Latex allergy

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Latex allergy
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Latex medical glove
Specialty Immunology

Latex allergy is a medical term encompassing a range of allergic reactions to the proteins present in natural rubber latex. [1] It generally develops after repeated exposure to products containing natural rubber latex. When latex-containing medical devices or supplies come in contact with mucous membranes, the membranes may absorb latex proteins. In some susceptible people, the immune system produces antibodies that react immunologically with these antigenic proteins. [2] Many items contain or are made from natural rubber, including shoe soles, pen grips, hot water bottles, elastic bands, rubber gloves, condoms, baby-bottle nipples, and balloons; consequently, there are many possible routes of exposure that may trigger a reaction. People with latex allergies may also have or develop allergic reactions to some fruits, such as bananas. [3]

Contents

Signs and symptoms

Allergic reactions to latex range from Type I hypersensitivity, the most serious form of reaction, to Type IV hypersensitivity. [4] Rate of onset is directly proportional to the degree of allergy: Type I responses will begin showing symptoms within minutes of exposure to latex, while Type IV responses may take hours or days to appear. [5]

Most commonly, latex allergy presents with hives at the point of contact, followed by rhinitis. The most common physiological reaction to latex exposure is dermatitis at the point of contact, which gives way to soreness, itching, and redness. Angioedema is also a common response to oral, vaginal, or rectal contact. [6]

Symptoms of more severe hypersensitivity include both local and generalized hives; feelings of faintness or impending doom; angioedema; nausea and vomiting; abdominal cramps; rhinitis; bronchospasm; and anaphylaxis. Type IV responses typically include erythema, blistering (forming vesicles and papules), itching, and crusting at the point of contact. [7] This irritant contact dermatitis is considered a nonimmune reaction to latex. [8] The degree of reaction is directly proportional to the duration of exposure, as well as skin temperature.

Among those with a latex allergy, 40% will experience irritant contact dermatitis; 33.1% will experience a Type I allergic reaction; 20.4% will experience Type IV allergic contact dermatitis; and 6.5% will experience both Type I and Type IV symptoms. [9]

Causes

Occupational exposure

Central line with latex cap Hickman line catheter with 2 lumens.jpg
Central line with latex cap

The prevalence of latex allergy is greater in certain populations with increased exposure and has historically been studied in this context. [10] Specifically, regular and prolonged occupational exposure to latex is a known risk factor for the development of an allergy. [11] Healthcare workers, dental specialists, food service workers, cosmetologists, rubber industry workers, law enforcement personnel, and painters are among some of the highest-risk occupations. [11] It is estimated that the worldwide prevalence of latex allergy in healthcare workers is 9.7%-12.4%. [10]

Latex allergy became a more common problem in healthcare in the 1980s and 1990s with the adoption of universal precautions, which involved frequent use of latex gloves, with the emergence of HIV/AIDs. [10] The rates of latex allergy dropped to 4-7% in the healthcare setting with the widespread introduction of non-powdered latex gloves. [12] On December 19, 2016, the FDA officially banned the use of powdered gloves in the US healthcare setting, citing the unnecessary burden of potential injury due to allergy. [13] General latex avoidance protocols have been put in to place in healthcare settings in the US and many other developed countries with the switch to nitrile gloves. [11] [12] However, latex exposure in healthcare settings in developing countries from latex gloves or latex components of medical devices such as urinary catheters, dialysis ports, or vial stoppers, remains a significant concern. [11] [12]

Alternative latex exposure

While most reported allergic reactions to latex have occurred in medical settings, non-healthcare workers show similar levels of latex antibodies, suggesting that they are sensitized to natural rubber latex through other sources, both inside the home and as medical patients. [14] In particular, individuals with chronic health concerns that lead to repeated surgeries or catheterizations thus experience greater exposure to latex allergens and may develop an allergy. [15] Outside of hospital environments, latex allergy may develop in amateur and professional athletes whose sports equipment includes natural rubber, such as swimsuits or running shoes. Rubber basketballs, in particular, may lead to contact dermatitis on the hands and fingertips. [16] The sensitization to latex in athletes may be accelerated by the use of topical analgesics and other agents that diminish the skin barrier and increase contact. [17] It has also been hypothesized that young children may develop a latex allergy due to exposure in the home and school environment from objects such as rubber balloons, boots, gloves, and toys. [18] [19]

Spina bifida

People with spina bifida often have latex allergies. Up to 68% of children with this condition will have a reaction to latex. [20] The mechanism of this association between spina bifida and latex allergy is not clearly defined. However, spina bifida patients may become sensitized to latex early in life as they often require frequent surgeries and medical procedures that involve exposure to latex products. [21] The most important latex allergens which sensitize spina bifida patients are: Hev b 1, Her b 3 and Hev b 6.01. [22]

Latex-fruit syndrome

People who have latex allergy also may have or develop an allergic response to some plants and/or products of these plants (such as fruits). This is known as latex-fruit syndrome (LFS). [23] This syndrome was described for the first time by Bianco et. al in 1994. Recent review by Gromek published in 2024, have summarised the last 30 years of research on LFS and analyzed 14 original studies.The analysis of original studies demonstrated a significant variability in the prevalence of latex-fruit syndrome (LFS), ranging from 4% to 88%. This variation was attributed to the use of diverse diagnostic tools, differences in geographical regions, and the size of study populations. The most commonly reported allergenic fruits among patients with LFS were banana, avocado, kiwifruit, and papaya. [22]

The primary latex allergens implicated in latex-fruit syndrome (LFS) include Hev b 2, Hev b 6.02, Hev b 7, Hev b 8, and Hev b 12. Genetic studies have suggested an association between LFS and specific human leukocyte antigen (HLA) types, particularly HLA-DQB1*0201, DRB1*0301, DRB1*0901, and the HLA-DR functional group E. [24]

Pathomechanism

One group of allergens that may contribute to the cross-reactivity between latex and certain fruits is chitinases. These enzymes catalyze the breakdown of β-1,4-N-acetyl-D-glucosamine bonds in chitin, a polymer widely found in nature. Chitinases are produced by various organisms, including bacteria, fungi, insects, plants, and vertebrates. Class I chitinases identified in fruits such as bananas (Mus a 2) and avocados (Pers a 1) have been shown to cross-react with class I chitinases in latex, specifically Hev b 6.01 (Prohevein) and Hev b 6.02 (Hevein). Chitinases have also been found in other fruits, including chestnut (class I), tomato (class II), Indian jujube (class III), raspberry (class III), and grape (class IV). However, in the case of kiwi and papaya, no specific allergens with chitinase activity have been identified to date. Other latex allergens involved in cross-reactivity with fruits may include profilins, glucanases, and non-specific lipid transfer proteins (nsLTPs).

Natural rubber latex contains several conformational epitopes located on several enzymes such as Hev b 1, [25] Hev b 2, [26] Hev b 4, [27] Hev b 5 [28] and Hev b 6.02. [29] [30]

Evaluation of hypersensitivity symptoms revealed that systemic allergic reactions accounted for 73% of reported cases, while only 27% presented with localized allergic manifestations.

FITkit is a latex allergen testing method for quantification of the major natural rubber latex specific allergens: Hev b 1, Hev b 3, Hev b 5, and Hev b 6.02. [31]

Prevention

The most effective form of primary prevention towards latex sensitization is limiting or completely avoiding contact with latex, particularly among children with risk factors such as spina bifida. [32] [33] The limitation of powdered latex glove use in hospital settings has also proven an effective primary prevention strategy among adult health care workers, [34] and as secondary prevention for sensitized individuals. [35] [36]

Epidemiology

Latex allergy is uncommon in the general population, at least compared to high-risk groups such as hospital workers and spina bifida patients. Estimates suggest a worldwide prevalence of around 4.3% among the general population. [37] Between 1% and 6% of the general population in the United States has latex allergy; assays of antibody levels in the blood suggest that 2.7 million to 16 million Americans are affected by some form of latex sensitivity. [38] Females are approximately three times as likely as males to have latex allergies. [39] Possible risk factors for the female population include increased employment in high-risk occupations and enhanced histamine release caused by female hormones. [40]

Alternatives

Alternatives to latex include:

The first polyurethane condoms, designed for people with latex allergies, were produced in 1994.

Some people are so sensitive that they may still have a reaction to replacement products made from alternative materials. This can occur when the alternative products are manufactured in the same facility as latex-containing products, leaving trace quantities of natural rubber latex on the non-latex products. [43]

See also

References

  1. ↑ "Safety and Health Topics | Latex Allergy". Osha.gov. Retrieved 2014-07-31.
  2. ↑ "Allergy to Latex Rubber". American Dental Association.
  3. ↑ Taylor, J.S. & Erkek, E. (2004). "Latex allergy: diagnosis and management". Dermatologic Therapy. 17 (4): 289–301. doi: 10.1111/j.1396-0296.2004.04024.x . PMID   15327474. S2CID   24748498.
  4. ↑ Sussman, Gordon L.; Tarlo, Susan; Dolovich, Jerry (June 5, 1991). "The Spectrum of IgE-Mediated Responses to Latex" . JAMA: The Journal of the American Medical Association. 265 (21): 2844–2847. doi:10.1001/jama.1991.03460210090035. PMID   2033741 . Retrieved December 29, 2021.
  5. ↑ Hamilton, Robert G. (May 2002). "Diagnosis of natural rubber latex allergy" . Methods. 27 (1): 22–31. doi:10.1016/S1046-2023(02)00048-8. PMID   12079414 . Retrieved December 29, 2021.
  6. ↑ Turjanmaa, K.; Alenius, H.; Mäkinen-Kiljunen, S.; Reunala, T.; Palosuo (1996). "Natural rubber latex allergy". Allergy. 51 (9): 593–602. doi: 10.1111/j.1398-9995.1996.tb04678.x . ISSN   0105-4538. PMID   8899110. S2CID   9316811.
  7. ↑ Reddy, Sumana (January 1, 1998). "Latex Allergy". American Family Physician. 57 (1): 93–100. PMID   9447217 . Retrieved December 29, 2021.
  8. ↑ Hepner, David L.; Castells, Mariana C. (April 2003). "Latex Allergy: An Update". Anesthesia & Analgesia. 96 (4): 1219–1229. doi: 10.1213/01.ANE.0000050768.04953.16 . PMID   12651689. S2CID   2753609.
  9. ↑ Heese, A.; Peters, K. P.; Koch, H. U. (January 1, 1997). "Type I allergies to latex and the aeroallergenic problem". The European Journal of Surgery Supplement. 579 (579): 19–22. PMID   9195178 . Retrieved December 29, 2021.
  10. 1 2 3 Nucera, Eleonora; Aruanno, Arianna; Rizzi, Angela; Centrone, Michele (2020-09-28). "Latex Allergy: Current Status and Future Perspectives". Journal of Asthma and Allergy. 13: 385–398. doi: 10.2147/JAA.S242058 . ISSN   1178-6965. PMC   7532063 . PMID   33061465.
  11. 1 2 3 4 Parisi, Claudio A.S.; Kelly, Kevin J.; Ansotegui, Ignacio J.; Gonzalez-Díaz, Sandra Nora; Bilò, Maria Beatrice; Cardona, Victoria; Park, Hae-Sim; Braschi, Maria Chiara; Macias-Weinmann, Alejandra; Piga, Mario A.; Acuña-Ortega, Natalhie; Sánchez-Borges, Mario; Yañez, Anahí (2021-07-28). "Update on latex allergy: New insights into an old problem". The World Allergy Organization Journal. 14 (8): 100569. doi:10.1016/j.waojou.2021.100569. ISSN   1939-4551. PMC   8335653 . PMID   34386153.
  12. 1 2 3 "Latex allergy: Epidemiology, clinical manifestations, and diagnosis". medilib.ir. Retrieved 2024-02-15.
  13. ↑ Health, Center for Devices and Radiological (2023-05-01). "Medical Gloves". FDA. Archived from the original on September 29, 2019.
  14. ↑ Condemi, John J. (August 2002). "Allergic reactions to natural rubber latex at home, to rubber products, and to cross-reacting foods". Journal of Allergy and Clinical Immunology. 110 (2): 107–110. doi:10.1067/mai.2002.124968. PMID   12170250 . Retrieved December 29, 2021.
  15. ↑ Kumar, R. Pradeep (January 2012). "Latex Allergy in Clinical Practice". Indian Journal of Dermatology. 57 (1): 66–70. doi: 10.4103/0019-5154.92686 . PMC   3312665 . PMID   22470217.
  16. ↑ Kockentiet, Brett; Adams, Brian B. (June 2007). "Contact dermatitis in athletes" . Journal of the American Academy of Dermatology. 56 (6): 1048–1055. doi:10.1016/j.jaad.2006.12.025. PMID   17307275 . Retrieved December 29, 2021.
  17. ↑ Ventura, M. T.; Dagnello, M.; Matino, M. G.; Di Corato, R.; Giuliano, G.; Tursi, A. (April 2001). "Contact dermatitis in students practicing sports: incidence of rubber sensitisation". British Journal of Sports Medicine. 35 (2): 100–102. doi:10.1136/bjsm.35.2.100. PMC   1724305 . PMID   11273970 . Retrieved December 29, 2021.
  18. ↑ Ylitalo, L.; Alenius, H.; Turjanmaa, K.; Palosuo, T.; Reunala, T. (November 2000). "Natural rubber latex allergy in children: a follow-up study" . Clinical and Experimental Allergy. 30 (11): 1611–1617. doi:10.1046/j.1365-2222.2000.00924.x. PMID   11069571. S2CID   32522055 . Retrieved December 29, 2021.
  19. ↑ Sorva, R.; Mäkinen-Kiljunen, S.; Suvilehto, K.; Juntunen-Backman, K.; Haahtela, T. (February 1995). "Latex allergy in children with no known risk factor for latex sensitization" . Pediatric Allergy and Immunology. 6 (1): 36–38. doi:10.1111/j.1399-3038.1995.tb00255.x. PMID   7550763. S2CID   20620438 . Retrieved December 29, 2021.
  20. 1 2 "Protect Yourself from Latex Allergies". Ivanhoe Broadcast News. December 2008. Archived from the original on July 9, 2015. Retrieved June 12, 2015.
  21. ↑ "Latex Allergy". Spina Bifida Association of New York State. Retrieved 2024-02-07.
  22. 1 2 Gromek, Weronika; Kołdej, Natalia; Świtała, Szymon; Majsiak, Emilia; Kurowski, Marcin (2024-07-19). "Revisiting Latex-Fruit Syndrome after 30 Years of Research: A Comprehensive Literature Review and Description of Two Cases". Journal of Clinical Medicine. 13 (14): 4222. doi: 10.3390/jcm13144222 . ISSN   2077-0383. PMC   11278189 . PMID   39064262.
  23. ↑ Brehler, R.; Theissen, U.; Mohr, C.; Luger, T. (1997). "'Latex-fruit syndrome': frequency of cross-reacting IgE antibodies". Allergy. 52 (4): 404–10. doi:10.1111/j.1398-9995.1997.tb01019.x. PMID   9188921. S2CID   27995880.
  24. ↑ Gromek, Weronika; Kołdej, Natalia; Świtała, Szymon; Majsiak, Emilia; Kurowski, Marcin (2024-07-19). "Revisiting Latex-Fruit Syndrome after 30 Years of Research: A Comprehensive Literature Review and Description of Two Cases". Journal of Clinical Medicine. 13 (14): 4222. doi: 10.3390/jcm13144222 . ISSN   2077-0383. PMC   11278189 . PMID   39064262.
  25. ↑ Chen, Zhiping; Cremer, Reinhold; Posch, Anton; Raulf-Heimsoth, Monika; Rihs, Hans-Peter; Baur, Xaver (1997). "On the allergenicity of Hev b 1 among health care workers and patients with spina bifida allergic to natural rubber latex". Journal of Allergy and Clinical Immunology. 100 (5): 684–93. doi: 10.1016/S0091-6749(97)70174-X . PMID   9389300.
  26. ↑ Barre, Annick; Culerrier, Raphaël; Granier, Claude; Selman, Laetitia; Peumans, Willy J.; Van Damme, Els J.M.; Bienvenu, Françoise; Bienvenu, Jacques; Rougé, Pierre (2009). "Mapping of IgE-binding epitopes on the major latex allergen Hev b 2 and the cross-reacting 1,3β-glucanase fruit allergens as a molecular basis for the latex-fruit syndrome" . Molecular Immunology. 46 (8–9): 1595–604. doi:10.1016/j.molimm.2008.12.007. PMID   19185347.
  27. ↑ Kolarich, Daniel; Altmann, Friedrich; Sunderasan, Elumalai (2006). "Structural analysis of the glycoprotein allergen Hev b 4 from natural rubber latex by mass spectrometry". Biochimica et Biophysica Acta (BBA) - General Subjects. 1760 (4): 715–20. doi:10.1016/j.bbagen.2005.11.012. PMID   16403599.
  28. ↑ Beezhold, Donald H.; Hickey, Vicky L.; Slater, Jay E.; Sussman, Gordon L. (1999). "Human IgE-binding epitopes of the latex allergen Hev b 5". Journal of Allergy and Clinical Immunology. 103 (6): 1166–72. doi:10.1016/S0091-6749(99)70194-6. PMID   10359901.
  29. ↑ Reyes-López, César A; Hernández-Santoyo, Alejandra; Pedraza-Escalona, Martha; Mendoza, Guillermo; Hernández-Arana, Andrés; Rodrı́guez-Romero, Adela (2004). "Insights into a conformational epitope of Hev b 6.02 (hevein)". Biochemical and Biophysical Research Communications. 314 (1): 123–30. doi:10.1016/j.bbrc.2003.12.068. PMID   14715255.
  30. ↑ Pedraza-Escalona, Martha; Becerril-Luján, Baltazar; Agundis, Concepción; Domínguez-Ramírez, Lenin; Pereyra, Ali; Riaño-Umbarila, Lidia; Rodríguez-Romero, Adela (2009). "Analysis of B-cell epitopes from the allergen Hev b 6.02 revealed by using blocking antibodies". Molecular Immunology. 46 (4): 668–76. doi:10.1016/j.molimm.2008.08.282. PMID   18930549.
  31. ↑ Koh, D.; Ng, V.; Leow, Y-H.; Goh, C.L. (2005). "A study of natural rubber latex allergens in gloves used by healthcare workers in Singapore". British Journal of Dermatology. 153 (5): 954–9. doi: 10.1111/j.1365-2133.2005.06820.x . PMID   16225605. S2CID   32823071.
  32. ↑ Niggemann, Bodo (October 26, 2010). "IgE-mediated latex allergy –An exciting and instructive piece of allergy history" . Pediatric Allergy and Immunology. 21 (7): 997–1001. doi:10.1111/j.1399-3038.2010.01006.x. PMID   20977498. S2CID   8236367 . Retrieved December 30, 2021.
  33. ↑ Nieto, Antonio; Mazón, Angel; Pamies, Rafael; Lanuza, Amparo; Muñoz, Alberto; Estornell, Francisco; García-Ibarra, Fernando (March 1, 2002). "Efficacy of latex avoidance for primary prevention of latex sensitization in children with spina bifida" . The Journal of Pediatrics. 140 (3): 370–372. doi:10.1067/mpd.2002.122732. PMID   11953738. S2CID   11967651 . Retrieved December 30, 2021.
  34. ↑ Allmers, Henning; Schmengler, Jörg; Skudlik, Christoph (August 2002). "Primary prevention of natural rubber latex allergy in the German health care system through education and intervention". Journal of Allergy and Clinical Immunology. 110 (2): 318–323. doi: 10.1067/mai.2002.126461 . PMID   12170275.
  35. ↑ Allmers, Henning; Brehler, Randolph; Chen, Zhipping; Raulf-Heimsoth, Monika; Fels, Hubert; Bauer, Xaver (November 1998). "Reduction of latex aeroallergens and latex-specific IgE antibodies in sensitized workers after removal of powdered natural rubber latex gloves in a hospital" . The Journal of Allergy and Clinical Immunology. 102 (5): 841–846. doi:10.1016/s0091-6749(98)70026-0. PMID   9819303 . Retrieved December 30, 2021.
  36. ↑ Ruëff, F.; Thomas, P.; Reißig, G.; Przybilla, B. (April 1998). "Natural rubber-latex allergy in patients not intensely exposed" . European Journal of Allergy and Clinical Immunology. 53 (4): 445–449. doi:10.1111/j.1398-9995.1998.tb03921.x. PMID   9574891. S2CID   27245106 . Retrieved December 30, 2021.
  37. ↑ Wu, Miaozong; McIntosh, James; Liu, Jian (March 20, 2016). "Current prevalence rate of latex allergy: Why it remains a problem?". Journal of Occupational Health. 58 (2): 138–144. doi:10.1539/joh.15-0275-RA. PMC   5356959 . PMID   27010091.
  38. ↑ Neugut, Alfred I.; Ghatak, Anita T.; Miller, Rachel L. (January 8, 2001). "Anaphylaxis in the United States: An Investigation Into Its Epidemiology". Archives of Internal Medicine. 161 (1): 15–21. doi: 10.1001/archinte.161.1.15 . PMID   11146694.
  39. ↑ Tomazic, Vesna J.; Withrow, Thomas J.; Fisher, Benjamin R.; Dillard, Sharon F. (August 1992). "Latex-associated allergies and anaphylactic reactions" . Clinical Immunology and Immunopathology. 64 (2): 89–97. doi:10.1016/0090-1229(92)90185-Q. PMID   1643748 . Retrieved December 29, 2021.
  40. ↑ Warshaw, Erin M. (July 1998). "Latex allergy" . Journal of the American Academy of Dermatology. 39 (1): 1–24. doi:10.1016/S0190-9622(98)70397-4. PMID   9674393 . Retrieved December 29, 2021.
  41. ↑ "Why do polyisoprene condoms work as latex allergy condom choices?". Std.about.com. Archived from the original on 2016-01-07. Retrieved 2014-07-31.
  42. ↑ Anderson, Christopher D.; Daniels, Eric S. (2003). Emulsion Polymerisation and Latex Applications. iSmithers Rapra. ISBN   9781859573815.
  43. 1 2 "Don't be Misled by 'Latex Free' Claims". FDA. March 30, 2015.
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