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Allergy to latex and papain

      To the Editor:

      Immediate hypersensitivity to latex was first reported by Nutter
      • Nutter AF.
      Contact urticaria to rubber.
      in 1979. During recent years, allergic reactions to latex have been reported with increasing frequency, especially in health care personnel and patients. Sensitization may occur as a result of direct contact with or airborne exposure to latex products.
      • Fisher A
      Allergic contact reactions in health personnel.
      • Baur X
      • Ammon J
      • Chen Z
      • et al.
      Health risk in hospitals through airborne allergens for patients presensitised to latex.
      An association between allergy to latex and allergy to a variety of fruits (banana, avocado, kiwi, apricot, chestnut, grape, passion fruit, and pineapple) has been noted. Papain is also reported to cross-react with bromelain from pineapple.
      • Baur X.
      Studies on the specificity of human IgE-antibodies to the plant proteases, papain and bromelain.
      • Levy D
      • Charpin D
      • Pecquet
      • et al.
      Allergy to latex.
      Many reports concern atopic individuals.
      A 28-year-old atopic patient was referred to us for treatment of angioedema after ingestion of papaya cake during a party. During the year before consultation, he had also experienced angioedema, urticaria, and acute dyspnea after contact with rubber gloves. We have also documented a case of classical allergy to Hevea brasiliensis latex in a chemist who worked with proteolytic enzymes of Carica papaya latex (i.e., papain). Results of skin prick tests were positive for latex and papaya. After this possible cross-reaction was recorded, skin prick tests with papaya latex were carried out in two other patients with well-documented allergy to Hevea latex, and a positive reaction to papaya was noted. Specific CAP RAST (Pharmacia, Uppsala, Sweden) confirmed positive reactions to papain (Rk201), but responses to papaya (Rf293) were negative in our three patients (Table I). Cross-inhibition tests with papain latex might solve the problem. It is, however, impossible to perform inhibition with a papain solution because this enzyme degrades IgE antibodies. The simultaneous occurrence of allergy to latex and papain in three patients is noted with clinical and RAST correlations.
      TABLE IPrevalence of symptoms (IgE, RAST, and skin prick test results) in three patients
      Age (yr)SymptomsIgE (U/ml)Latex (kU/L)Banana (kU/L)Carica papaya (kU/L)Papain (kU/L)Positive SPT results
      28Urticaria, dyspnea180212.802.53Banana,latex, papain, avocado
      angioedema
      36Dyspnea,70.78000.5Banana, kiwi, avocado, latex,
      urticariapapain
      45Rhinitis,1875.91.4300.48Banana, latex, avocado,
      angioedemakiwi, papain
      SPT, Skin prick test.
      1/8/62513

      References

        • Nutter AF.
        Contact urticaria to rubber.
        Br J Dermatol. 1979; 101: 597-598
        • Fisher A
        Allergic contact reactions in health personnel.
        J ALLERGY CLIN IMMUNOL. 1992; 90: 729-738
        • Baur X
        • Ammon J
        • Chen Z
        • et al.
        Health risk in hospitals through airborne allergens for patients presensitised to latex.
        Lancet. 1993; 342: 1148-1149
        • Baur X.
        Studies on the specificity of human IgE-antibodies to the plant proteases, papain and bromelain.
        Clin Allergy. 1979; 9: 451-457
        • Levy D
        • Charpin D
        • Pecquet
        • et al.
        Allergy to latex.
        Allergy. 1992; 47: 579-587