthwashes
___Type allergy can develop to chemicals in dental products?
Type IV
Over 200 chemicals added to NRL & synthetic rubber gloves. ________________ and ____________ are allergenic
- Accelerators
- Antioxidants
What other allergenic dental chemicals may permeate gloves?
- acrylates (bonding agents)
- epoxides & resins
- glutaraldehyde, formaldehyde
What is the Latex Allergy Background?
1890: latex surgical gloves
1979: 1st case of latex allergy repaired
1988: increase # of allergy reports (16 deaths)
1991: FDA latex allergy alert to HCW
1997: FDA relations for manufacturer, label, protein & hypoallergenic claims
9/30/98: FDA regulations go into effect
Latex Hypersensitivity: Type I localized ?
1) Immediate IgE allergic rxn
2) develops within minutes to latex protein challenge
3) urticaria, hives, prutitius, rhinits
Latex Hypersensitivity: Type I systematic ?
1) MORE generalized, serve manifestations
2) conjunctivitis, laryngeal/respiratory distress
Latex Hypersensitivity: Type IV?
1) Delayed contact dermatitis
2) Slow-forming, localized rash, necrosis, sloughing
3) develops within 12-24 hours to chemical challenge
A _____________Allergy develops to Plant-Based Proteins in NRL
1) Natural rubber latex (NRL) is harvested from Hevea brasiliensis tree
- Laticifer cells
- outerbark
2) Contains over 260 plant-based proteins
What is PART 1 of the Natural Rubber Latex Glove Manufacturing Process ?
1) Collection container w/ NH3
2) Concentration from 30-60% solid
3) Compounding additives
- accelerators
- antioxidants
- stabilizers
- others
What is PART 2 of the Natural Rubber Latex Glove Manufacturing Process ?
1) Coagulant Dip
2) Latex Dip
3) Oven
4) Cornstarch Application
5) Vulcanizing
6) Leaching (REMOVES a PORTION of EXTRACTABLE PROTEINS)
Care of latex allergic persons?
-LATEX AVOIDANCE
