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LauraKorhonen

Latex Allergy

Suspect latex allergy in a person who gets symptoms from products containing rubber, such as gloves, balloons, babies' dummies, condoms or medical instruments.
Every patient scheduled to undergo surgery should beforehand be asked about symptoms suggestive of latex allergy.

Latex allergy is an immediate (type I) hypersensitivity reaction to proteins of the rubber tree. Delayed (type IV) hypersensitivity reaction to chemicals added to natural rubber latex is called rubber chemical allergy. The symptom of delayed allergy is eczema.
15 different allergens have been identified in latex.
About 1% of the population are approximated to suffer from latex allergy, health care personnel more often than general population.
In the 2000's, the prevalence of latex allergy has decreased among health care personnel, along with the introduction of powder-free gloves and the reduction of protein content of latex gloves.

The following products, for example, may contain latex:
- gloves (examination or household gloves, sterile gloves)
- healthcare equipment, such as catheters, radiographic balloons, manometry balloons, intubation tubes, anaesthesia masks, sphygmomanometer tubing
- protective membranes used by dentists (cofferdam)
- children's dummies and teats , condoms, rubber bands, balloons.

The most severe reactions are usually caused by direct contact of natural rubber latex with mucous membranes during an operation, delivery and different investigations.
Local or generalized urticaria, swelling and itching
Hand eczema
Conjunctivitis
Rhinitis
Asthma
Anaphylactic reaction
Symptoms vary from mild allergic symptoms to severe anaphylaxis.

Persons who are atopic or suffer from hand eczema
Repeatedly (especially as a child) operated patients (e.g. spina bifida patients)
Health care personnel
Persons using household gloves

Some allergens in latex have cross-reactions with pollens, such as with birch pollen.
Allergens of latex cross-react also with some fruits and vegetables (e.g. banana, avocado, chestnut, kiwi)
The established cross allergies vary based upon the latex allergen the patient is sensitized to.
The clinical significance and need for an elimination diet depend on the patient's symptoms. Only food substances that bring about symptoms should be avoided.

Essentially based on history of immediate symptoms associated with latex exposure. A positive allergy test result to latex may also be due to cross-reaction and hence does not necessarily mean real latex allergy.
If real latex allergy is suspected based on the patient's symptoms, consider referring the patient to a specialist for more thorough investigations.
Sensitization may be examined by skin prick tests and by determining specific IgE antibodies against latex Diagnostic Tests in Dermatology.
As further allergy workup it is possible to determine IgE antibodies against different proteins in latex.
Challenge tests (skin, lung) are performed at a specialist clinic.

It is essential to avoid contact with products containing natural rubber latex.
Persons who have had a severe allergic reaction should have an adrenaline auto-injector Anaphylaxis.
Staff members with latex allergy can use low allergenic latex gloves if these do not cause any symptoms. If needed, gloves with no latex should be used.
All staff members working in the same area should use low allergenic gloves because natural rubber allergens spread into the environment by glove powder.
When handling patients with latex allergy it is essential to use gloves and other equipment completely free of natural rubber latex.

Mari A, Scala E, D'Ambrosio C et al. Latex allergy within a cohort of not-at-risk subjects with respiratory symptoms: prevalence of latex sensitization and assessment of diagnostic tools. Int Arch Allergy Immunol 2007;143(2):135-43. [PubMed]
Allmers H, Schmengler J, John SM. Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers. J Allergy Clin Immunol 2004;114(2):347-51. [PubMed]