Document 5Z9xnwn2oq8V0OyJryBLbvYR

scientific trials. Though this may explain the mecha nism of action of anabolic steroids in athletes, these results and the assumptions within this hypothesis require further investigation. We thank Dr J A Davies, Professor 0 C Bird, Professor D Johnston, Mr N Williams, and Mr J Primrose for their encouragement and for help in obtaining biopsy specimens; Peter Walsh and Elizabeth Wakefield for technical help; and Sterling Research for financial help. 1 Suc-Ling MM. HosegooJ jL, Johnston D, McMahon MJ, Davies JA. Gimpanson of oral stanozolol with low dose heparin in prevention of deep venous thrombosis in high risk patients after elective major abdominal Mirgery. Fibnnnlyut 1988;2:37-41. 2 Dubowiu V. M utile btopn: a practual approach. 2nd ed. London: Bailltirc Tindall. 1985. 3 Larsson (., Ansvcd T. Effects of long-term physical mining and detraining on enzyme histochcmicai and functional skeletal muscle ' -----... Mutcle Nerve 1985;8:714-22. 4 Saltin B. Hcwiksson J, Nygaard E, Andersen P, Jans metabolic potentials of skeletal muscles in sedenta runners. Ann NY AcadSci 1977;301:3-29. (Accepted 27June 7988) Department of Clinical Sciences, University of Tampere, Tampere, Finland K Turjanmaa, mo, senior lecturer T Reunala, md, associate mfessor Department of Obstetrics ind Gynaecology, Jniversity Central Hospital I'ampere, Tampere J Tuimala, md, senior ecturer Jniversity Central Hospital Iclsinki, Hospital for tiiergic Diseases, Helsinki Karkkainen, piid, chemist drrespondence to: Dr K urjanmaa. Department of lermacology. University cnirat IlospitalTampere, \ F-33520 Tampere, inland. \ v Allergy to latex gloves: unusual complication during delivery K Turjanmaa, T Reunaia, R Tuimala, T Karkkainen inhaled allergens on routine prick testing. Three of them had allergic rhinitis and one extrinsic asthma. Prick tests from several brands of gloves gave strongly positive reactions (bigger than those to histamine), and radioallergosorbent tests for latex showed raised titres of specific IgE. A Prausnitz-Kiistner test with serum from our first patient gave positive results in two healthy recipients. Several drugs cause anaphylactic reactions during anaesthesia, including barbiturate induction agents and muscle relaxants such as suxamethonium.1 Anaphylactic reactions to drugs such as propanidid and oxytocin during caesarean section have been reported.11 We describe four women who developed systemic allergic reactions during delivery, the allergen was latex that eluted from surgical gloves worn by the obstetrician. Comment During the past 10 years several reports have shown that latex eluting from surgical or cleaning gloves can sensitise people and cause local contact urticaria.' * The frequency of this allergy among doctors and nurses in the operating unit at University Central Hospital, Tampere, was 6-4%.' This study, and one other,5 show that people with the allergy may be at risk during delivery, operations, and even vaginal examina Case reports tion. In addition to medical staff, people sensitised All four patients had previously experienced local after wearing cleaning gloves made from latex may also wheal and flare reactions when using latex gloves. The be at risk, as in one of our patients. Surgical and first patient, a nurse, had an anaphylactic reaction cleaning gloves both contain latex allergen, but the during her first delivery, which was performed by amount of protein eluting from these gloves varies. caesarean section, and anaesthetic drugs were sus People who are allergic to latex are generally atopic, pected to be the cause. Her second delivery was tend to be women, and have a history of irritation vaginal, and she developed generalised cutaneous from wearing gloves. Prick testing with glove allergen symptoms immediately after ventouse delivery. The will confirm the diagnosis, and many, though not all, patient was convinced that the surgeon's gloves had people allergic to latex yield positive results to the caused her symptoms. This was confirmed by a prick radioallergosorbent test for latex, which is now com- test and radioallergosorbent test for latex.' Thereafter xmercially available.' Patients should be informed of> she had two uneventful deliveries, in which oxytocin ("their allergy, and during operations or deliveries staff and ergometrine maleate were used and the staff wore , ) should use non-latex gloves--that is, gloves made from only polyvinyl chloride gloves. polyvinyl chloride or synthetic rubber.* Rubber masks, Allergy to latex was diagnosed in cur second patient,/ tubes, and cuffs should also be avoided. a surgeon, before her first delivery. Despite this an' allergic reaction after stitching of the episiotomy ^ wound was a surprise both to her and to the obstetri cian. During her next two deliveries latex gloves were not used, but during her third delivery she developed contact urticaria after having a rubber cuff on her arm. In the other`patients, a dentist and a secretary, the symptoms developed immediately after stitching of the episiotomy wound but an allergic reaction was not 1 Sloelting RK. Allergic reactions during anesthesia. Anouk Analg |983;62: 341-36. 2 Slater RM, Bowles BJM, Pumphrey RSH. Anaphylactoid reaction to oxytocin in pregnancy. Anaetthetia 1985;40:655-6. 3 Turiaomaj R, Reunaia T. Contact urticaria from rubber g*o**s. OerrmtCHr. 1988;6:47-51. 4 Turjanmaa K, Laurila K, Mskinen-KiJjunen 5, Reunaia T. Rubber contact urticaria. Allergenic properties of 19 brands of latex gloves. Contact Dermatint (in press). 5 Axelwon JGK, Johansson SCO, Wrangsjd K. IgE-mediated anaphylactoid reactions to rubber. Allergy 1987;42:46-50. diagnosed. In the dentist an intradermal test for allergy (Accepted IJJuly 1988) to lignocaine was performed but the result was negative.1 All patients were treated with intravenous hydro cortisone or methvlprednisolone, and the first patient received adrenaline as well because of severe hypo tonia and bronchospasm under general anaesthesia. They all recovered quickly, but their urticaria lasted for up to 18 hours. All of the women had a history of atopic dermatitis Correction Maternal serum screening for Down's syndrome in early pregnancy A primer's error occurred in the authors' footnote of this paper by Professor Nicholas J Wald and others (8 October, p 883). f-TnuiirA C CnnUU i> unim leLMMfkr and not CRC technical and gave at least one positive reaction to common lecturer as published^ \ ^ fern' * . J baa ^ . | i TF>chn>f'.*'J Deot.. | ~ 4 NOV '988 MJ VOLUME 297 22 OCTOBER 1988 BFG13031 H. M. CLAYTON- j ... -- u 1029 21338001 21ZV\OOIDOCUMENT NUMBER: Pulled for Attorney-Client Privilege / Work Product