More on Latex

The severity of a reaction to latex generally correlates with how often the patient is exposed to the allergen, natural rubber latex. This reaction can be exacerbated when powder is present because latex can stick to the powder and be spread in the air or by contact.

Only a qualified physician can accurately diagnose a latex allergy and advise you on ways to prevent and treat the sensitivity. Those at particular risk of suffering from a latex allergy include those who wear latex gloves (health care workers, janitors, cafeteria workers, etc.), as well as those who have other allergies.

Variations in Severity

In general, an individual's allergic reactions to latex become progressively worse with continued exposure, requiring less latex protein to trigger a reaction. Conversely, decreasing exposure to latex can decrease a person's sensitivity to latex .⁴

The severity of a particular allergic reaction to latex depends on several factors:

• Degree to which a person has been sensitized to latex
• Amount of latex protein to which a person is exposed at any given time
• Whether the latex comes into contact with skin, mucous membranes (the linings of the body's airways), or internal body tissues

Because the mucosa (found in oral, vaginal, nasal, and eye tissues) and internal body tissues absorb most of the protein in latex, their exposure to latex can accelerate the development of sensitivity. Their susceptibility also helps account for the exceptionally high risk for latex allergies experienced by spina bifida patients and others whose bodies regularly undergo invasive procedures with medical equipment that contains latex. This group also includes patients who have multiple surgeries or tracheotomies.

The Problem With Powder

Use of powder, such as the cornstarch often used to coat the inside of latex gloves, exacerbates latex exposure. The latex protein can adhere to the powder, and as gloves are snapped on and off, the latex-coated powder becomes airborne. As the latex particles are dispersed via the powder, they may contaminate entire rooms by lingering in the air and being inhaled, or by landing on people, equipment, and surfaces. As they are inhaled, they may cause respiratory problems such as asthma and allergic rhinitis, not to mention anaphylaxis. Airborne particles may land on mucosal tissues, such as around the eye, in the nose, or on oral membranes, which are particularly susceptible to latex sensitization. For these reasons, health care professionals, hospitals, policy makers, and even manufacturers are pushing the use of non-powdered gloves.

Asthma is a condition in which the airways narrow due to an allergic hypersensitivity.

Who Is Most at Risk

The highly exposed
Latex allergy seems to occur in people who develop sensitivity to it after repeated exposure. The people who are at greatest risk of suffering allergic reactions to latex include health care professionals, cafeteria workers, janitors, children with congenital defects (such as spina bifida), those who have had multiple surgeries, and others who have medical conditions or occupations that involve repeated, ongoing exposure to latex. Most experts estimate the number of health care workers with latex sensitization ranges from 8% to 17%, or as many as 935,000.^5,6 Estimates of the number of spina bifida patients allergic to latex run as high as 67%.^7,8

People with other allergies
Aside from repeated exposure to latex, risk factors include a history of asthma or atopy. Atopy is a tendency toward allergic symptoms (such as allergic rhinitis and eczema, also known as dermatitis) to a variety of allergens.^9-13 Moreover, people with allergies to grass pollens (also known as hay fever) or other allergies, particularly to foods such as bananas, avocados, kiwi, and chestnuts, are frequently cross-reactive to latex because the proteins of these foods are very similar to that of latex.^14,15

Diagnosing Latex Allergy

Signs of allergic hypersensitivity to latex can occur immediately, especially if they occur after contact with balloons, rubber gloves, or other latex products, or after dental or other medical exams or procedures.

If latex allergy is suspected, people should consult their doctors regarding diagnosis and precautionary measures. Diagnostic tests should only be performed in medical facilities prepared to treat anaphylaxis with epinephrine and stocked with emergency resuscitative equipment.

Prevention and Treatment

As with other potentially life-threatening allergies, the primary method of protection is avoiding contact with latex and being prepared to treat anaphylactic emergencies with epinephrine injections, as well as prompt medical attention.

Avoidance
Avoidance is crucial in guarding against further sensitization and severe allergic reactions to latex. People who exhibit allergic symptoms after contact with latex should substitute latex-free versions of latex products in their homes and workplaces and should alert their health care providers that they need to be treated with latex-free equipment.

Though latex seems to be everywhere and is difficult to avoid entirely, avoidance is becoming easier as health care facilities, professional organizations, consumer advocacy groups, policy makers, and even manufacturers are working to make latex substitutes or at least powder-free, low-protein latex products more readily available. Latex-free trays, examining and operating rooms, dental, and emergency equipment are becoming more standard. Many vinyl gloves are not very expensive, but may not adequately protect—and others can be expensive; therefore, manufacturers are working on better, more affordable synthetic substitutes.

Emergency treatment
Since not all allergic reactions can be avoided, and because allergic reactions can progress quickly to deadly anaphylaxis, the American Academy of Allergy, Asthma and Immunology currently advises:

Your allergist/Immunologist may also prescribe a self-injectable epinephrine shot to carry with you.  This medication reverses the allergic reaction, at least temporarily, to provide the life-saving time needed to get further treatment in a medical facility.  Learn how to self-administer the epinephrine according to your allergist/immunologist's instructions, and replace the device before the labeled expiration date.¹⁶

EpiPen^® and EpiPen^® Jr auto-injectors are the leading form of self-injectable epinephrine.  Administering EpiPen^® at the first sign of a severe allergic reaction can provide a person with the time needed to get to an Emergency Room.

Epinephrine, or adrenaline, works rapidly to reverse the symptoms of anaphylaxis by relaxing smooth-muscle tissue in the lungs; speeding up the heart rate; combating hives and welts on the skin; and reducing the swelling of the mouth, throat, and face.

Side effects of epinephrine may include palpitations, tachycardia (an abnormally fast heartbeat), sweating, nausea and vomiting, and respiratory difficulty. Cardiac arrhythmias may follow administration of epinephrine. Patients should ask their physician about the circumstances under which this life-saving medication should be used.

Many physicians also recommend that antihistamines such as diphenhydramine be administered to lessen the symptoms of an allergic reaction, but antihistamines should only be taken in addition to epinephrine for the treatment of anaphylaxis and should not be considered a substitute for it. Only epinephrine can halt the potentially deadly effects of anaphylaxis.

Even after administering epinephrine, emergency medical treatment should be sought at once because severely allergic people experiencing anaphylaxis may need emergency respiratory or cardiac care, or even to be resuscitated if they stop breathing altogether. More commonly, these patients will need professional care to determine whether additional epinephrine, steroids, antihistamines, or other treatments are required. In any case, follow-up diagnosis and care by medical professionals after administration of epinephrine is critical to recovery. Delayed or secondary reactions do occur, and patients should remain under medical supervision for at least 4 hours after an episode of anaphylaxis occurs.¹⁷

Additionally, wearing a medical identification bracelet describing your allergies and susceptibility to anaphylaxis can help ensure prompt and proper treatment during an emergency.

References

1. Ownby DR, Ownby HE, et al. The prevalence of anti-latex IgE antibodies in 1000 volunteer blood donors. J Allergy Clin Immunol. 1996;97:1188-1192.
    
2. Kelly KJ, Sussman G, Fink JN. Stop the sensitization. J Allergy Clin Immunol. 1996;98:857-858.
    
3. Arellano R, Bradley J, Sussman G. Prevalence of latex sensitization among hospital physicians occupationally exposed to latex gloves. Anesthesiology. 1992;77:905-908.
    
4. NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Workplace. US Dept. of Health and Human Services. August 1998:3.
    
5. Watts DN, Jacobs RR, Forrester B, et al. An evaluation of the prevalence of latex sensitivity among atopic and non-atopic intensive care workers. Am J Ind Med. 1998;34:359-363.
    
6. Liss GM, Sussman GL, Deal K, et al. Latex allergy: epidemiological study of 1351 hospital workers. Occup Environ Med. 1997;54:335.
    
7. Sussman GL, Beezhold DH. Allergy to latex rubber. Ann Intern Med. 1995;122:43-46.
    
8. Yassin MS, Lierl MB, Fisher TJ, et al. Latex allergy in hospital employees. Ann Allergy Asthma Immunol. 1994;72:245.
    
9. Liebke C, Niggemann B, Wahn U. Sensitivity and allergy to latex in atopic and nonatopic children. Pediatric Allergy Immunol. 1996;7:103-107.
    
10. Swartz J, Braude BM, Gilmour RF, et al. Intraoperative anaphylaxis to latex. Can J Anaesth. 1990;37:589-592.
     
11. Bubak ME, Reed C, Fransway AF, et al. Allergic reactions to latex among health-care workers. Mayo Clin Proc. 1992;67:1075-1079.
     
12. Tarlo SM, Wong l, Roos J, Booth N. Occupational asthma caused by latex in a surgical glove manufacturing plant. J Clin Immunol. 1990;85:626-631.
     
13. Orfan NA, Reed R, Dykewicz MS, Ganz M, Kolski GB. Occupational asthma in a latex doll manufacturing plant. J Allergy Clin Immunol. 1994; 94: 826-830.
     
14. Blanco C, Carrillo T, et al. Latex allergy: clinical features and cross-reactivity with fruits. Ann Allergy Asthma Immunol. 1994;73:309-314.
     
15. Beezhold DH, Sussman GL, et al. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy. 1996;26:416.
     
16. AAAAI. Latex allergy. Tip #29. Available at: http://www.aaaai.org.
     
17. Wood RA. Anaphylaxis in children. Patient Care. 1997;31(13):161.