Allergen‐induced matrix metalloproteinase‐9 in nasal lavage fluid

reactions to food allergens derived from banana, kiwi, and chestnut. Absolute values of IgE to latex showed no signi®cant alterations except at the end of the study, when an increase of approximately 4±6 URAST/ml was seen. However, IgE speci®c for chestnut clearly decreased during treatment from 0.72 to 0.30 kU/l). The behavior of IgG class speci®c for latex was similar to that of speci®c IgE. We did not detect latex-speci®c IgG4 during the study; however, this immunoglobulin apparently began to appear at the end of the study. Clinical symptoms improved steadily, with an evident reduction in nasal obstruction and eye manifestations. This was corroborated by the patient, who reported improvement even in areas of the hospital that produced signi®cant exposure to latex gloves, which she had previously been unable to tolerate. Acquisition of tolerance to the environment in her workplace was gradual during SIT, but was more pronounced once the maintenance period was started upon her discharge from the hospital and return to work. Because of the occupational nature of the allergy, the best provocation test for the allergen was constant exposure to latex in the workplace. However, we also used speci®c, controlled provocation tests. The patient entered a 1-m airtight cabin and handled four pairs of latex gloves for 15 min; her clinical symptoms were then evaluated during the 6 h following this exposure to the allergen. Clinical examination after the provocation test showed that she had no cutaneous, eye, nasal, or bronchial symptoms during the following 6 h. In terms of local reactions, tolerance of SIT was excellent, with no delayed local reactions and only one episode of immediate local reaction during the maintenance phase (erythema with papules measuring 60 mm in mean diameter). This reaction did not require treatment or a change in the desensitization schedule. We believe that the allergenic extract is safe, at least at concentrations up to 0.4 mg latex protein. Tolerance was excellent, and, like other authors who used accelerated schedules (6), we established the MD on the basis of the appearance of a systemic reaction. We felt this to be the most prudent approach, in contrast to other studies in which the appearance of a systemic reaction led only to a change in the dose schedule (7, 8). Use of a conventional schedule would probably have allowed us to reach a higher MD, a possibility that deserves further study. We consider SIT with latex to be highly effective, and found the allergenic extract used to be safe and well tolerated.