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Latex Allergy
Aka: Latex Allergy, Latex Hypersensitivity, Rubber Sensitivity
- See Also
- Natural Rubber Latex
- Allergic Reaction
- Contact Dermatitis
- Allergic Contact Dermatitis
- Contact Urticaria
- Epidemiology
- Health care personnel: 5-10%
- Asymptomatic Latex Allergy: 50%
- Causes
- Reaction to Natural Rubber Latex
- Types
- Irritant Contact Dermatitis (non-immunologic)
- Delayed Hypersensitivity (Type IV) or Allergic Contact Dermatitis
- Immediate Hypersensitivity (Type I): Urticaria, Angioedema, Anaphylaxis
- 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
- 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)
- Local erythematous rash in contact with latex
- Pruritus
- Swelling
- Blistering, weeping, or crusting
- 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
- Associated Conditions
- See Food Allergy (Banana, Kiwi, Avocado)
- See Natural Rubber Latex
- 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
- 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
- Rubber latex vial stoppers (venipuncture tubes) or syringe plungers
- Only insert needle through stopper once
- Medications with latex in Vaccine packaging
- https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/latex-table.pdf
- Medic alert bracelet
- Epinephrine self-injection pen (e.g. EpiPen)
- 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):
- Nitrile Powder Free gloves (non-sterile)
- Sterile gloves
- Duraprene for procedures not requiring signficant tactile Sensation (e.g. dermatologic procedures)
- Regent Medical - Biogel Neotech for procedures requiring tactile Sensation (e.g. Vasectomy)
- References
- Pollart (2009) Am Fam Physician 80(12): 1413-20 [PubMed]
- Taylor (2004) Dematol Ther 17(4): 289-301 [PubMed]
- Nettis (2002) Clin Exp Allergy 32(3): 441-7 [PubMed]