Dverse Reactions to Latex Products

1Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

Online Course: www.dentalcare.com/en-US/dental-education/continuing-education/ce81/ce81.aspx

Disclaimer: Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their practice. Only sound evidence-based dentistry should be used in patient therapy.

This course is based on a review of the literature and presents the etiology and epidemiology of adverse reactions to latex products, clinical manifestations of adverse reactions to latex products, and strategies for the prevention and treatment of adverse reactions to latex products.

Conflict of Interest Disclosure Statement Dr. Huber reports no conflicts of interest associated with this course. Dr. Terzhalmy has done consulting work for Procter & Gamble and is a member of the dentalcare.com

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Michaell A. Huber, DDS; Gza T. Terzhalmy, DDS, MAContinuing Education Units: 2 hours

Adverse Reactions to Latex Products: Preventive and Therapeutic Strategies for Oral Healthcare Settings


OverviewEvidence-based infection control/exposure control practices are evolutionary in nature. Elements of historical note were first recorded with the suggestions of Lister for guidelines on aseptic procedures.1 Others, like Semmelweis, promoted the practice of hand washing by medical students and physicians prior to leaving autopsy suites and before entering the labor and delivery areas of hospitals.2 Halstead is credited with being the first to use surgical gloves in a clinical setting.3 While the use of latex surgical gloves became routine by the end of World War I, it wasnt until the adoption of universal precautions by the Centers for Disease Control and Prevention in 1987 that the use of gloves was officially expanded to cover virtually all aspects of patient care.4 Since then the ubiquitous use of latex gloves and other latex products in healthcare has resulted in a parallel increase in latex-associated adverse reactions. To provide for a safe environment for both oral healthcare workers (OHCWs) and patients alike, clinicians must understand the basis for latex-related adverse reactions, recognize associated signs and symptoms, and initiate appropriate preventive and therapeutic strategies. The recommendations for preventing or minimizing latex-related adverse reactions in the oral healthcare setting are based on current knowledge and a common sense approach to the problem.

Learning ObjectivesUpon completion of this course, the dental professional should be able to: Discuss the etiology and epidemiology of adverse reactions to latex products. Recognize the clinical manifestations of irritant contact dermatitis, allergic contact dermatitis, and

immediate allergic reactions. Discuss diagnostic issues related to adverse reactions to latex products. Establish strategies for the prevention of adverse reactions to latex products. Implement strategies for the treatment of adverse reactions to latex products.

Course Contents Etiology and Epidemiology Clinical Manifestations

Irritant Contact Dermatitis Allergic Contact Dermatitis Immediate Allergic Reactions Urticaria Angioedema Allergic Rhinoconjunctivitis and Asthma Anaphylaxis

Diagnosis Medical History Laboratory Testing Skin-patch Testing Skin-puncture Testing (SPT) Radioallergosorbent Test (RAST) Glove Provocation Testing (GPT)

Preventive Strategies for the Oral Healthcare Setting

Treatment Strategies Conclusion Course Test Preview References About the Authors

Etiology and Epidemiology Latex is a product of the Brazilian Hevea brazilienses rubber tree harvested mainly in Malaysia, Indonesia, and Thailand.5-6 A milky sap flows in lactifers under the surface of the bark, which is collected by making diagonal cuts in the bark of the tree. Once collected, ammonia is added to the sap to prevent autocoagulation and bacterial contamination of the latex.5,7,9 There are two types of ammonia-latex concentrates: high ammonia-latex concentrate (0.7% ammonia by weight) and low ammonia-latex concentrate (0.2-0.3% ammonia by weight). While the higher ammonia concentration is more effective in stabilizing the latex, it also increases the incidence of irritant contact dermatitis.7,10

Natural rubber latex contains cis-1,4-polyisoprene (the major component), proteins, lipids, carbohydrates, and numerous inorganic constituents such as potassium, manganese, copper, zinc, and iron.11 Over 250 proteins have been identified in latex and, depending on the source; the overall protein content varies from


1-1.8%. These proteins are involved in numerous processes of biosynthesis and defensive, structural, and housekeeping functions.9 While about 30-60 latex proteins are believed to be responsible for virtually all of the immediate hypersensitivity reactions (Gell and Coombs Type I), only 13 of these proteins have been classified and labeled by the International Nomenclature Committee of Allergens.5,11,12

Gloves are produced by one of two processes: coagulant dipping or straight dipping.8 In coagulant dipping a destabilizing chemical is deposited on the formers, while in straight dipping no destabilizing agent is used. After dipping, the latex product on the former is washed (leached) to remove residual chemicals and proteins. In order to enhance elasticity, strength, and stability it is then subjected to the process of vulcanization (heating in the presence of sulfur). To reduce the time and temperature required for vulcanization, numerous accelerators and promoters (thiurams, mercaptobenzothiazoles, and carbamates) are added. After vulcanization, post-cure leaching further removes residual chemicals and proteins. Residual chemicals are primarily responsible for allergic contact dermatitis associated with latex glove use (Gell and Coombs Type IV).7,9,10,13-15

If the gloves are destined to be free of donning powder, another washing followed by chlorination and further washing is undertaken to reduce the inherent tackiness of latex.8 Alternatively, donning powder may be added by dipping the gloves into slurry prior to removal from the

formers. Donning powder (typically cornstarch) is recognized as a major vector for the development of latex sensitivity.8,14,16-26 Free extractable proteins not removed during the glove manufacturing process may be adsorbed by the cornstarch. During the donning, use and removal of these gloves, the cornstarch-protein complexes come in direct contact with skin and mucosal surfaces or become suspended in the air (aeroallergens) for up to six hours.27 Following direct contact, mucosal surfaces appear to absorb latex proteins much more readily than intact skin and exposure to aeroallergens is considered the predominant method of inducing latex sensitization in healthcare workers.18.19,25,28 While an allergy to cornstarch is rare, evidence exists that it may act as an immunoadjuvant further increasing the risk of latex-induced allergic reactions.7,18,29

Improvements in the manufacturing of latex gloves includes the use of enzymatic processes to breakdown raw latex proteins; increased centrifugation of the raw latex liquid to separate out more latex proteins; refined leaching protocols; and chemical deproteinization during the leaching process.8 In addition the use of oat starch in lieu of cornstarch as a donning powder appears to be associated with reduced aeroallergen formation.25 An increasing number of latex-free alternatives are also becoming available; however, residual chemicals associated with the manufacturing of non-latex gloves may also induce delayed hypersensitivity reactions.8

The incidence of latex allergy in the general population is 1 to 2 percent.30 Patients with spina bifida, because of repeated exposure of mucous membranes to latex during various medical/surgical procedures, are at highest risk of latex allergy with a prevalence rate that ranges from 20 to 67 percent.30 Healthcare workers have the second highest risk of developing latex allergy with sensitization rates that are three times higher than in the general population.30,31,32 Healthcare workers who are exposed to latex products on a regular basis are at higher risk than those who are not routinely exposed.7 There is also a positive correlation between the risk of latex allergy and the length of employment in healthcare.33 Finally, exposure to powdered gloves appears to be associated with symptoms of asthma, allergic rhinitis, conjunctivitis, and angioedema.7,30,32


Clinical ManifestationsAdverse reactions following exposure to latex products may be categorized as: (1) irritant contact dermatitis, (2) allergic contact dermatitis, or (3) immediate hypersensitivity reactions (urticaria, angioedema, allergic rhinitis, asthma, or anaphylaxis).5,7,10,14,34

Irritant Contact DermatitisThe most common reaction to latex products, specifically to latex gloves, is irritant contact dermatitis (ICD). ICD, characterized by dry, cracked, itchy, irritated areas of the skin (usually of the hands) is not an allergy. The time of onset is gradual (over several days) and may result from abrasion and maceration from wearing gloves constantly, repeated hand washing and drying, incomplete hand drying, the use of cleaners and sanitizers, exposure to powder added to gloves, and exposure to other workplace products and chemicals.5,7,10,35 These signs and symptoms are similar to those associated with allergic contact dermatitis, which can only be ruled out by allergy testing. In one study, only 9 percent of healthcare workers who reported symptoms of allergic contact dermatitis actually had a latex allergy; the remainders had ICD.36 In a study of dental students, of the 10 percent who reported reactions to latex, only 1 percent had confirmed diagnosis of latex sensitization.31 Other studies suggest that 80 percent of the cases of hand dermatitis are a result of ICD.34,37 It is important to note that ICD increases the potential for allergic sensitization.9,20,30,35-40

Allergic Contact DermatitisAllergic contact dermatitis (ACD) is a delayed hypersensitivity reaction (Gell and Coombs Type IV) caused primarily by the accelerators, promoters, and antioxidants that are added to

natural rubber latex during harvesting, processing, or manufacturing.5,7,9,10,13,15,24,35,39 Many of these processing chemicals are also utilized in the manufacturing of nitrile and neoprene gloves.15 ACD is a T cell-mediated immune response. It is characterized by a papular, pruritic rash; redness; and itching, which usually begin 24 to 48 hours after contact with offending products and may progress to oozing vesicles and blisters and spread to areas of skin untouched by latex15,41,42 (Figure 1). The reaction is similar to those caused by nickel and poison ivy. A skin rash may be the first sign of allergy to latex and more serious reactions could occur with continued exposure. Since the clinical signs and symptoms of ACD are similar to ICD, it is necessary to confirm the allergic nature of the reaction in order to avoid further sensitization. The most frequently cited allergen for glove-related ACD is the accelerator thiuram.5,43 ACD can develop upon re-exposure to an antigen many years after initial exposure.7

Immediate Allergic ReactionsThe risk of progression from ACD to more serious reactions is unknown, but at least some patients initially develop ACD; then urticaria; then allergic rhinitis, sneezing, scratchy throat, conjunctivitis, angioedema, wheezing, asthma (coughing, difficulty breathing); and, rarely, anaphylaxis. Immediate allergic reactions are all IgE mediated.24,34

UrticariaUrticaria (local or generalized) is the most common presentation of a type I hypersensitivity reaction to latex (Figure 2). It likely reflects an IgE-mediated immediate hypersensitivity reaction in response to contact with latex proteins, although not all cases are associated with detectable latex-specific IgE antibodies. Symptoms usually occur within 10 to

Figure 1. Allergic contact dermatitis characterized by rash, redness, and itching, which began about 24 hours after dental treatment under a rubber dam.


proteins) on the mucosal surfaces of the eyes and upper respiratory tract initiate the IgE-mediated allergic response. If sufficient aeroallergens penetrate below the level of the glottis, the allergic response progresses to include asthma.22 An estimated 2.5% of healthcare workers are susceptible to asthma induced by exposure to latex aeroallergens.21

AnaphylaxisAnaphylaxis is the most severe manifestation of a type I hypersensitivity reaction. Latex proteins interact with IgE antibodies found on tissue mast cells and peripheral blood basophiles. A massive release of histamine and other mediators initially results in weakness, dizziness, and cutaneous symptoms such as flushing and urticaria. Anaphylaxis progresses rapidly and sequentially to include laryngeal edema (resulting in stridor), bronchospasm (resulting in wheezing); followed by hypotension, tachycardia, and vascular collapse as a result of decreased systemic vascular resistance (Figure 4).45 While anaphylaxis is seldom the first sign of latex allergy, latex exposure is estimated to account for 12 to 40 percent of anaphylactic reactions that occur during adult surgery.30,46,47 In oral healthcare settings, anaphylactic reactions to latex products have been reported to occur with

15 minutes of direct contact and is characterized by itching, redness, and wheal and flare reaction at the site of contact. Urticaria may represent a transitional stage in the progression from ACD to immediate hypersensitivity. Reactions that occur within 60 minutes of exposure to a latex product are highly suggestive of IgE-mediated allergy, while delayed or persistent urticaria is suggestive of delayed hypersensitivity.44

AngioedemaAngioedema may be a feature of urticaria. It is characterized by episodes of localized, well-circumscribed, nonpitting swelling commonly affecting the lips (Figure 3), face, limbs, trunk, abdominal viscera, and larynx. When edema affects the larynx, upper airway obstruction can be severe and life threatening. Involvement of the gastrointestinal tract is associated with severe pain.

Allergic Rhinoconjunctivitis and AsthmaNasal congestion, sneezing, rhinorrhea, watery eyes, and an itching sensation of the oropharyngeal mucosa are clinical symptoms of a type I hypersensitive reaction known as allergic rhinoconjunctivitis.22 It is generally accepted that deposits of aeroallergens (in this case latex

Figure 2. Acute urticaria characterized by pruritic, red wheals that range from 1.5 to 3.0 cm in diameter, which began about an hour after exposure to latex gloves.

Figure 3. Angioedema characterized by localized, well-circumscribed, non-pitted swelling affecting the lips.


known to have allergens that cross-react with latex.30,36

Many latex proteins, collectively called pathogenesis-related (PR) proteins, serve to protect the rubber tree from a variety of environmental threats such as infections (fungal, bacterial, and viral), wounding, and chemical insults.50 These same proteins are also expressed in numerous other plant species.51,52 For example, the latex protein -1,3-glucanase shares high association with the -1-3-glucanase proteins found in avocado, banana, chestnut, and kiwi. Other latex PR proteins share moderate association with analogous proteins in apple, carrot, celery, melon, papaya, tomato, and potato. Low or undetermined association exists between still other latex PR proteins and many other fruits and vegetables, e.g., turnip and zucchini.53 It is estimated that a patient with a history of fruit allergy has an 11% risk of concurrent latex allergy.59 Conversely, up to 50% of patients with latex allergy are hypersensitive to some plant-derived foods.5,30,54

Laboratory TestingThere is no standardized testing protocol for diagnosing latex allergy and screening for latex allergy in the general population has not been found useful and is not indicated.7,55 However, testing may be helpful in high-risk patients (e.g., patients with a high number of previous surgical procedures, a history of atopy, and a history of adverse reaction to latex).28,47,56

Skin-patch TestingSkin-patch testing is a sensitive test for diagnosing type IV delayed hypersensitivity reactions to rubber additives (e.g., chemical accelerators,

exposure to gloves, dental rubber dams, and exposure to latex-related aeroallergens.7 Rapid detection of signs and symptoms with immediate intervention is necessary to prevent serious complications and death.10,48

DiagnosisThe diagnostic algorithm for latex allergy entails obtaining a thorough medical history, skin-patch testing for diagnosing type IV delayed hypersensitivity, i.e., allergic contact dermatitis; serum IgE measurement to confirm suspected severe latex allergy, i.e., type I immediate hypersensitivity; and glove provocation testing when the patients clinical history is incongruent with IgE results.7,29,49

Medical HistoryObtaining a complete medical history is the first step in diagnosing latex allergy. OHCWs and patients who relate a history of papular, pruritic rash of the skin; rhinitis; conjunctivitis; urticaria (local or generalized); angioedema; and coughing, shortness of breath, or wheezing; and/or a drop in blood pressure following exposure to latex should be suspected of latex allergy. As noted earlier, certain patient populations (i.e., those with neural tubal defects and occupational exposure) are at higher risk for latex allergies than the general population. Other risk factors include a history of atopy (persons predisposed to multiple allergies such as those with a familial history of hay fever, asthma, dry skin, or eczema), multiple surgeries, previous hand dermatitis of any kind, and allergies to foods

Figure 4. Anaphylactic reactions to latex allergens in the oral healthcare setting characterized by angioedema of the lips and oropharynx associated with stridor, wheezing, hypotension, and tachycardia.


CA, USA], ImmunoCAP [Phadia AB, Portage, MI, USA], CLA Allergen-Specific IgE Assay [Hitachi Chemical Diagnostics, Mountain View, CA, USA], and HY TECH-288 [Hycor Biomedical Incorporated, Garden Grove, CA, USA] licensed by the FDA. Their sensitivity and selectivity is variable, ranging from 50 to 90 percent and 80 to 87 percent, respectively.30

Glove Provocation Testing (GPT)GPT is useful when the patients clinical history is inconsistent with IgE results.30 During the test, the patient wears one finger of a latex glove while the physician watches for a reaction. If there is no urticarial reaction after 15 minutes, the exposed surface area is increased. The test concludes when an urticarial response is identified (i.e., a positive provocation test), or when the patient is able to wear the full glove for 15 minutes with no reaction (i.e., a negative provocation test).7,30 Because of variations of latex content in gloves, this test has varied sensitivity and could be unsafe in highly sensitized persons.7

Preventive Strategies for the Oral Healthcare SettingTo prevent cross-contamination, oral healthcare workers must perform proper hand hygiene (work practice controls) and wear gloves (engineering controls) during the treatment of all patients and when cleaning and disinfecting instruments, dental units, and environmental surfaces.58,59 Sterile surgical gloves are used during surgery. Non-sterile examination gloves are used for routine examinations, restorative procedures, and preventive care and thick utility gloves are used during cleaning procedures. Most available glove types contain latex proteins in variable amounts, as well as processing chemicals that are responsible for precipitating type I or type IV allergic reactions, respectively.

The proteins responsible for latex allergies fasten to the powder (cornstarch) used as a donning lubricant in some gloves. While cornstarch is an extremely rare sensitizing agent, when powdered gloves are used, more latex proteins reach the host. During donning, use, and removal, the water-soluble cornstarch/latex protein particles become airborne. These aerosols can be inhaled and absorbed systemically, causing conjunctivitis, rhinitis, and asthma. Work areas,

antioxidants) and helps to differentiate ACD from ICD. It is performed by applying allergen samples to intact skin and covering them with a dressing. The patient is checked for skin reaction at 30 minutes, 24 hours, and 48 hours.7,30 Swelling, redness, or blistering characterize a positive test. If the test is negative, the site is reexamined again at 72 and 96 hours because weak reactions may appear later. A refinement of the technique, the thin layer rapid use epicutaneous (TRUE) test (Allerderm, Petaluma, CA, USA), has been licensed by the FDA and is available commercially. The TRUE test consists of a pre-prepared testing strip containing 24 of the most common contact allergens, including four rubber screening mixes and mercaptobenzothiazole.9

Skin-puncture Testing (SPT)The skin-puncture test (SPT) is the most sensitive testing method for diagnosing type I immediate hypersensitivity reactions.30,36,55,57 A minute quantity of allergen, sufficient to react with IgE antibodies fixed in cutaneous mast cells, is introduced into the epidermis at a single point. After 15 minutes, a wheal formation equal to or larger than half the control signifies a positive response.30 However, SPT should only be performed at medical centers with staff experienced and equipped to manage severe IgE-mediated immediate hypersensitivity reactions and an FDA-approved latex skin-puncture testing reagent is not available in the United States.30,42

Radioallergosorbent Test (RAST)The radioallergosorbent test (RAST), a quantitative measurement of allergen-specific IgE antibodies, is considered to be the safest testing method for confirming suspected severe latex allergy because there is no risk of anaphylaxis.30 There are a number of assays (e.g., Alastat [Diagnostic Products Corporation, Los Angeles,


by following the recommendations of the National Institute for Occupational Safety and Health (Figure 5).28

Treatment StrategiesOnce an individual becomes allergic to latex, special precautions are needed to prevent exposure at home, at work, and during medical and dental care. They should also be aware of common natural rubber latex products, as well as foods with cross-reactive proteins.30 Pretreatment with antihistamines, corticosteroids, and bronchodilators do not predictably prevent latex or other IgE-mediated anaphylactic reactions, consequently, complete latex avoidance is the most effective approach to this problem.26 While symptoms of latex allergy resolve quickly with avoidance, elevated IgE levels can remain detectable for more than 5 years after exposure, suggesting the importance of long-term avoidance.65 OHCWs and patients with a history of type I hypersensitivity to latex should wear a Medic Alert bracelet and carry epinephrine for emergency use.39 Strategies for the management of emerging

where only powder-free gloves are used, show low or undetectable levels of allergy-causing latex proteins.4,9,21,23,24 Consequently, low-protein, powder-free gloves; or latex-free gloves provide a primary prevention of latex allergy.32,60-62

The amount of latex exposure to produce sensitization or symptoms of an allergic reaction is unknown. However, reductions in exposure to latex products have been reported to be associated with decreased sensitization and symptoms.19,24,36,44,63 Table 1 contains some of the products used in dentistry that contain latex and a list of alternative products.52 Practitioners should routinely check with their suppliers to stay current on the availability of latex-free substitutes. The cost of latex alternatives and non-latex gloves has been analyzed, and it was found to be less expensive when compared to the disability and liability costs associated with exposure to latex products.6,64

Allergic reactions to latex products in the healthcare setting can be minimized or prevented

Table 1. Dental products that frequently contain latex and alternatives.52


Reductions in exposure to latex products have been reported to be associated with decreased sensitization and symptoms, consequently, a reasonable reduction of latex products in the oral healthcare setting should be considered for the protection of both OHCWs and the patient. Low-protein, powder-free gloves, or latex-free gloves provide a primary prevention of latex allergy.

adverse reactions to latex are presented in Figure 6.66,67

ConclusionAdverse reactions to latex products in the oral healthcare setting can result in potentially serious health problems; however, such adverse reactions can be minimized or prevented.

Figure 5. Strategies for the prevention of adverse reactions to latex products.


Figure 6. Strategies for the treatment of allergic reactions to latex products.


Course Test PreviewTo receive Continuing Education credit for this course, you must complete the online test. Please go to: www.dentalcare.com/en-us/dental-education/continuing-education/ce81/ce81-test.aspx

1. Naturally occurring proteins found in latex are believed to be responsible for inducing what type of allergic reaction?a. Type Ib. Type IIc. Type IIId. Type IV

2. The process in which latex is heated in the presence of sulfur is termed:a. Leachingb. Vulcanizationc. Autocoagulationd. Chlorination

3. The most commonly used donning powder is ____________.a. talcumb. baby powderc. cornstarchd. oat starch

4. During the donning process, donning powder may become suspended in the air for up to __________.a. 10 minutesb. 1 hourc. 6 hoursd. 24 hours

5. Residual chemicals associated with the manufacturing of non-latex gloves may also induce delayed hypersensitivity reactions.a. Trueb. False

6. The most common form of adverse reaction to latex glove use is ____________.a. irritant contact dermatitisb. allergic contact dermatitisc. immediate hypersensitivity reaction

7. Factors contributing to irritant contact dermatitis include:a. Frequent hand washingb. Constant wearing of glovesc. Exposure to donning powderd. All of the above.

8. Allergic contact dermatitis is ____________.a. delaying hypersensitivity reactionb. caused by latex proteinsc. caused by accelerators, promoters and antioxidants added during glove manufacturingd. A and C


9. One of your assistants develops a hand rash while working in the office. She relates that the rash only occurs when she wears brand X, but not brand Y. She is most likely describing what type of adverse reaction?a. Irritant contact dermatitisb. Allergic contact dermatitisc. Immediate hypersensitivity reaction

10. The most common presentation of a type I hypersensitivity reaction is:a. Asthmab. Angioedemac. Urticariad. Allergic rhinitis

11. Type I hypersensitivity reactions are mediated by:a. IgAb. IgDc. IgEd. IgM

12. The most serious manifestation of a type I hypersensitivity reaction is:a. Anaphylaxisb. Asthmac. Angioedemad. Allergic rhinitis

13. The diagnostic algorithm for latex allergy include _______________.a. obtaining a thorough medical historyb. skin-patch testing for diagnosing type IV delayed hypersensitivity and serum IgE measurements

to confirm type I immediate hypersensitivityc. glove provocation testing when patients clinical history is incongruent with IgE resultsd. All of the above.

14. Historical clues to a possible latex sensitivity include:a. Signs and symptoms of an allergic response after exposure to latexb. Atopyc. Multiple surgical exposuresd. All the above.

15. The risk of latex allergy in an individual with a fruit allergy is estimated to be ______.a. 1%b. 11%c. 20%d. 50%

16. Patch testing is diagnostic of a:a. Type I hypersensitivity reactionb. Type II hypersensitivity reactionc. Type III hypersensitivity reactiond. Type IV hypersensitivity reaction


17. To reduce latex exposure, when performing routine restorative dentistry which of the following is not recommended?a. Use only properly sized surgical gloves.b. Use reduced protein, powder-free gloves.c. When possible, use latex-free productsd. Practice proper hand hygiene

18. When managing a patient who has a confirmed type I hypersensitivity to latex, which of the following is not recommended?a. Premedicate the patient with an antihistamine one hour prior to the appointment.b. Schedule the patient for the first appointment of the day.c. Schedule the patient for the last available appointment of the day.d. A and C

19. The most effective medication available to manage allergic contact dermatitis is ____________.a. Epinephrineb. Benadrylc. A topical corticosteroidd. An oral H1 receptor antagonist

20. Which of the following medication is most critical for managing anaphylaxis?a. Epinephrineb. Benadrylc. An inhaled beta2-adrenergic agonistd. An oral H1 receptor antagonist


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About the Authors

Michaell A. Huber, DDSAssociate ProfessorHead, Oral Medicine DivisionDepartment of Dental Diagnostic ScienceThe University of Texas Health Science Center at San Antonio, Dental School

Dr. Huber is an Associate Professor, Head, Division of Oral Medicine, Department of Dental Diagnostic Science, the University of Texas Health Science Center at San Antonio, Dental School, San Antonio, Texas.

Dr. Huber received his DDS from the University of Texas Health Science Center at San Antonio Dental School, San Antonio, Texas in 1980 and a Certificate in Oral Medicine from the National Naval Dental Center, Bethesda, Maryland in 1988. He is certified by the American Board of Oral Medicine as an


officer of the Dental Corps, United States Navy. Dr. Hubers assignments included numerous ships and shore stations and served as Chairman, Department of Oral Medicine and Maxillofacial Radiology and Director, Graduate Program in Oral Medicine, National Naval Dental Center, Bethesda, Maryland. In addition he served as Specialty Leader for Oral Medicine to the Surgeon General of the United States Navy, Washington, DC; and Force Dental Officer, Naval Air Force Atlantic, Norfolk, Virginia. He has many professional affiliations and over the past 24 years, he has held a variety of positions in professional organizations.

Since joining the faculty in 2002, Dr. Huber has been teaching both pre-doctoral and graduate dental students at the University of Texas Health Science Center Dental School, San Antonio, Texas, and is the Director of the schools Oral Medicine Tertiary Care Clinic. He is currently serving as the Public Affairs Chairman for the American Academy of Oral Medicine. Dr. Huber has accepted invitations to lecture before many local, state, and national professional organizations. He has been published in numerous journals including: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology; Dental Clinics of North America, Journal of the American Dental Association, and Quintessence International.

Email: [email protected]

Gza T. Terzhalmy, DDS, MAProfessor and Dean EmeritusSchool of Dental MedicineCase Western Reserve University

Dr. Terzhalmy is Professor and Dean Emeritus, School of Dental Medicine, Case Western Reserve University. In addition, he is a Consultant, Naval Postgraduate Dental School, National Naval Medical Center; and Civilian National Consultant for Dental Pharmacotherapeutics, Department of the Air Force.

Dr. Terzhalmy earned a B.S. degree from John Carroll University; a D.D.S. degree from Case Western Reserve University; an M.A. in Higher Education and Human Development from The George Washington University; and a Certificate in Oral Medicine from the National Naval Dental Center. Dr. Terzhalmy is certified by the American Board of Oral Medicine and the American Board of Oral and Maxillofacial Radiology (Life).

Dr. Terzhalmy has many professional affiliations and over the past 40 years, has held more than 30 positions in professional societies. He has served as editor or contributing editor for several publications, co-authored or contributed chapters for several books and has had over 200 papers and abstracts published. Dr. Terzhalmy has accepted invitations to lecture before many local, state, national, and international professional societies.

Email: [email protected]

Documents

Dverse Reactions to Latex Products