Latex allergy

Last updated
Latex allergy
Disposable gloves 09.JPG
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]

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. [22] Fruits (and seeds) involved in this syndrome include banana, avocado, chestnut, kiwifruit, mango, passionfruit, fig, strawberry, papaya, apple, melon, celery, potato, tomato, carrot, and soy. The proteins in these fruits are similar to latex proteins. Hevein-like protein domains [23] are a possible cause for allergen cross-reactivity between latex and banana [24] or fruits in general. [25]

Natural rubber latex contains several conformational epitopes located on several enzymes such as Hev b 1, [26] Hev b 2, [27] Hev b 4, [28] Hev b 5 [29] and Hev b 6.02. [30] [31]

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. [32]

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. [33] [34] The limitation of powdered latex glove use in hospital settings has also proven an effective primary prevention strategy among adult health care workers, [35] and as secondary prevention for sensitized individuals. [36] [37]

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. [38] 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. [39] Females are approximately three times as likely as males to have latex allergies. [40] Possible risk factors for the female population include increased employment in high-risk occupations and enhanced histamine release caused by female hormones. [41]

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. [44]

See also

Related Research Articles

<span class="mw-page-title-main">Allergy</span> Immune system response to a substance that most people tolerate well

Allergies, also known as allergic diseases, are various conditions caused by hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis. Symptoms may include red eyes, an itchy rash, sneezing, coughing, a runny nose, shortness of breath, or swelling. Note that food intolerances and food poisoning are separate conditions.

An allergen is a type of antigen that produces an abnormally vigorous immune response in which the immune system fights off a perceived threat that would otherwise be harmless to the body. Such reactions are called allergies.

<span class="mw-page-title-main">Hypersensitivity</span> Medical condition

Hypersensitivity is an abnormal physiological condition in which there is an undesirable and adverse immune response to antigen. It is an abnormality in the immune system that causes immune diseases including allergies and autoimmunity. It is caused by many types of particles and substances from the external environment or from within the body that are recognized by the immune cells as antigens. The immune reactions are usually referred to as an over-reaction of the immune system and they are often damaging and uncomfortable.

<span class="mw-page-title-main">Food allergy</span> Hypersensitivity reaction to a food

A food allergy is an abnormal immune response to food. The symptoms of the allergic reaction may range from mild to severe. They may include itchiness, swelling of the tongue, vomiting, diarrhea, hives, trouble breathing, or low blood pressure. This typically occurs within minutes to several hours of exposure. When the symptoms are severe, it is known as anaphylaxis. A food intolerance and food poisoning are separate conditions, not due to an immune response.

<span class="mw-page-title-main">Contact dermatitis</span> Human disease

Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.

<span class="mw-page-title-main">Atopy</span> Predisposition towards allergy

Atopy is the tendency to produce an exaggerated immunoglobulin E (IgE) immune response to otherwise harmless substances in the environment. Allergic diseases are clinical manifestations of such inappropriate, atopic responses.

<span class="mw-page-title-main">Hypoallergenic dog breed</span> Type of dog

A hypoallergenic dog breed is a dog breed that is purportedly more compatible with allergic people than are other breeds. However, prominent allergen researchers have determined that there is no basis to the claims that certain breeds are hypoallergenic and, while allergen levels vary among individual dogs, the breed is not a significant factor.

<span class="mw-page-title-main">Patch test</span> Medical test to determine substances causing allergic reactions

A patch test is a diagnostic method used to determine which specific substances cause allergic inflammation of a patient's skin.

<span class="mw-page-title-main">Allergic contact dermatitis</span> Medical condition

Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD).

<span class="mw-page-title-main">Milk allergy</span> Type of food allergy caused by milk

Milk allergy is an adverse immune reaction to one or more proteins in cow's milk. Symptoms may take hours to days to manifest, with symptoms including atopic dermatitis, inflammation of the esophagus, enteropathy involving the small intestine and proctocolitis involving the rectum and colon. However, rapid anaphylaxis is possible, a potentially life-threatening condition that requires treatment with epinephrine, among other measures.

<span class="mw-page-title-main">Wheat allergy</span> Medical condition

Wheat allergy is an allergy to wheat which typically presents itself as a food allergy, but can also be a contact allergy resulting from occupational exposure. Like all allergies, wheat allergy involves immunoglobulin E and mast cell response. Typically the allergy is limited to the seed storage proteins of wheat. Some reactions are restricted to wheat proteins, while others can react across many varieties of seeds and other plant tissues. Wheat allergy is rare. Prevalence in adults was found to be 0.21% in a 2012 study in Japan.

FITkit is an immunological test for measuring natural rubber latex (NRL) allergens from a variety of rubber products, such as gloves.

<span class="mw-page-title-main">Pro-hevein</span>

Pro-hevein is a wound-induced and a lectin-like protein from Hevea brasiliensis where it is involved in the coagulation of latex.

<span class="mw-page-title-main">Ara h1</span>

Ara h 1 is a seed storage protein from Arachis hypogaea (peanuts). It is a heat stable 7S vicilin-like globulin with a stable trimeric form that comprises 12-16% of the total protein in peanut extracts. Ara h 1 is known because sensitization to it was found in 95% of peanut-allergic patients from North America. In spite of this high percentage, peanut-allergic patients of European populations have fewer sensitizations to Ara h 1.

<span class="mw-page-title-main">Nickel allergy</span> Medical condition

Nickel allergy is any of several allergic conditions provoked by exposure to the chemical element nickel. Nickel allergy often takes the form of nickel allergic contact dermatitis (Ni-ACD), a form of allergic contact dermatitis (ACD). Ni-ACD typically causes a rash that is red and itchy and that may be bumpy or scaly. The main treatment for it is avoiding contact with nickel-releasing metals, such as inexpensive jewelry. Another form of nickel allergy is a systemic form: systemic nickel allergy syndrome (SNAS) can mimic some of the symptoms of irritable bowel syndrome (IBS) and also has a dermatologic component.

<span class="mw-page-title-main">Fish allergy</span> Type of food allergy caused by fish

Fish allergy is an immune hypersensitivity to proteins found in fish. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include anaphylaxis, a potentially life-threatening condition which requires treatment with epinephrine. Other presentations may include atopic dermatitis or inflammation of the esophagus. Fish is one of the eight common food allergens which are responsible for 90% of allergic reactions to foods: cow's milk, eggs, wheat, shellfish, peanuts, tree nuts, fish, and soy beans.

<span class="mw-page-title-main">Dust mite allergy</span> Medical condition

Dust mite allergy, also known as house dust allergy, is a sensitization and allergic reaction to the droppings of house dust mites. The allergy is common and can trigger allergic reactions such as asthma, eczema or itching. The mite's gut contains potent digestive enzymes that persist in their feces and are major inducers of allergic reactions such as wheezing. The mite's exoskeleton can also contribute to allergic reactions. Unlike scabies mites or skin follicle mites, house dust mites do not burrow under the skin and are not parasitic.

<span class="mw-page-title-main">Shellfish allergy</span> Type of food allergy caused by shellfish

Shellfish allergy is among the most common food allergies. "Shellfish" is a colloquial and fisheries term for aquatic invertebrates used as food, including various species of molluscs such as clams, mussels, oysters and scallops, crustaceans such as shrimp, lobsters and crabs, and cephalopods such as squid and octopus. Shellfish allergy is an immune hypersensitivity to proteins found in shellfish. Symptoms can be either rapid or gradual in onset. The latter can take hours to days to appear. The former may include anaphylaxis, a potentially life-threatening condition which requires treatment with epinephrine. Other presentations may include atopic dermatitis or inflammation of the esophagus. Shellfish is one of the eight common food allergens, responsible for 90% of allergic reactions to foods: cow's milk, eggs, wheat, shellfish, peanuts, tree nuts, fish, and soy beans.

<span class="mw-page-title-main">Metal allergy</span> Medical condition

Metal allergies inflame the skin after it has been in contact with metal. They are a form of allergic contact dermatitis. They are becoming more common, as of 2021, except in areas with regulatory countermeasures.

References

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  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.
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  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.
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  32. ↑ 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.
  33. ↑ 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.
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  36. ↑ 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.
  37. ↑ 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.
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  39. ↑ 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 . Retrieved December 29, 2021.
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  43. ↑ Anderson, Christopher D.; Daniels, Eric S. (2003). Emulsion Polymerisation and Latex Applications. iSmithers Rapra. ISBN   9781859573815.
  44. 1 2 "Don't be Misled by 'Latex Free' Claims". FDA. March 30, 2015.
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