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Latex describes either the sap of
the Brazilian rubber tree ( Hervea brasiliensis) or products
made by dipping forms into the sap (gloves, balloons, condoms).
Allergic reactions are against proteins naturally present (1%)
in liquid latex. Which particular protein is the problem is
unclear; one with molecular weight 14,600 is favourite. Latex is
harmless to most people. But for some, like other things in
nature - shellfish, bee stings, peanuts, venom - latex can cause
People who are allergic to latex
may also react to banana, avocado, kiwi fruit, chestnut, plum,
peach, cherry, apricot, fig, papaya, tomato, potato and some
other plant foods. The list is still growing. The reason is that
these plants contain proteins which are similar enough to latex
proteins to react with our allergy-producing antibodies to
For the general public, the risk
of an allergic reaction to latex is less than 1 percent. But
because of constant exposure to latex, two groups are at greater
risk--health-care workers and children with spina bifida and
other conditions involving multiple surgical procedures. Because
latex-containing medical devices abound in surgical suites,
dental offices, and other health-care settings, contact with
latex is an occupational hazard for health-care workers. It is
also part of daily health maintenance routines (for example,
catheterization) and the many surgeries high-risk children
Symptoms of Latex Reactions
There are three different types of reactions to
natural rubber latex. They are irritation, delayed
hypersensitivity (allergic contact dermatitis) and immediate
hypersensitivity (anaphylactic symptoms). Irritation is classed
as a non allergic condition. The irritated skin is dry and
crusty, and the symptoms resolve when contact with latex ceases.
Delayed hypersensitivity presents as skin becoming dry, crusty
and leathery with eruptions appearing as sores and blisters.
This response occurs between six and 48 hours after contact.
Repeated latex exposure causes the skin condition to expand
beyond the area of contact. Many people with delayed
hypersensitivity have a history of atopy (allergy, dermatitis,
Immediate hypersensitivity is an allergic response mediated by
IgE (an antibody found in the circulation). On the skin this can
present hives that migrate beyond the point of contact with
latex. Systemic allergic symptoms can include itching eyes,
swelling of lips or tongue, breathlessness, dizziness, abdominal
pain, nausea, hypotension, shock and, potentially, death. These
symptoms are likely to result from a massive release of
histamine at a local or whole body level. This results from
binding of the latex allergen to sensitised receptors on mast
Allergic reactions to latex can include:
-swollen red skin
-itching or burning eyes
-swollen lips and tongue with difficulty in breathing, wheezing
-shortness of breath
There are several Tests available.
Skin-prick testing is often thought to be the 'gold
standard' of sensitivity testing. Latex is introduced into the
skin in small quantities at a pinprick site. Positive results
are swelling or reddening of the skin, and these can be graded
according to size. Skin-prick testing is thought by some to be
dangerous, particularly intradermal injection, because of the
possibility of life threatening anaphylactoid reactions. Testing
has to be performed with the allergen against which the patient
is allergic. The different types of available allergen extracts
may not contain the particular allergen.
There are also safer in vitro tests. A blood
sample is taken and tested for the presence of IgE antibodies
specific to latex. There are a number of tests from different
manufacturers who may use different latex extracts. Processes
which link allergen proteins using amino groups give very good
results compared with skin-prick testing. In one study, of 52
skin-prick latex positive patients, 50 were positive by blood
tests. The excellent results now possible with blood tests,
their relative low cost and freedom from the danger of immediate
hypersensitivity associated with skin-prick testing makes them
the method of choice, though there may be differences between
manufacturers in kit quality for latex.
Studies which have used immunoassays to detect
latex-specific IgE have been reviewed critically. Skin and
serological testing have been compared directly, and either may
be used as a reliable method of diagnosing latex allergy.
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In most cases, there are
alternative products you can use. For instance, foil balloons
are fine for a child with latex allergy. Latex-free condoms are
widely available in most chemists.
If you are allergic to latex, it is important that you wear a
Medic Alert bracelet or necklace. These are pieces of jewellery
containing a telephone number which any doctor can ring to find
out about your medical conditions. This avoids you being
mistakenly treated using products containing latex. Your medical
records at your local hospital, your dentist and your GP should
also have a sticker on the front saying you are allergic to
If you are highly allergic to latex, it may be worth carrying a
set of sterile latex-free gloves, especially if you are
travelling away from home. Hospitals and doctors in the UK are
becoming more aware of latex allergy, but unfortunately the same
may not be true of health care abroad.
If you suffer severe reactions to latex, that is, anaphylaxis, a
doctor may recommend for you to always carry a pre-loaded
adrenaline (epinephrine) syringe. More details about this are
available in our page on
If you have significant latex
allergy respiratory symptoms from inhaling latex particles, you
need to avoid areas where powdered gloves are used frequently.
Ideally, all high glove use areas should use powder-free gloves
to avoid allergic reactions. Using latex condoms can be a severe
problem for some latex-allergic people. One option is natural
skin condoms. These do not contain latex and can prevent
pregnancy, but they do not protect against viruses like HIV,
which cause AIDS, or some other sexually-transmitted diseases
(STDs). Synthetic rubber condoms, created to prevent both
pregnancy and STDs, are now available.
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There are several medications to treat the
symptoms of latex allergy once it develops. However, because no
cure is available the best course of action is avoidance.
The treatment for a serious allergic reaction is
adrenaline (also known as epinephrine). During
anaphylaxis, blood vessels leak, bronchial tissues swell and
blood pressure drops, causing choking and collapse. Adrenaline (epinephrine)
acts quickly to constrict blood vessels, relax smooth muscles in
the lungs to improve breathing, stimulate the heartbeat and help
to stop swelling around the face and lips (angioedema).
adrenaline injection kits are available on prescription for
those believed to be at risk. These are available in two
strengths - adult and junior. The injection must be given, as
directed, as soon as a serious reaction is suspected and an
ambulance must be called. If there is no improvement in 5-10
minutes, give a second injection.
Because this must be administered without delay,
patients known to be at risk often carry their own adrenaline
injection kits for use in an emergency.
The injection many doctors prescribe is the
EpiPen, an easy-to-use device with a concealed needle.
The EpiPen is available on prescription and distributed by ALK
-Abelló, 2 Tealgate, Hungerford, Berkshire RG17 0YT. Tel
A relatively new adrenaline injection kit called
Anapen is also available on prescription. It is
manufactured and distributed by Celltech Pharmaceuticals Ltd,
208 Bath Road, Slough, Berkshire SL1 3WE. Tel 01753 447690.
Both companies provide trainer pens for practice
purposes. For information on how to administer the EpiPen
(click here) and Anapen,
It is important to emphasise that even after
adrenaline is administered, medical assistance should be sought
urgently because the effects may wear off after 5 to 10 minutes
and the injection may have to be repeated.
In fact, doctors often prescribe more than one
injection kit so that if medical assistance is delayed, patients
may administer a second dose.
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below is interesting in that it shows that continued exposure to
latex seems to increase the likelihood of developing an allergic
reaction to the latex.
Occupational exposure to natural
rubber latex has led to sensitization of health-care workers.
However, the prevalence of latex allergy among occupationally
exposed workers in American hospitals has not been reproducibly
determined. The objectives of the current study were to
determine the prevalence of and risk factors for latex
sensitization among a cohort of highly exposed health-care
workers. METHODS: Participants were 168 of 171 eligible
anaesthesiologists and nurse anaesthetists working in the
Department of Anaesthesiology and Critical Care Medicine. A
clinical questionnaire was administered, and testing was
performed using a characterized no ammoniated latex reagent for
puncture skin testing, a Food and Drug Administration-approved
assay to quantify latex-specific immunoglobulin E antibody in
serum, and, when required for clarification, a validated
two-stage (contact-inhalation) latex glove provocation
procedure. RESULTS: The prevalence of latex allergy with
clinical symptoms and latex sensitization without clinical
symptoms was 2.4% and 10.1%, respectively. The prevalence of
irritant or contact dermatitis was 24%. The risk factors
identified for latex sensitization were atopy (odds ratio, 14.1;
95% CI, 1.8-112.1; P = 0.012); history of allergy to selected
fruits, such as bananas, avocados, or kiwis (odds ratio, 9.8;
95% CI, 1.6-61.9; P = 0.015); and history of skin symptoms with
latex glove use (odds ratio, 4.6; 95% CI, 1.6-13.4; P = 0.006).
CONCLUSIONS: The prevalence of latex sensitization among
anaesthesiologists is high (12.5%). Of these, 10.1% had occult
(asymptomatic) latex allergy. Hospital employees may be
sensitized to latex even in the absence of perceived latex
allergy symptoms. These data support the need to transform the
health-care environment into a latex-safe one that minimizes
latex exposure to patients and hospital staff.
PMID: 9710386 [PubMed - indexed for MEDLINE]
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