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
Approximately 30 percent to 70 percent of latex allergic patients show an associated hypersensitivity to one or more fruits.6-8
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.
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
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
The identification of patients at risk for a latex allergy is an essential step before medical procedures that involve latex exposure occur.3
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
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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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
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.