Latex allergy

Definition
Natural latex rubber is made from a milky fluid found in the rubber tree called Hevea brasiliensis. The proteins found in natural latex may cause mild to severe allergic reactions for some people.
To manufacture commercial latex, many chemicals are added to natural latex rubber. Many types of synthetic rubber are considered latex, but these do not contain the natural rubber latex proteins that may cause an allergic reaction.


Causes/associated factors
Repeated exposure to latex -- through occupations such as health care work, hairdressing, housekeeping, greenhouse work, latex glove manufacturing and food handling, for example -- increases the risk of developing a latex allergy. In fact, testing shows that about 8 to 12 percent of health care workers have evidence of latex sensitivity compared to about 3 to 6 percent of the general population. A history of spina bifida or multiple surgical procedures (such as with abnormalities of the urogenital tract) also increases the risk of latex allergy, presumably because of repeated exposures to latex-containing products.
People who have allergies and associated skin problems tend to be more likely to develop latex allergies from repeated latex exposures. Sometimes, people who have latex allergies have associated food allergies to certain types of foods, such as avocados, bananas, chestnuts, kiwi fruit and, less often, potatoes, tomatoes, papaya, melons, figs, apricots, passion fruit, pineapple, cherries, peaches, plums, grapes, hazelnuts, peanuts and celery. The proteins in these foods are similar to some of the proteins in natural rubber latex.

If you have a latex allergy, exposure to the proteins in natural latex rubber may cause a reaction. Reactions can vary depending on the specific latex product, frequency of past latex exposures, and the degree of sensitization that develops. Reactions may occur within minutes of exposure, or may not appear until hours later. Although the amount of exposure needed to produce sensitivity to latex or allergy symptoms is unknown, decreasing exposure to natural latex rubber, especially powdered latex gloves, can reduce sensitivity and symptoms.

Sensitization or allergic symptoms may occur when you have skin contact with latex particles, breathe in latex particles, or ingest food contaminated by latex particles. For example, some of the latex proteins in latex gloves are drawn out by the powder inside the gloves even before they're worn. During use, skin moisture draws out more latex particles. Both factors result in skin exposure to latex. When the gloves are put on or removed, the latex-coated powder becomes airborne and can be inhaled or contaminate nearby food.


Products that contain latex
According to the National Institute for Occupational Safety and Health, the following products may contain latex.
Emergency medical equipment

blood pressure cuffs
stethoscopes
disposable gloves
oral and nasal airways
endotracheal tubes
tourniquets
intravenous tubing
syringes
electrode pads
bandages and elastic wraps
Personal protective equipment

gloves
surgical masks
goggles
respirators
rubber aprons
Office supplies

rubber bands
erasers
Hospital supplies

anesthesia masks
catheters
wound drains
injection ports
dental dams
rubber tops from multidose vials
Household objects

automobile tires
motorcycle handgrips
carpeting
bicycle handgrips
racquet handles
swimming goggles
shoe soles
expandable fabric (such as certain waistbands and undergarments)
baby bottle nipples
pacifiers
dishwashing gloves
hot water bottles
condoms
diaphragms
balloons
carpeting

Signs/symptoms
Latex reactions may be localized or systemic (affecting the entire body). A local reaction may result in acute or chronic dermatitis (inflammation of the upper layers of skin, which may cause redness and itching). A systemic reaction may result in a widespread itchy rash, swelling, wheezing, coughing or a life-threatening anaphylactic reaction.
Typical latex reactions

Irritant contact dermatitis (inflammation of the upper layers of skin) is the most common reaction to latex products and gloves in general, even the nonlatex variety. The skin becomes irritated, dry and itchy. Irritant contact dermatitis is not considered a true allergy. It's caused by irritation related to such things as frequent hand washing, inadequate hand drying, use of cleaning or sanitizing products, exposure to the powders that are often added to disposable gloves, or the excess sweating and moisture that occurs while wearing gloves.

Chemical sensitivity dermatitis, also referred to as allergic contact dermatitis, is a delayed reaction to the chemicals added to natural latex. It's not considered a true latex allergy. Within six to 48 hours after exposure, the chemicals may cause a skin reaction that appears similar to poison ivy. You may develop weeping blisters that, in some cases, spread away from the area originally exposed to the latex.

A true latex allergy can cause an immediate hypersensitivity at the time of exposure. The reaction may occur within minutes of exposure or up to a few hours later. Similar to reactions sometimes caused by bee stings, mild symptoms may include itching, hives and skin redness at the site of contact with the latex.
If latex particles are inhaled, allergic rhinitis or asthma may develop. The symptoms of rhinitis include runny nose, sneezing, itchy eyes and irritated throat. Asthma may produce wheezing, coughing and difficulty breathing.

Less often, the exposure will lead to a severe life-threatening reaction known as anaphylaxis. The first symptom may be a feeling of impending doom. Other symptoms may include:

severe difficulty breathing
swelling of the throat, tongue, lips or eyes
difficulty swallowing or speaking
nausea, vomiting, diarrhea or abdominal cramps
chest tightness
seizures
shock

Diagnosis
The doctor will review your general medical history and specific symptoms that may be associated with latex exposure and do a physical exam. You may need blood tests to detect latex antibodies (compounds that help neutralize or destroy foreign substances in the blood). The doctor may also recommend a skin test that involves pricking or scratching your skin with a drop of liquid that contains a preparation of latex proteins. Due to the potential of a serious reaction, this test should be done only in medical offices prepared to handle major allergic reactions. No standardized skin test preparation is currently available, and current blood tests are not very sensitive. The interpretation of test results can be complicated by the effects of any recent allergic reactions to latex.
A standardized skin patch test may be used to diagnose allergic contact dermatitis from the additives to natural rubber latex products. For this test, a patch containing latex additives is placed on an area of your skin and you'll be monitored for a positive reaction (such as redness, itching, swelling or blistering) under the covered area. The patch cannot be used while you're experiencing an acute latex reaction because the primary rash may cause false-positive reactions.

Other tests, such as a gram stain and culture, may be done to rule out a secondary infection at the site of a skin rash.


Treatment
It's essential to minimize or, if possible, eliminate your exposure to latex. The doctor may prescribe antihistamines and/or oral or topical steroids to reduce your latex allergy symptoms. Inhalers may be necessary if you have asthma-type symptoms. It may also help to apply cool compresses to the affected areas. Antibiotics may be prescribed if you have a secondary infection.
It may take up to two to three weeks for allergic contact dermatitis to clear up. Again, avoid any further exposure to latex, as this may prolong or increase your symptoms.

If you have a life-threatening allergic condition, wear a medical identification tag that lists your allergies and any other serious medical conditions. Your doctor may also recommend carrying an emergency epinephrine (adrenaline) injection pen (sometimes called an EpiPen) at all times. If you have a serious allergic reaction, an emergency epinephrine shot may save your life by temporarily halting the severe response and giving you time to seek medical attention. If you suspect that you are developing a life-threatening allergic reaction, call 911 immediately for medical assistance.


Pregnancy-specific information
Pregnancy does not increase the risk of developing a latex allergy. If you have a latex allergy, be sure to tell your doctor.

Senior-specific information
Growing older is not a risk factor for developing a latex allergy.

Prevention
To prevent an allergic reaction, follow these suggestions from the National Institute for Occupational Safety and Health. (The same suggestions may help prevent sensitization if you're in a high-risk group.)
Become familiar with the type of products that contain latex and avoid them. Also, learn to recognize the symptoms of a latex reaction.

Wear appropriate protective nonlatex gloves (synthetic gloves like nitrile, for example) when you may be exposed to infectious materials. Hypoallergenic latex gloves do not reduce the risk of an allergic reaction to latex -- they simply decrease the occurrence of reactions to the other chemicals used to produce latex gloves.

If you have irritant contact dermatitis and choose to wear latex gloves, use glove liners or powder-free gloves that usually have a reduced protein content and less sensitizing risk.

After removing latex gloves, wash your hands with a mild soap and dry them thoroughly.

Clean areas that may be contaminated with latex dust, such as upholstery, carpets and ventilation ducts, often. Frequently change ventilation filters and vacuum bags used in latex-contaminated areas.

If you develop symptoms after exposure to latex, call your doctor. Seek medical attention if the symptoms are severe. Avoid further contact with latex products until you consult your doctor.

Again, if you're diagnosed with a latex allergy, wear a medical identification bracelet. In case of emergency, it may also be wise to carry an anaphylaxis kit containing epinephrine (EpiPen) to use if there's any possibility that you're developing a serious allergic reaction. Your doctor can teach you how to use the kit.