Latex Allergy

Aka: Latex Allergy, Latex Hypersensitivity, Rubber Sensitivity

1. See Also
   1. Natural Rubber Latex
   2. Allergic Reaction
   3. Contact Dermatitis
   4. Allergic Contact Dermatitis
   5. Contact Urticaria
2. Epidemiology
   1. Health care personnel: 5-10%
   2. Asymptomatic Latex Allergy: 50%
3. Causes
   1. Reaction to Natural Rubber Latex
4. Types
   1. Irritant Contact Dermatitis (non-immunologic)
   2. Delayed Hypersensitivity (Type IV) or Allergic Contact Dermatitis
   3. Immediate Hypersensitivity (Type I): Urticaria, Angioedema, Anaphylaxis
5. Risk Factors
   1. Neural Tube Defects
   2. Occupational exposure (e.g. healthcare workers)
   3. Atopic Dermatitis (RR 4)
   4. History of Hand Dermatitis (allows latex penetration)
   5. Food allergies with cross-reactivity to Natural Rubber Latex
   6. Multiple surgery history
      1. Each successive surgery increases overall risk
         1. In Neural Tube Defect history, each surgery increases increases Latex Allergy risk by 13 fold
      2. Latex is the most common cause of Anaphylaxis during surgery
         1. Child: Anaphylaxis occurs in 0.01% of pediatric surgeries and latex accounts for 76% of triggers
         2. Adult: Anaphylaxis occurring in adult surgeries is triggered by Latex Allergy in up to 40% of cases
6. Symptoms
   1. Irritant Contact Dermatitis (non-immunologic)
      1. Stinging or burning
      2. Pruritus
      3. Skin fissuring
   2. Delayed Hypersensitivity (Type IV) or Allergic Contact Dermatitis (occurs 24-48h after exposure)
      1. Local erythematous rash in contact with latex
      2. Pruritus
      3. Swelling
      4. Blistering, weeping, or crusting
   3. Immediate Hypersensitivity (Type I) with potentially life-threatening systemic Hypersensitivity
      1. Occurs with skin, mucosal or even airborne contact
      2. Generalized Rash
      3. Urticaria
      4. Pruritus
      5. Eye and nose irritation
         1. Allergic Rhinitis type symptoms
      6. Throat swelling
      7. Respiratory symptoms
         1. Wheezing
         2. Shortness of Breath
         3. Chest tightness
      8. Palpitations
      9. Anaphylaxis
7. Associated Conditions
   1. See Food Allergy (Banana, Kiwi, Avocado)
   2. See Natural Rubber Latex
8. Diagnosis
   1. Skin Prick Testing for Latex Allergy
      1. Available in Europe but not in the United States
      2. Would be a first-line test if available in the United States
   2. Serum IgE levels
      1. Variable efficacy
   3. Glove provocative test (glove challenge test)
      1. Progressive exposure every 15 minutes to each finger of a glove and ultimately the entire hand
      2. Negative test for Latex Allergy if the entire glove can be worn for 15 minutes without reaction
      3. Test has variable efficacy and there is a risk of Anaphylaxis
   4. Skin Patch Testing
      1. Indicated for Type IV Delayed Hypersensitivity Reaction
      2. Skin rechecked at 30 minutes, 24 hours and 48 hours after patch application
9. Management
   1. Avoid further Natural Rubber Latex exposure
   2. Mild Latex Allergy (Contact Dermatitis)
      1. Avoid common latex exposures (e.g. latex gloves)
   3. Severe Latex Allergy (systemic reaction, Anaphylaxis)
      1. Avoid all latex exposure
         1. Rubber latex vial stoppers (venipuncture tubes) or syringe plungers
            1. Only insert needle through stopper once
         2. Medications with latex in Vaccine packaging
            1. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/latex-table.pdf
      2. Medic alert bracelet
      3. Epinephrine self-injection pen (e.g. EpiPen)
10. Prevention
    1. Avoid the use of Natural Rubber Latex gloves
       1. Use powder free latex gloves if not possible to eliminate latex gloves from facility
    2. Systemic Hypersensitivity has very serious implications
       1. Requires avoidance of healthcare setting
       2. Career change may be indicated for healthcare worker
    3. Health care institutions should strongly consider limiting latex products in their facilities (especially latex gloves)
       1. Evidence exists for cost savings in switching to non-latex gloves
       2. LaMontagne (2006) Occup Environ Med 63(5): 359-64 [PubMed]
       3. Tarlo (2001) J Allergy Clin Immunol 108(4): 628-33 [PubMed]
    4. Use alternatives to latex gloves (Dr Moses' favorites):
       1. Nitrile Powder Free gloves (non-sterile)
       2. Sterile gloves
          1. Duraprene for procedures not requiring signficant tactile sensation (e.g. dermatologic procedures)
          2. Regent Medical - Biogel Neotech for procedures requiring tactile sensation (e.g. Vasectomy)
11. References
    1. Pollart (2009) Am Fam Physician 80(12): 1413-20 [PubMed]
    2. Taylor (2004) Dematol Ther 17(4): 289-301 [PubMed]
    3. Nettis (2002) Clin Exp Allergy 32(3): 441-7 [PubMed]