Asthma to latex in a seamstress

Latex is recognized as a cause of occupational asthma (OA) in various working environments. Latex allergy in the textile industry has been recently reported (1). We herein describe the first case of a seamstress who developed OA to latex. A 36-year-old woman, a nonsmoker, started work as a seamstress in 1981. She worked with cotton and gabardine. From 1991, she sewed elasticized ribbons, using a different sewing machine, for a few days at a time at irregular intervals, but almost weekly. In 1993, she developed nasal congestion, rhinorrhea and sneezing, and runny and itchy eyes, as well as itchy skin, followed a few weeks later by chest tightness, wheezing, and cough. Symptoms occurred progressively when whe worked with the elasticized ribbons, and a few days of exposure also caused nocturnal awakenings. These symptoms improved during weekends and when she was reassigned to other jobs in the same plant. When we first evaluated her in December 1997, after a week of not working with the elasticized ribbons, spirometry was normal (FEV1/FVC=2.57/3.19 l, pred 2.67/3.05 l) (2). Methacholine PC20 was <1 mg/ml (48% fall in FEV1 at 1 mg/ml, the first concentration given) (3). Skin prick tests (SPT) with 22 common inhalants were negative; SPT with latex (Stallergènes, Paris, France, and Omega, Montreal, Canada) were positive (wheals of 5×4 and 5×3 mm, respectively) with a negative control and a histamine wheal of 5×5 mm. In January 1998, after having worked several days with the elasticized ribbons, FEV1/FVC fell to 1.74/2.45, returning to normal after salbutamol (2.78/3.38). She was treated with topical nasal and inhaled steroids (fluticasone 1000 μg/day) and salbutamol as needed (higher need when at work). After withdrawal from work in February 1998, there was a marked improvement. Serial peak-flow monitoring at and off work suggested work-related asthma. In May 1998, we performed specific inhalation challenge (SIC) in the laboratory by the method proposed by Cockcroft et al. (4). On a control day, exposure to nebulized phosphate-buffered saline (Wright nebulizer, output=0.14 ml/min) for 8 min was not followed by any significant change in FEV1; methacholine PC20 at the end of the day was 0.7 mg/ml. The next day, the subject was exposed to nebulized latex extract (Stallergènes, Paris, France) in increasing doses, starting with a dilution of 1/16 for 60 s up to the undiluted extract for 30 s (the undiluted extract caused a 4×4 mm wheal on SPT and contained 100 IR/ml of latex allergen). This exposure induced a dual asthmatic reaction with an immediate fall in FEV1 of 20.5% at 20 min after exposure with complete recovery at 50 min, followed by a 16.6% fall at 5.5 h with complete recovery after inhaled salbutamol. The next morning, when her FEV1 was 22% lower than the previous baseline, methacholine PC20 was significantly reduced (0.07 mg/ml). Respiratory symptoms were exacerbated for several days with nocturnal awakenings in the 3 days following SIC; she was given fluticasone 2000 μg/day. By 10 days after exposure, FEV1 had returned to normal (FEV1/FVC=2.86/3.32), and methacholine PC20 was 0.25 mg/ml. OA to latex is reported increasingly in health-care workers (5) and in other industrial environments (6, 7). We describe the case of latex allergy in a seamstress who developed rhinoconjunctivitis and asthma after sewing elasticized ribbons. Recently, latex allergy was demonstrated in 2/10 workers in an elasticized ribbon-manufacturing plant, one of them experiencing work-related asthma confirmed by SIC (1). These workers were sensitized by handling powdered natural rubber, like health-care workers who wore powdered natural rubber gloves, where the latex allergen is adsorbed to the air-suspended powder. Our subject was exposed to rubber in a form that is not usually sensitizing by inhalation; however, sewing the elasticized ribbons induced a fine white dust of cloth and latex that could be inhaled, explaining the route of sensitization. This case illustrates that one should be mindful of the possibility of latex allergy in different occupational settings. We thank Lori Schubert for reviewing the manuscript, and the technicians for their collaboration.