LATEX ALLERGY

By Gary M. White, MD


Latex allergy is a broad term that describes hypersensitivity to natural rubber latex. Latex is the milky colored sap from the Brazilian rubber tree. The term natural rubber latex refers to rubber made from latex. Latex is strong, elastic, and a good barrier against bacteria and viruses. Patients who are allergic to latex can develop anaphylaxis after a simple examination of their mucosa by a latex-gloved hand. Because of these reasons, most of health care has become a latex-free environment. Typical products that have been a source of latex include gloves, adhesive tape, balloons, rubber balls, condoms, rubber bands, paint, tourniquets, electrode pads, and Foley catheters.

Several food allergies commonly occur in latex-allergic individuals. The most common foods are avocados, bananas, kiwi, papaya, and chestnuts. Many other foods (e.g., almond, apple, apricot, Brazil nut, cantaloupe, carrot, celery, cherry, coconut, honeydew, passion fruit, peach, peanut, pear, plum, potato, swede, tomato, walnut, watermelon) may be allergenic as well. There are some plants to which latex-allergic patients may react. Those include Ficus benjamina (weeping fig) and Marsdenia condurango (found in some herbal teas and bitter liquors).

The classic latex allergy is IgE mediated (type I hypersensitivity). Type IV (delayed hypersensitivity) as well as irritant contact dermatitis occur as well. The powder in latex gloves can contain significant levels of latex. These allergens easily become airborne and thus the patient may react merely by entering a health care area. The powder can remain in the air for up to 24 hours.

Clinical

Reactions can range from mild to severe. They may occur only in the area of contact or be systemic. Specific signs and symptoms include pruritus, urticaria (either contact urticaria under gloves or widespread urticaria), rhinitis, conjunctivitis, asthma (wheezing, coughing, shortness of breath), hypotension, and anaphylaxis. Onset may be within seconds of exposure to as long as 45 minutes after.

For diagnostic purposes, a latex RAST test is available. Unfortunately, it can have a significant false negative rate. Use tests or patch tests as of this writing are not FDA-approved and CAN POTENTIALLY CAUSE ANAPHYLAXIS.

Treatment

Patients should avoid latex. They should wear a Medic Alert bracelet. They should carry an EpiPen. They should notify all health care providers and dentists of their allergy. They should be aware of potential food and plant cross reactions as well as other sources of latex in their environment. They may want to carry latex-free gloves when traveling in case they need medical or dental attention. One woman noted reacting to foods she ate at restaurants or purchased in markets where the food was handled by employees wearing latex gloves [NEJM 1999;341;1858].

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