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Latex Allergy: Overview, Diagnosis, and Treatment
About Latex Allergy
Natural rubber latex (NRL) or latex allergy has been recognized as a significant concern for both patients and healthcare employees.1 Latex allergy is an IgE-mediated reaction to the proteins present in latex that come from the milky fluid of the Brazilian rubber tree, Hevea brasiliensis.2 Such reactions typically manifest as systemic urticaria, rhinitis, conjunctivitis, bronchospasm, and anaphylaxis.3
30% to 70% of patients
Approximately 30 percent to 70 percent of latex allergic patients show an associated hypersensitivity to one or more fruits.6-8
Latex reactions are typically classified into three major types:1
1. Irritant contact dermatitis: This is the most frequent reaction associated with latex gloves and is a non-allergic reaction of the skin to an irritant.
2. Allergic contact dermatitis or delayed hypersensitivity (type IV): This is a delayed immune reaction that takes place 24 to 48 hours after initial contact.
3. IgE-mediated hypersensitivity (type I): This is the least frequent but most dangerous reaction and typically occurs within 30 to 60 minutes of initial contact. Symptoms can range from mild (e.g., pruritus, cutaneous rash, urticaria, edema of the eyes, rhinitis, conjunctivitis, slight hypotension, and tachycardia) to potentially life-threatening anaphylactic reactions.
The diagnosis of latex allergy should not be made on the basis of detailed history of latex exposure and associated symptoms alone, making laboratory testing often necessary.3-5
Latex allergy: Refining differential diagnosis through testing
Healthcare providers should evaluate for latex allergy when there is a history of prior latex-specific IgE and symptoms consistent with IgE-mediated reactions to latex-containing devices.4
Evaluation of the patient with a suspected latex allergy should include a detailed history of risk factors, exposures, and reactions to latex.5 The diagnosis of latex allergy should not be made on the basis of detailed history of latex exposure and associated symptoms alone, making laboratory testing often necessary.3-5
Diagnosis of latex allergy can be divided into three parts:1
- A thorough preoperative interview
- Preoperative symptoms of latex allergy
- Diagnostic tests
Who should be tested?
While the general population has a low incidence of latex allergy―the prevalence of latex allergy in the general population is less than 1 percent―certain groups remain at high risk.1,4
These high-risk groups include:1
- Patients with a history of asthma, dermatitis, or eczema.
- Patients with food allergy, especially to avocado, kiwi, banana, mango, melon, pineapple, chestnut, or hazelnut.
- Patients exposed to repeated bladder catheterization.
- Patients with a history of anaphylaxis of uncertain etiology.
- Children with a history of multiple surgeries or medical procedures.
- Healthcare workers who frequently wear latex gloves.
- Workers with occupational exposure to latex (e.g., hairdressers, greenhouse workers, latex glove manufacturers, housekeeping personnel, and textile workers).
The identification of patients at risk for a latex allergy is an essential step before medical procedures that involve latex exposure occur.3
Healthcare providers must be aware of medical products that may contain latex protein allergens, in order to produce a safe environment for patients.5
Items containing latex
Many medical and dental supplies, such as latex gloves, catheters, and dental dams, are manufactured from NRL. So are condoms, toys, and sports equipment, which can trigger allergic reactions in some individuals.3 Latex gloves are implicated in most cases of latex-mediated reactions.1
Latex fruit syndrome
Studies have shown that certain fruits (such as avocado, banana, chestnut, and kiwi) contain proteins that have allergenic similarities with latex.6-8 Approximately 30 to 70 percent of latex allergic patients show an associated hypersensitivity to one or more fruits.6-8 The association between latex and these fruits is attributed to cross-reactivity.8
Testing Increases Diagnostic Confidence
Adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis to 90 percent.i,ii Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and a physical examination. However, adding diagnostic testing to aid in a differential diagnosis has been shown to increase confidence in diagnosis.i,ii Diagnostic testing can also help to improve the patient’s quality of life and productivity, reduce costs associated with absenteeism, and optimize use of medication, in addition to decreasing unscheduled healthcare visits.iii,iv
i. Duran-Tauleria E, Vignati G, Guedan MJ, et al. The utility of specific immunoglobulin E measurements in primary care. Allergy. 2004;59 (Suppl78):35-41.
ii. NiggemannB, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen specific IgE testing. Pediatr Allergy Immunol. 2008;19:325-331
iii. Welsh N, et al. The Benefits of Specific Immunoglobulin E Testing in the Primary Care Setting. J Am Pharm Assoc. 2006;46:627.
iv. Szeinbach SL, Williams B, Muntendam P, et al. Identification of allergic disease among users of antihistamines. J Manag Care Pharm. 2004; 10 (3): 234-238
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Management and care of patients with latex allergy
Since a wide variety of medical and household products contain NRL, a completely latex-free environment is not realistic.6
As such, healthcare providers should advise their patients with confirmed latex allergy to follow precautions, including:3
- Avoid latex exposure
- Wear a latex allergy medical alert bracelet
- Carry a supply of non-latex gloves
- Keep an epinephrine auto-injection kit
And healthcare providers must be aware of medical products that may contain latex protein allergens, in order to produce a safe environment for patients and healthcare workers with latex allergy.5
Although there is no cure for latex allergy, trigger management can minimize the risk of reaction.1 Practice parameters have been developed to help guide the management and treatment of patients with systemic reactions to latex.
- Demaegd J, Soetens F, Herregods L. Latex allergy: a challenge for anaesthetists. Acta Anaesthesiol Belg. 2006;57(2):127-135.
- Kumar RP. Latex allergy in clinical practice. Indian J Dermatol. 2012;57(1):66-70.
- Slater JE. Latex allergy. J Allergy Clin Immunol. 1994; (2)139 – 149.
- Poley, GE. et al. Latex allergy. J Allergy Clin Immunol. 2000:105(6) 1054 – 1062.
- Accetta D, Kelly KJ. Recognition and Management of the Latex-Allergic Patient in the Ambulatory Plastic Surgical Suite, Aesthetic Surgery J. 2011;31(5) 560–565.
- Alenius H, Turjanmaa K, Palosuo T. Natural Rubber Latex Allergy. Occup Environ Med 2002;59:419–424.
- Sussman GL et al. Allergens and natural rubber proteins. J Allergy Clin Immunol. 2002;110 (2) S33 - S39.
- Radauer C et al. Latex allergic patients sensitized to the major allergen hevein and heveinlike domains of class I chitinases show no increased frequency of latex associated plant food allergy. Mol Immunol. 2011 Jan; 48(4): 600–609.
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