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    What is Latex Allergy?
    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 health problems.

    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 latex.

    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 undergo.
     


     
    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, or asthma).

    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 cells.

    Allergic reactions to latex can include:
    -skin rash
    -itching
    -hives
    -swollen red skin
    -tears
    -itching or burning eyes
    -swollen lips and tongue with difficulty in breathing, wheezing
    -shortness of breath
    -dizziness
    -fainting
    -abdominal pain
    -nausea
    -diarrhoea.
     

    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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    Risk Indicator

    In most instances avoidance of latex products is sufficient to control your reaction. However, if you experience symptoms that suggest an anaphylactic reaction, seek medical attention immediately. If you carry an EpiPen, use it if you suspect you are having an attack or reaction. You must still seek Medical Assistance.

    If you are undergoing a medical procedure and know or suspect you have a latex allergy tell your doctor.


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    Triggers
    • Rubber latex gloves, catheters, other medical products. The list below cites some of the products containing latex in the operating theatre, but is by no means complete;

    Commonly Used Latex Medical Products

    --rubber gloves
    --elastic bandages
    --adhesive tape
    --urinary catheters
    --electrode pads
    --wound drains
    --stomach and intestinal tubes
    --condom urinary collection devices
    --protective sheets
    --enema tubing tips
    --dental cofferdams
    --rubber pads
    --fluid circulating warming blankets
    --haemodialysis equipment
    --anaesthesia Equipment Containing Latex
    --rubber masks
    --electrode pads
    --head straps
    --rubber tourniquets
    --rubber nasal-pharyngeal airways
    --rubber oral-pharyngeal airways
    --teeth protectors
    --bite blocks
    --blood pressure cuffs
    --rubber breathing circuits
    --reservoir breathing bags
    --rubber ventilator hoses
    --rubber ventilator bellows
    --rubber endotracheal tubes
    --latex cuffs on plastic tracheal tubes
    --latex injection ports on intravenous tubing
    --certain epidural catheter injection adapters

    (Source: Journal of the American Association of Nurse Anaesthetists, October
    1991)

  • Children's latex balloons are dipped natural rubber latex products manufactured by very similar methods as gloves, just like gloves there is a wide range to the protein level found on balloons, some are fairly low protein and others are very high. Latex allergic individuals should avoid contact with latex balloons, Mylar balloons are a safe alternative.
  • latex or rubber dummies and baby bottle teats
  • rubber stretching toys
  • rubber bands
  • adhesive tape and bandages (not all types necessarily)
  • condoms
  • other items such as carpet backing, some shower curtains, window insulation and clothing elastics.
     

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    What helps?
    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 latex.

    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 anaphylaxis

    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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    Medication

    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).
    Pre-loaded 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 01488 686016.

    A relatively new adrenaline injection kit called the 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, (click here).

    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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    Statistics
    The statistic 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.

    Publication Types:
    Clinical Trial

    PMID: 9710386 [PubMed - indexed for MEDLINE]


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