II. Epidemiology
- Health care personnel: 5-10%
- Asymptomatic Latex Allergy: 50%
III. Causes
- Reaction to Natural Rubber Latex
IV. Types
- Irritant Contact Dermatitis (non-immunologic)
- Delayed Hypersensitivity (Type IV) or Allergic Contact Dermatitis
- Immediate Hypersensitivity (Type I): Urticaria, Angioedema, Anaphylaxis
V. Risk Factors
- Neural Tube Defects
- Occupational exposure (e.g. healthcare workers)
- Atopic Dermatitis (RR 4)
- History of Hand Dermatitis (allows latex penetration)
- Food allergies with cross-reactivity to Natural Rubber Latex
- Multiple surgery history
- Each successive surgery increases overall risk
- In Neural Tube Defect history, each surgery increases increases Latex Allergy risk by 13 fold
- Latex is the most common cause of Anaphylaxis during surgery
- Child: Anaphylaxis occurs in 0.01% of pediatric surgeries and latex accounts for 76% of triggers
- Adult: Anaphylaxis occurring in adult surgeries is triggered by Latex Allergy in up to 40% of cases
- Each successive surgery increases overall risk
VI. Symptoms
-
Irritant Contact Dermatitis (non-immunologic)
- Stinging or burning
- Pruritus
- Skin fissuring
- Delayed Hypersensitivity (Type IV) or Allergic Contact Dermatitis (occurs 24-48h after exposure)
- Immediate Hypersensitivity (Type I) with potentially life-threatening systemic Hypersensitivity
- Occurs with skin, mucosal or even airborne contact
- Generalized Rash
- Urticaria
- Pruritus
- Eye and nose irritation
- Allergic Rhinitis type symptoms
- Throat swelling
- Respiratory symptoms
- Wheezing
- Shortness of Breath
- Chest tightness
- Palpitations
- Anaphylaxis
VII. Associated Conditions
- See Food Allergy (Banana, Kiwi, Avocado)
- See Natural Rubber Latex
VIII. Diagnosis
-
Skin Prick Testing for Latex Allergy
- Available in Europe but not in the United States
- Would be a first-line test if available in the United States
- Serum IgE levels
- Variable efficacy
- Glove provocative test (glove challenge test)
- Progressive exposure every 15 minutes to each finger of a glove and ultimately the entire hand
- Negative test for Latex Allergy if the entire glove can be worn for 15 minutes without reaction
- Test has variable efficacy and there is a risk of Anaphylaxis
- Skin Patch Testing
- Indicated for Type IV Delayed Hypersensitivity Reaction
- Skin rechecked at 30 minutes, 24 hours and 48 hours after patch application
IX. Management
- Avoid further Natural Rubber Latex exposure
- Mild Latex Allergy (Contact Dermatitis)
- Avoid common latex exposures (e.g. latex gloves)
- Severe Latex Allergy (systemic reaction, Anaphylaxis)
- Avoid all latex exposure
- Medic alert bracelet
- Epinephrine self-injection pen (e.g. EpiPen)
X. Prevention
- Avoid the use of Natural Rubber Latex gloves
- Use powder free latex gloves if not possible to eliminate latex gloves from facility
- Systemic Hypersensitivity has very serious implications
- Requires avoidance of healthcare setting
- Career change may be indicated for healthcare worker
- Health care institutions should strongly consider limiting latex products in their facilities (especially latex gloves)
- Evidence exists for cost savings in switching to non-latex gloves
- LaMontagne (2006) Occup Environ Med 63(5): 359-64 [PubMed]
- Tarlo (2001) J Allergy Clin Immunol 108(4): 628-33 [PubMed]
- Use alternatives to latex gloves (Dr Moses' favorites):