ArticlePDF Available

Latex Allergies: A Review of Recognition, Evaluation, Management, Prevention, Education, and Alternative Product Use

Authors:

Abstract and Figures

To provide information about latex allergies; to determine how to recognize, evaluate, and manage emergencies related to latex allergies; and how to identify those at risk for latex allergies. Additionally, ways to prevent latex exposure, to educate health care workers and athletes about latex allergy, and to provide safe alternatives to latex are investigated. We searched MEDLINE and SPORT Discus for the years 1998-2002 using the key words latex, allergies, rubber, anaphylaxis, gloves, cross-reaction, IgE (immunoglobulin G) proteins, and radioallergosorbent test (RAST). Latex, a sap from the rubber tree, is found in many products used in everyday life. Latex is composed of compounds that may cause an allergic reaction, whose severity can range from irritant dermatitis to type IV dermatitis to type I systemic reaction. Recognition of the signs and symptoms associated with these reactions by the health care professional may help to prevent a more severe reaction from occurring. Reactions can be complicated by contact with other substances, thus causing a cross-reaction. Some individuals are more at risk of latex allergies due to repetitive exposure to latex through their career paths, multiple surgeries, other allergies, or respiratory conditions. Management of an acute reaction involves removal of the irritant, cleansing of the affected area, monitoring vital signs for changes, and seeking additional medical assistance as warranted. Those at risk may be identified through a thorough medical history and allergy testing. Prevention techniques and guidelines are examined, with an emphasis on education at multiple levels. Product information for nonlatex equipment and supplies for the athletic training room is offered, with additional resource information provided.
Content may be subject to copyright.
Journal of Athletic Training 133
Journal of Athletic Training 2003;38(2):133–140
q by the National Athletic Trainers’ Association, Inc
www.journalofathletictraining.org
Latex Allergies: A Review of Recognition,
Evaluation, Management, Prevention,
Education, and Alternative Product Use
Helen M. Binkley*; Traci Schroyer†; Jennifer Catalfano‡
*Mesa State College, Grand Junction, CO; †Hood College, Frederick, MD; ‡Elon University, Elon, NC
Helen M. Binkley, PhD, ATC-L, CSCS*D, and Traci Schroyer, BS, ATC, contributed to conception and design; acquisition and
analysis and interpretation of the data; and drafting, critical revision, and final approval of the article. Jennifer Catalfano, BS,
ATC-L, contributed to acquisition of the data and drafting, critical revision, and final approval of the article.
Address correspondence to Helen M. Binkley, PhD, ATC-L, CSCS*D, Athletic Training, Mesa State College, 1100 North
Avenue, Grand Junction, CO 81501. Address e-mail to hbinkley@mesastate.edu.
Objectives:
To provide information about latex allergies;
to determine how to recognize, evaluate, and manage emer-
gencies related to latex allergies; and how to identify those
at risk for latex allergies. Additionally, ways to prevent latex
exposure, to educate health care workers and athletes about
latex allergy, and to provide safe alternatives to latex are
investigated.
Data Sources:
We searched MEDLINE and SPORT Discus
for the years 1998–2002 using the key words
latex, allergies,
rubber, anaphylaxis, gloves, cross-reaction, IgE (immunoglob-
ulin G) proteins,
and
radioallergosorbent test (RAST).
Background:
Latex, a sap from the rubber tree, is found in
many products used in everyday life. Latex is composed of
compounds that may cause an allergic reaction, whose severity
can range from irritant dermatitis to type IV dermatitis to type I
systemic reaction. Recognition of the signs and symptoms as-
sociated with these reactions by the health care professional
may help to prevent a more severe reaction from occurring.
Reactions can be complicated by contact with other substanc-
es, thus causing a cross-reaction. Some individuals are more
at risk of latex allergies due to repetitive exposure to latex
through their career paths, multiple surgeries, other allergies,
or respiratory conditions. Management of an acute reaction in-
volves removal of the irritant, cleansing of the affected area,
monitoring vital signs for changes, and seeking additional med-
ical assistance as warranted.
Recommendations:
Those at risk may be identified through
a thorough medical history and allergy testing. Prevention tech-
niques and guidelines are examined, with an emphasis on ed-
ucation at multiple levels. Product information for nonlatex
equipment and supplies for the athletic training room is offered,
with additional resource information provided.
Key Words:
athletic injury, RAST, gloves, cross-reaction, IgE
antibodies, fruit
A
n injured athlete approaches the certified athletic
trainer with a laceration on the dorsum of the hand
that is bleeding mildly. The athletic trainer, in ac-
cordance with universal protocol, puts on latex gloves,
cleans the wound, applies skin-closure tapes, covers the
wound with a bandage, and disposes of wastes appropriately
in a biohazard container. Within 15 to 20 minutes, the ath-
lete experiences pruritis (severe itching)
1
with measurable
wheals and erythema
1
at the site of the tapes and the ban-
dage. The athlete has a runny nose, itchy and watery eyes,
and a tickle in the throat with a cough. These signs and
symptoms were not previously noted and developed after
the injury. What is happening? Is it an allergic reaction?
What should be done now?
The purpose of this review is to provide information about
latex allergies; how to recognize, evaluate, and manage emer-
gencies related to latex allergies; and how to identify those at
risk of latex allergies. In addition to identifying the condition,
ways to prevent or decrease one’s exposure to latex in the
athletic training room are considered.
DEFINITIONS AND TYPES OF LATEX ALLERGIES
AND REACTIONS
Latex is a natural sap of the rubber tree (Hevea brasiliensis)
that coagulates on exposure to air.
1–15
This sap is used to make
natural rubber, which is found in more than 40 000 industrial
products in the United States.
9,16–20
Approximately 400 such
products are used in the medical community.
21
These products
are composed of 2 types of substances that may cause medical
problems: added chemical antioxidants and natural proteins
associated with immunoglobulin E (IgE)-mediated reac-
tions.
16,19,22
The chemical antioxidants may cause type IV der-
matitis reactions, and the natural proteins may cause type I
systemic allergic reactions in some individuals.
5,6,14,20,23,24
Irritant dermatitis is a nonallergic, localized inflammation of
the skin (redness, itching, various skin lesions) caused by
chemical irritation that does not involve the immune system.
24
The irritation allows the latex allergens easier access into the
body.
15,20,23,25–27
Type IV dermatitis is limited to the skin and
is a chemical contact inflammation (redness, itching, various
skin lesions) that is a T-cell (immune system)–dependent re-
134 Volume 38
Number 2
June 2003
action caused by chemicals used in latex production.
17,24
Typ-
ically, direct physical contact with a substance containing latex
allows increased access for proteins to enter the body. Re-
peated exposures decrease tolerance and increase the likeli-
hood of a type I reaction.
8–11,14–16,23,25
A type I systemic reaction is a true hypersensitivity reaction
moderated by the development of IgE antibodies to specific
proteins in latex, causing a serious and potentially lethal reac-
tion.
24
For some sensitive individuals, it may be associated with
cross-reactivity to certain foods.
28
The reaction is due to the
immune response, which causes mast cells and basophils to re-
lease histamine, leukotrienes, prostaglandins, and kinins. Signs
and symptoms may range from rhinitis to death.
8–10,14–16,20,25
Type I conditions are categorized by 5 stages:
Stage 1—local urticaria (a vascular reaction of the skin char-
acterized by sudden general eruption of wheals or papules that
itch)
1
in the area of contact.
20,23
Stage 2—generalized urticaria with angioedema
20,23
(swelling
of skin tissue, mucous membranes, or viscera associated with
specific antigen sensitivity).
1
Stage 3—urticaria with asthma, eye or nose itching, and gas-
trointestinal symptoms.
20,23
Stage 4—urticaria with anaphylaxis
20,23
(a hypersensitivity re-
action to an antigen, which is mediated by interactions be-
tween factors released by mast cells and IgE proteins capable
of acting as antibodies that attach to mast cells in the respi-
ratory tract and intestinal tract and play a major role in allergic
reactions; these interactions produce the antigen-antibody re-
action).
1
Stage 5—chronic asthma and permanent lung damage.
23
Recognition and Evaluation
Prevalence and At-Risk Individuals. Latex can enter the
body through mucous membranes,
7,15,17,27–29
contact with
the skin,
17,25,27,29
open wounds, contact with internal organs
(as in surgery),
25
intravenous exposure, and inhalation of or
contact with latex powder.
11,16,17,25,26,29
The incidence of la-
tex allergies has increased for health care workers in the last
10 years because of the institution of mandatory universal
precautions for handling bodily fluids.
6,10,16–18,21,28,30,31
In
the health care profession, latex particles from the powder
used inside gloves as a drying agent can spread through the
air and be inhaled.
4,32
The powder binds with the latex and
becomes the carrier of latex molecules when released into the
air.
8,20–22,28,33,34
Mineral talc was used in gloves until 1940,
when it was replaced with cornstarch because the mineral talc
binds more firmly to latex molecules. Although mineral talc
is heavier and less frequently airborne than cornstarch, it pro-
duces a more severe reaction in latex-sensitive individuals.
The airborne particles, regardless of the powder used, can
enter a person’s lungs and mucous membranes, causing an
allergic reaction.
2,6,31,35,36
The increasing prevalence of latex sensitivity is not only
seen in the health care profession but also in children with
spina bifida,
7,15,17,20,29,37,38
latex-industry workers,
7,22–24,27
those who have undergone multiple surgeries (especially on
the urinary tract),
15,17,19,24,28,29,38
blood donors, individuals
with a history of allergies,
7,29,30,37
and those who have recur-
rent contact with latex.
2,11,14,18,21,33
The rate of occurrence of
latex allergy for children with spina bifida, due to multiple
surgeries and congenital denervation of mast cells,
37
ranges
from 12% to 73%.
29,37,38,39
Prevalence is reported to be 3%
to 17% in health care workers,
10,24,28,32–34,37–39
11% in latex-
glove–plant workers,
7,14,22
and 1% to 6.5% in the general pop-
ulation.
2,9,19,40,41
Signs and Symptoms
An immediate allergic reaction may occur within minutes
of coming into contact with latex. Symptoms of a reaction
include hives; wheezing; coughing; shortness of breath; sneez-
ing; nasal congestion; runny nose; conjunctivitis (red, itchy,
watery eyes)
1
; nasal, palatal, or ocular itching; urticaria; na-
sorhinitis (chronic runny nose)
1
; asthma; and hypoten-
sion.
18,22,30,31,33,42–45
Hives can appear anywhere on the body
and not necessarily at the point where direct contact with the
latex occurred.
17
The immediate reactions can ‘develop into
a life-threatening condition when blood pressure drops, air-
ways become blocked, and the throat closes.’
17
This condition
can eventually progress into anaphylaxis.
17,21,26,28,33,42
These symptoms can be exacerbated in certain people when
specific foods are ingested.
40,46
Latex can cross-react with the
hevamine in fruits and may cause an immediate and more
serious reaction. A person who comes in contact with latex
may sustain a mild allergic reaction. However, when later in-
gesting a cross-reacting food, new reactions can occur within
5 to 30 minutes, resulting in itching and irritation of oral tis-
sues, swelling of the lips and tongue, and sometimes papules
or blistering of these tissues.
47
The allergens can cross-react
after either latex exposure or ingestion of certain foods.
46
Other Associated Allergies
Allergy to latex rubber involves sensitization to multiple
constituent proteins; therefore, different groups of patients re-
spond to specific latex proteins in various ways.
6,7
These
groups of proteins are found in many products, including, but
not limited to, certain tree pollens, some plants, and (most
commonly) fresh fruits.
6,47,48
Fresh fruits that commonly cause
hypersensitivity when associated with latex proteins are avo-
cado, banana, celery, chestnut, and pear. Less common culprits
are apricot, buckwheat, cherry, fig, grape, kiwi, mango, melon,
nectarine, orange, papaya, passion fruit, peach, peanut, pine-
apple, plum, potato, tomato, and walnut.
7,39,40,44
The problem
manifests itself in 2 ways: (1) the fruit allergy triggers previ-
ously undiagnosed recognition of the latex allergy or (2) after
years of latex exposure and latex sensitivity, the person de-
velops fruit allergies.
6
Whether this dual latex-fruit sensitivity
is determined by common antigens or cross-reacting antigens
has yet to be determined.
7
CASE STUDIES
As an athletic trainer, recognizing and evaluating the la-
tex-sensitive individual is important to maintaining safety
and preventing serious reactions. It may be the athlete or
another athletic trainer who has a sensitivity reaction that
needs to be managed and treated. A number of cases of
latex-sensitivity reactions have been documented in the lit-
erature.
7,18,27,30,31,44,49–54
Four such cases representing the
allied health professions and 1 in athletics follow.
Case 1
A 35-year-old female laboratory technician wore latex
gloves for approximately 13 years. She stopped wearing latex
Journal of Athletic Training 135
gloves after developing sneezing, pruritus, conjunctivitis, and
facial angioedema (facial swelling)
1
but continued working
with colleagues who wore latex gloves. She was sent to an
outpatient facility because of chronic rhinitis with sneezing,
nasal congestion, and a runny nose. She underwent a radio-
allergosorbent test (RAST), which identifies specific IgE an-
tibodies in the blood,
22,25
with positive results for latex and
banana.
31
Case 2
A 23-year-old female nurse’s aide with 3 years’ experience
was assessed with recurrent anaphylaxis preceded by chronic
rhinitis and conjunctivitis for approximately 1 month. The first
reaction occurred after she wore latex gloves. After this re-
action, she stopped wearing the gloves, and her symptoms de-
creased. The second and third incidents occurred after eating
cherries and a banana, respectively. After these incidents, the
patient avoided latex gloves. However, when she came back
into contact with latex products at a later date, she experienced
severe rhinoconjunctivitis with urticaria and dyspnea.
1
Allergy
testing showed increased sensitivity to latex. The saline test
solution produced no symptoms, whereas the latex solution
produced a reaction within 5 minutes.
31
Case 3
A 25-year-old female laboratory technician experienced in-
termittent asthma and allergic rhinitis for 3 years. She wore
latex gloves at work and began noticing hives on her hands
after sweating in the gloves. Also, she experienced vaginal
pruritus and soreness after intercourse using a latex condom.
Ten minutes into her cesarean section, which was being per-
formed by a surgeon wearing latex gloves, she experienced a
severe drop in blood pressure. Heart rate increased, and signs
of asthma, difficulty breathing, and nasal congestion were
present. At that point, she received treatment for her reactions,
and improvement was noted. After surgery, the patient was
evaluated and found to have a positive RAST for latex.
30
Case 4
A 25-year-old female squash player had a history of allergic
rhinitis for 13 years, neurodermatitis for 18 months, and 5
previous surgeries. She suffered a severe anaphylactic reaction
with generalized urticaria during the most recent surgery. The
reaction was successfully treated, but the reason for anaphy-
laxis remained unclear. She had an ongoing case of contact
dermatitis after wearing latex gloves the previous 2 months.
On the day she presented in the emergency room with a severe
anaphylactic shock reaction, she had just finished playing a
game of squash. Within 10 minutes after the match was com-
pleted, her hands and feet swelled and she experienced peri-
orbital tingling and dizziness. She lost consciousness for a
short time and was admitted to the hospital but was treated
and released the next morning. Follow-up allergy testing re-
vealed positive skin-prick tests to several extracts of latex and
latex gloves. It was determined that the latex in the handle of
her squash racquet, in combination with the ball and the dust
from the squash courts, elicited the latest anaphylactic reac-
tion.
55
Case 5
A 41-year-old female registered nurse suffered multiple, un-
identified allergic reactions at work that continued for years.
Her first severe reaction occurred after visiting a family mem-
ber in the hospital. She developed breathing difficulties so in-
tense that she was required to spend 3 days on a ventilator. At
that time, it was assumed that her reaction was due to the
cleaning agents used in the hospital. It was later determined
that the cleaning agents had only served to make latex particles
more airborne, therefore contributing to her allergic reaction.
Whenever she changed jobs, she informed her supervisors of
her allergy and was supplied with nonlatex gloves. Her co-
workers, however, continued to use latex gloves throughout
the hospital. At times, she would run out of the hypoallergenic
gloves and revert to latex gloves, which always provoked an
allergic reaction. Her last episode occurred after she wore latex
gloves and developed anaphylaxis. She was rushed to the
emergency room, where she informed medical personnel that
she was latex sensitive. The staff treating her continued using
the latex gloves, resulting in the death of the patient 40 min-
utes after first entering the emergency room. Postmortem
blood tests found high levels of latex antibodies in her blood-
stream.
52
MANAGEMENT
Management of latex allergies consists of treating an emer-
gency, screening for the condition, and preventing reactions
and situations from occurring in the first place. Three main
levels of allergic reactions, as previously defined, are associ-
ated with latex. Therefore, treatment ranges from simple to
emergent-care procedures.
For irritant dermatitis, remove the irritating substance,
cleanse the area with soap and water, apply topical corticoste-
roids to reduce the inflammatory response, use hydrating
creams after water contact, use hydrating creams overnight
covered by cotton gloves, and recommend evaluation by a
dermatologist for allergic contact dermatitis.
20,23,24,26,53
For type IV dermatitis, follow the same procedure as de-
scribed for irritant dermatitis. The patient should now obtain
a serum test for latex IgE.
20,23,24
For type I systematic reation, remove the irritating sub-
stance, treat life-threatening conditions first (follow the ABCs
of cardiopulmonary resuscitation), cleanse the area of contact
with soap and water if possible, transfer to a medical facility,
monitor vital signs, and continue to administer emergent care
as needed.
20,23,24
SCREENING
The first step in prevention is to identify individuals sus-
ceptible to latex allergies. It is essential to obtain a thorough
medical history and physical examination to initially identify
at-risk individuals
9,14,15,20,23,25–27,33
(Table 1). After screening,
further assessment and management are determined by wheth-
er the history was positive or negative and whether the person
is in a high- or low-risk group
9,15
(Figure). Several latex-sen-
sitivity tests are used in the United States today.
Skin-Patch Test
This test is used for irritant and contact dermatitis. A patch
with immunogenic rubber chemicals is taped on the person’s
136 Volume 38
Number 2
June 2003
Table 1. Screening Questionnaire
Are you allergic to rubber or latex products?
4
Yes No
Have you ever developed hives under latex gloves?
4
Yes No
Have you ever experienced coughing, wheezing, shortness of breath, or itching immediately after exposure to latex in the
home or at work?
23,35
Yes No
Have you ever had rhinitis or conjunctivitis?
23
Yes No
Have you experienced hives, itching of the lips or throat, or more severe symptoms when you handle or eat apple, apricot,
avocado, banana, carrot, celery, cherry, chestnut, fig, grape, kiwi, melon, nectarine, papaya, passion fruit, peach, pear,
plum, pineapple, potato, or tomato?
23
Yes No
Have you ever experienced swelling or itching of the mouth after a dental exam?
23,35
Yes No
Are you exposed to latex on a regular basis?
16
Yes No
What surgeries or invasive medical procedures have you had?
23
If exposed to latex on a regular basis, in what type of setting?
4
What type of latex or rubber products do you use?
Latex screening and management.
9,26
skin for 48 to 96 hours and then interpreted using standardized
techniques.
4,5,8,10,17,20,25,26
Skin-Prick Test
This test is used for type I latex-sensitivity diagnosis. To
perform the test, a drop of latex extract is placed on the skin,
and the skin is scratched with a sharp, bifurcated needle. The
person is monitored for signs of an allergic reaction.
Intradermal Test
This test is used for type I latex-sensitivity diagnosis. A
needle containing latex solution is inserted into the skin. Re-
actions are monitored because this test generates a higher level
of allergic reactions than a skin-prick test. It should be per-
formed in a facility with emergency medical equipment avail-
able to handle an anaphylactic reaction.
8,22,54,56,57
Currently,
the Food and Drug Administration has not approved a latex
extract for the skin-prick or intradermal tests. Typically, a
powdered latex glove is cut into an 8- 3 8-cm square patch
and soaked in 10 mL of extraction fluid overnight. Then it is
passed through a sterile Millipore filter (Millipore Corp, Bed-
ford, MA) and diluted to 1:10, 1:100, and 1:1000 for testing.
58
Research is being conducted on a standardized, nonammon-
iated latex extract (Greer Laboratories, Lenoir, NC) for skin-
prick tests. The early results show safety (by not causing an
anaphylactic reaction) and true-positive results for latex aller-
gy of 95% with the 100 mcg/mL concentration and 99% pos-
itive results with the 1 mg/mL concentration. Similarly, the
true-negative results were 100% with the 100 mcg/mL and
96% negative results with the 1 mg/mL concentration for those
without latex allergy.
59
IgE Antibody Immunoassays
These are methods used to identify the IgE antibodies in
the serum and to confirm the diagnosis of latex sensitivity.
However, a negative latex-specific IgE test does not rule out
a latex allergy.
5,8,56,57
Several methods are described in the
literature, including RAST, enzyme-linked immunosorbent as-
say, AlaSTAT (Diagnostic Products Corp, Los Angeles, CA),
ImmunoCAP (Pharmacia Corp, Peapack, NJ), and HY-TEC
(Hycor Biomedical Inc, Garden Grove, CA). In one study, the
AlaSTAT and CAP assays produced 24% and 27% false-neg-
ative results, respectively, whereas the HY-TEC produced a
27% false-positive result when compared with the skin-prick
test.
60
In another study, combining assays raised the diagnostic
sensitivity compared with using 1 in vitro test alone.
56
Others
have indicated that the assays may lack sensitivity in patients
presenting with urticaria only.
61
Use Test
This test is performed when the immunoassay tests are neg-
ative, but the history of symptoms is compelling. A fingertip
is cut from a latex glove, dampened with water, and placed on
the person’s finger for 15 minutes. A positive test results in
urticaria with itching or erythema. If no reaction occurs, plac-
ing an entire dampened glove on the hand for 15 minutes or
until a reaction occurs is considered safe.
20,26,62
PREVENTION
Currently, as with other allergies, there is no cure for latex
sensitivity. The only way of decreasing the allergic reactions
is to avoid exposure to latex.
2,14,17,19,21,25
High-risk areas
should be identified so they can be avoided.
5,11,22,26,34
Areas
subject to high-volume use of latex products include blood
banks and medical laboratories. However, many items contain
latex; therefore, it is imperative that the allergy-sensitive health
care worker or patient be familiar with the diverse sources of
latex.
25,27
A number of steps can be taken to avoid exposure,
the first being finding safe alternatives.
63
Latex-free alterna-
Journal of Athletic Training 137
tives include nitrile, vinyl, neoprene, styrene butadiene, and
Tactylon (Tactyl Technologies, Inc, Vista, CA).
21,25
Although
these alternatives exist, it is sometimes necessary to use latex
products. In this case, the following steps should be taken:
Use topical barriers.
2,4,25,26
Use cotton glove liners.
4,21,25
Wash hands immediately after glove use or contact with oth-
er latex products.
4,21,25,27
Use nonpetroleum-based moisturizing agents, especially
over cuts or cracks in skin.
4
Avoid touching the mucous membranes during or after con-
tact with a latex product.
4,21
Eliminate unnecessary latex-glove use, and remove the
gloves frequently to reduce hyperhydration or excessive oc-
clusion.
26
Make sure ventilation is adequate where these products are
used and that air filters are changed or cleaned frequent-
ly.
5,26,27
Avoid exposure to people and objects (countertops, drawers,
computer keyboards, and telephones) that have come into
contact with latex products.
26
Avoid using detergents, alcohol, formaldehyde, and antimi-
crobial agents, usually in the form of hand washes or hand
rubs, which may increase latex sensitivity.
34
Those who exhibit symptoms of severe hypersensitivity, in-
cluding anaphylaxis, should carry and know how to use an Epi-
Pen (Dey, Napa, CA). MedicAlert jewelry (MedicAlert Foun-
dation Intl, Turlock, CA) should also be worn.
2,4,5,11,14,21,26
AVOIDANCE AND EDUCATION
Programming and Education
Education is key in controlling allergic reactions. The first
level of education lies with the latex-sensitive individual. The
person who is diagnosed with latex sensitivity needs to be
educated on the condition and understand prevention and
avoidance techniques.
63
The second level of education is for
the individual to notify his or her employer of the condition,
so latex-free alternatives can be made available.
4,25,26
The
third level of education involves the employer specifically.
Employers must establish policies and procedures to ensure
the safety of the latex-sensitive person.
27
All other employees
must be informed of practices to prevent exposure to latex and
to recognize the signs and symptoms of an allergic reac-
tion.
9,25,26
Employers also need to conduct worksite evalua-
tions to identify areas of potential problems.
27,63
The same 3 levels of education apply to an athlete in the
athletic training room setting. As health care providers, athletic
trainers are obligated to develop guidelines from recommen-
dations that provide a balance between the risk of communi-
cable disease transmission and latex-hypersensitivity reac-
tions.
5,21,25
To help reduce the occurrence of latex allergies among
health care workers and patients, the American College of Al-
lergy, Asthma, & Immunology established new practice guide-
lines
4
:
Develop educational programs to promote awareness of the
allergy.
Encourage manufacturers of products that contain latex to
label them accurately.
Fund projects to develop an adequate alternative to rubber
products.
Establish standards for the maximum level of allergens per-
mitted in latex gloves.
Develop an improved and more time-efficient method for the
diagnosis of latex allergies.
4
Within the educational framework, there should be more
publicity and time spent understanding latex allergies. The em-
ployer should conduct inservice training for athletic training
and associated personnel (teachers, coaches, etc) responsible
for administering first aid. Information sessions for athletes
and parents concerning the possibility of latex sensitivity
should also be provided.
16
This will help increase the aware-
ness of potential latex sensitivity with product use.
Product Information
The athletic training environment has many known and hid-
den latex products. Creating a completely latex-free facility
may be unrealistic at this time. Products that contain latex,
including adhesive bandages, elastic wraps, and Thera-band
tubing (The Hygenic Corp, Akron, OH), are used daily in the
athletic training room. It would be beneficial to an athletic
training program to provide a medical kit with latex-free prod-
ucts. Although this approach may seem expensive at first, a
life may be saved if an athlete or athletic trainer has a sensi-
tivity or reaction to latex.
11,13,19,25
Several alternatives are
available to the latex products commonly used in the athletic
training facility
16,6466
(Table 2). Other products containing
latex that an athlete may use include tight-fitting workout
clothing, goggles, bathing caps, water shoes, balls, and racquet
handles.
67,68
Resource Information
Several Web sites offer information on latex allergies, in-
cluding current clinical management and prevention of allergic
disorders. Answers to frequently asked questions, educational
resources, and alternative products are available.
69
American Academy of Allergy Asthma & Immunology
(AAAAI), http://www.aaaai.org.
American Association of Nurse Anesthetists (AANA), http://
www.aana.com/crna/prof/latex.asp.
American College of Allergy, Asthma, & Immunology
(ACAI), http://allergy.mcg.edu/physicians/ltxhome.html.
American Latex Allergy Association and A.L.E.R.T., Inc,
http://www.latexallergyresources.org.
Latex Allergy Information Resource (LAIR), http://
www.anesth.com/lair/lair.html.
National Institute for Occupational Safety and Health
(NIOSH), http://cdc.gov/niosh/latexpg.html.
National Latex Allergy Network (NLAN), http://www.
latex-allergy.org.
Occupational Safety and Health Administration (OSHA),
http://www.osha-slc.gov/SLTC/latexallergy/index.html.
The Allergy Report, http://www.theallergyreport.org.
CONCLUSIONS
The opening scenario presented an athlete with pruritis, er-
ythema, runny nose, itchy and watery eyes, and a tickle in the
throat with a cough. If the reader suspected an allergic reaction
to latex, that is correct. To manage this condition, remove the
138 Volume 38
Number 2
June 2003
Table 2. Latex-Free Alternatives
64–66
Product Type Product Name or Generic Alternative Manufacturer
Ambu bags Bag Easy Respironics, Murrysville, PA
Capno-Flo Nellcor Puritan-Bennett Inc, Carlsbad, CA
SPUR Ambu Inc, Linthicum, MD
Bandages Active Strips (check for latex in packaging) 3M, St Paul, MN
Sterile dressing with latex-free tape
Blood pressure cuffs, tubing Cleen Cuff Vital Signs, Inc, Totowa, NJ
Dinamap GE Medical Systems, Waukesha, WI
Perfect Balance Trimline Medical Products Corp, Branchburg, NJ
Webril The Kendall Co, Walpole, MA
Use over clothing
Stockinette
Cohesive bandages CoFlex Andover Coated Products, Salisbury, MA
Cold and hot therapy products Technol Technol Orthopaedic Products, Fort Worth, TX
Cardiopulmonary resuscitation mannequins Little Anne, Resusci Anne Laerdal Medical Corp, Wappingers Falls, NY
Crutches’ axillary and hand pads Cover with cloth or tape
Dressings Bioclusive Johnson & Johnson, New Brunswick, NJ
Comfeel Plus Coloplast Ltd, Peterborough, UK
DuoDerm ConvacTec, Princeton, NJ
Metalline Lohmann & Rauscher
Opsite Smith 1 Nephew, Hull, UK
Reston Self-Adhering Foam 3M
Veni-Gard Lohmann & Rauscher GmbH & Co, Rengsdorf,
Germany
Webril The Kendall Co
Xerofoam The Kendall Co
Elastic wraps Adban Cohesive Compression Bandage Avcor HealthCare, Fort Worth, TX
CEB Hartman-Conco Inc, Rock Hill, SC
Champ Elastic Wrap Cramer Sports Medicine, Gardner, KS
Comprilan JOBST, Charlotte, NC
X-Mark Avcor HealthCare
Electrode bulbs, pads, grounding* Baxter Intl, Round Lake, IL
Conmed, Utica, NY
Vermont Medical, Inc, Bellows Falls, VT
Valleylab, Boulder, CO
Medtronic, Minneapolis, MN
Staodyn EMS, Longmont, CO
Gloves Allerderm Nitrile Allerderm Laboratories, Petaluma, CA
Allergard Johnson & Johnson
Dermaprene Ansell Limited, Red Bank, NJ
Duraprene Allegiance Healthcare Corp, McGaw Park, IL
N-DEX Best Manufacturing, Menlo, GA
Neolon PF Maxxim Medical, Waltham, MA
Nitrile Magid Glove and Safety Manufacturing Co,
Chicago, IL
Pure Advantage Tillotson Healthcare Corp, Dixville Notch, NH
Sensicare Surgicare Maxxim Medical
TACTYLON Tactyl Technologies, Inc, Vista, CA
Tru-Touch Becton, Dickinson and Co, Franklin Lakes, NJ
Vinyl
Neoprene
Ice wraps ProPac ProPac, Inc, Charleston, SC
Peak flow meters* Respironics Healthscan, Cedar Grove, NJ
Resistance tubing Rolyan Rolyan Ability One, Germantown, WI
Cover with cloth or exercise putty
Rubber reflex hammer Cover with plastic bag
Stethoscopes Littman Armstrong Medical Industries, Inc, Lincolnshire, IL
Scopecoat Devtron, Phoenix, AZ
Cover tubing with stockinette
Tapes Dermicel Johnson & Johnson
Durapore 3M
Microfoam 3M
Micropore 3M
Scanpore Hermal Kurt Herrmann GmbH & Co, Reinbek,
Germany
Transpore 3M
*Individual products not listed. Please check with manufacturers for details.
Journal of Athletic Training 139
skin-closure tapes and bandage using nonlatex gloves. Wash
the area and dry it. If the bleeding has stopped, a topical cor-
ticosteroid cream should be placed on the area of irritation.
The wound should then be bandaged with nonlatex products
and the athlete monitored for other signs and symptoms of a
more severe reaction. If the wound is still bleeding, gauze
should be applied using nonlatex products and direct pressure.
Treat the skin irritation after the bleeding has subsided. After
this reaction, the athlete should be instructed to avoid fruits
for the next 24 hours and to discuss the extent and severity of
the allergic response with a physician. The athletic trainer
should document the incident and follow up with the athlete
to ensure adequate medical care. Education is the key to re-
sponding and reacting to emergencies as they are presented.
Prevention is essential for decreasing the chance of an allergic
reaction to latex.
REFERENCES
1. Thomas CL, ed. Taber’s Cyclopedic Medical Dictionary. 18th ed. Phil-
adelphia, PA: FA Davis; 1997.
2. Meeropol E. Latex allergy update: clinical practice and unresolved issues.
J Wound Ostomy Continence Nurs. 1996;23:193–196.
3. Webster’s Encyclopedic Unabridged Dictionary of the English Language.
New York, NY: Random House; 1989.
4. Muller BA, Steelman VM, Hartley PG, Casale TB. An approach to man-
aging latex allergy in the health care worker. J Environ Health. 1998;61:
8–18.
5. Bey D, Browne B. Clinical management of latex allergy. Nutr Clin Pract.
1997;12:68–71.
6. Frankland AW. Latex allergy. J Nutr Environ Med. 1999;9:313–322.
7. Freeman GL. Cooccurrence of latex and fruit allergies. Allergy Asthma
Proc. 1997;18:85–88.
8. Hamilton RG, Adkinson NF Jr. Validation of the latex glove provocation
procedure in latex-allergic subjects. Ann Allergy Asthma Immunol. 1997;
79:266–272.
9. Hammer AL, Paulson PR. Latex allergy: implementation of an agency
program. Gastroenterol Nurs. 1997;20:156–161.
10. Safadi GS, Corey EC, Taylor JS, Wagner WO, Pien LC, Melton AL Jr.
Latex hypersensitivity in emergency medical service providers. Ann Al-
lergy Asthma Immunol. 1996;77:3942.
11. Bykowsky MJ. Latex allergy: an emerging crisis in health care. JSCMed
Assoc. 1996;92:267–270.
12. Wilkinson SM, Beck MH. Allergic contact dermatitis from latex rubber.
Br J Dermatol. 1996;134:910–914.
13. Banov C. Latex hypersensitivity: a worldwide crisis. J Investig Allergol
Clin Immunol. 1997;7:322.
14. Reddy S. Latex allergy. Am Fam Physician. 1998;57:93–102.
15. Sussman GL, Beezhold DH. Allergy to latex rubber. Ann Intern Med.
1995;122:43–46.
16. Elder EJ, Helsley NM. Latex allergies: a growing risk for athletic trainers.
Athl Ther Today. 1998;3(5):4447.
17. Stewart CM. Allergic to latex? RDH. 1996;16:22–23,47.
18. Warpinski JR, Folgert J, Cohen M, Bush RK. Allergic reaction to latex:
a risk factor for unsuspected anaphylaxis. Allergy Proc. 1991;12:95–102.
19. Brehler R, Kutting B. Natural rubber latex allergy: a problem of inter-
disciplinary concern in medicine. Arch Intern Med. 2001;161:1057–1064.
20. Kellett PB. Latex allergy: a review. J Emerg Nurs. 1997;23:27–36.
21. Evangelisto M. Latex allergy: the downside of standard precautions. To-
day’s Surg Nurse. 1997;19:28–33.
22. Zuskin E, Mustajbegovic J, Kanceljak B, Schachter EN, Macan J, Budak
A. Respiratory function and immunological status in workers employed
in a latex glove manufacturing plant. Am J Ind Med. 1998;33:175–181.
23. Edlich RF, Woods JA, Cox MJ. Society awakens. Latexallergyhelp.com.
Available at: http://www.latexallergyhelp.com/doctor.htm. Accessed June
2, 1998.
24. Walsh K. EMS and the latex allergic patient. Latexallergyhelp.com.
Available at: http://www.latexallergyhelp.com/emt.htm. Accessed June 2,
1998.
25. Zak HN, Kaste LM, Schwarzenberger K, Barry MJ, Galbraith GMP.
Health-care workers and latex allergy. Arch Environ Health. 2000;55:
336–346.
26. Gliniecki CM. Management of latex reactions in the occupational setting.
AAOHN J. 1998;46:82–93.
27. Preventing allergic reactions to natural rubber latex in the workplace.
National Institute for Occupational Safety and Health Alert. Available at:
http://www.cdc.gov/niosh/latexalt.html. Accessed July 28, 1998.
28. Wickware P. Latex allergy poses threat to patients, practitioners. Dermatol
Times. 2000;21:16.
29. Cremer R, Hoppe A, Korsch E, Kleine-Diepenbruck U, Blaker F. Natural
rubber latex allergy: prevalence and risk factors in patients with spina
bifida compared with atopic children and controls. Eur J Pediatr. 1998;
157:13–16.
30. Oei HD, Tjiook SB, Chang KC. Anaphylaxis due to latex allergy. Allergy
Proc. 1992;13:121–122.
31. Moneret-Vautrin DA, Debra JC, Kohler C, et al. Occupational rhinitis and
asthma to latex. Rhinology. 1994;32:198–202.
32. Liss GM, Sussma GL, Deal K, et al. Latex allergy: epidemiological study
of 1351 hospital workers. Occup Environ Med. 1997;54:335–342.
33. Weesner BW Jr. Latex allergies and adverse reactions: a review of the
literature. J Tenn Dent Assoc. 1997;77:21–26.
34. Thompson G. Ways of avoiding latex allergy. Community Nurse. 1997;
3:33–34.
35. Crippa M, Pasolini G. Allergic reactions due to glove-lubricant-powder
in health-care workers. Int Arch Occup Environ Health. 1997;70:399
402.
36. Lundberg M, Wrangsjo¨ K, Johansson SGO. Latex allergy from glove
powder: an unidentified risk with the switch from talc to cornstarch?
Allergy. 1997;52:1222–1228.
37. Bode CP, Fullers U, Roseler S, Wawer A, Bachert C, Wahn V. Risk factors
for latex hypersensitivity in childhood. Pediatr Allergy Immunol. 1996;7:
157–163.
38. Ylitalo L, Turjanmaa K, Palosuo T, Reunala T. Natural rubber latex al-
lergy in children who had not undergone surgery and children who had
undergone multiple operations. J Allergy Clin Immunol. 1997;100:606–
612.
39. Theissen U, Theissen JL, Mertes N, Brehler R. IgE-mediated hypersen-
sitivity to latex in childhood. Allergy. 1997;52:665–669.
40. Brehler R, Theissen U, Mohr C, Luger T. ‘Latex-fruit syndrome’’: fre-
quency of cross-reacting IgE antibodies. Allergy. 1997;52:404410.
41. Study suggests latex allergy may affect 6% of population. Health Facil
Manage. 1995;8:9–11.
42. Warner L. Latex allergy: policy, procedure, and latex-safe box. J Emerg
Nurs. 1997;23:139–141.
43. Pisati G, Baruffini A, Bernabeo F, Stanizzi R. Bronchial provocation test-
ing in the diagnosis of occupational asthma due to latex surgical gloves.
Eur Respir J. 1994;7:332–336.
44. Savonius B, Kanerva L. Anaphalaxis caused by banana. Allergy. 1993;
48:215–216.
45. Jaeger D, Kleinhans D, Czuppon AB, Baur X. Latex-specific proteins
causing immediate-type cutaneous, nasal, bronchial, and systemic reac-
tions. J Allergy Clin Immunol. 1992;89:759–768.
46. Ownby DR. Mechanisms in adverse reactions to food: the whole body.
Allergy. 1995;50(20 suppl):26–30.
47. Vickerstaff-Joneja JM. Oral allergy syndrome, cross-reacting allergens
and co-occurring allergies. J Nutr Environ Med. 1999;9:289–304.
48. Fuchs T, Spitzauer S, Vente C, et al. Natural latex, grass pollen, and weed
pollen share IgE epitopes. J Allergy Clin Immunol. 1997;100:356–364.
49. Tan BB, Lear JT, English JSC. Latex contact urticaria presenting as facial
swelling in a motor mechanic. Contact Dermatitis. 1997;36:229–230.
50. Tarlo SM, Sussman G, Contala A, Swanson MC. Control of airborne latex
by use of powder-free latex gloves. J Allergy Clin Immunol. 1994;93:
985–989.
51. Santos R, Hernandez-Ayup S, Galache P, Morales FG, Batiza VA, Mon-
toya D II. Severe latex allergy after a vaginal examination during labor:
a case report. Am J Obstet Gynecol. 1997;177:1543–1544.
140 Volume 38
Number 2
June 2003
52. Latex as killer: one nurse’s story. Dermatol Nurs. 1997;9:348.
53. Bernstein DI. Allergic reactions to workplace allergens. JAMA. 1997;278:
1907–1913.
54. Hadjiliadis D, Banks DE, Tarlo SM. The relationship between latex skin
prick test responses and clinical allergic responses. J Allergy Clin Im-
munol. 1996;97:1202–1206.
55. Beuers U, Baur X, Schraudolph M, Richter WO. Anaphaylactic shock
after a game of squash in atopic women with latex allergy. Lancet. 1990;
335:1095.
56. Kim KT, Safadi GS, Sheikh KM. Diagnostic evaluation of type I latex
allergy. Ann Allergy Asthma Immunol. 1998;80:66–70.
57. Ebo DG, Stevens WJ, Bridts CH, De Clerck LS. Latex-specific IgE, skin
testing, and lymphocyte transformation to latex in latex allergy. J Allergy
Clin Immunol. 1997;100:618–623.
58. Yunginger JW, Jones RT, Fransway AF, Kelso JM, Warner MA, Hunt LW.
Extractable latex allergens and proteins in disposable medical gloves and
other rubber products. J Allergy Clin Immunol. 1994;93:836–842.
59. Hamilton RG, Adkinson NF Jr. Natural rubber latex skin testing reagents:
safety and diagnostic accuracy of nonammoniated latex, ammoniated la-
tex, and latex rubber glove extracts. J Allergy Clin Immunol. 1996;98(5
Pt 1):872–883.
60. Hamilton RG, Biagini RE, Krieg EF. Diagnostic performance of food and
drug administration-cleared serologic assays for natural rubber latex-spe-
cific IgE antibody: the Multi-Center Latex Skin Testing Study Task Force.
J Allergy Clin Immunol. 1999;103(5 Pt 1):925–930.
61. Marais GI, Fletcher JM, Potter PC. In vivo and vitro in diagnosis of latex
allergy at Groote Schuur Hospital. S Afr Med J. 1997;87:1004–1008.
62. Kelly KJ, Kurup VP, Reijula KE, Fink JN. The diagnosis of natural rubber
latex allergies. J Allergy Clin Immunol. 1994;93:813–816.
63. Jack M. Latex allergies: a new infection control issue. Can J Infect Con-
trol. 1994;9:67–70.
64. Bernstein ML. Latex-safe emergency cart products list. J Emerg Nurs.
1998;24:58–61.
65. Latex-free alternatives (medical). Latex Allergy News. Available at: http://
www.latexallergyhelp.com/tablemed.htm. Accessed June 2, 1998.
66. Latex-free alternatives for the home. Latex Allergy News. Available at:
http://www.latexallergyhelp.com/tablehom.htm. Accessed June 2, 1998.
67. Potera C. Athletic-gear alert. Women’s Sports Fitness. 1995;17:29.
68. Ventura MT, Dagnello M, Matino MG, Di Corato E, Giuliano G, Tursi
A. Contact dermatitis in students practicing sports: incidence of rubber
sensitisation. Br J Sports Med. 2001;35:100–102.
69. On-line resources about latex allergies. Nursing. 2001;31:10–11.
... El diagnóstico complementario se basa en pruebas cutáneas y en determinaciones de IgE específicas. (Tabla 1) 4,6,[15][16][17] Según un reciente estudio 18 , aún se recomienda realizar como primer estudio el prick test, pero existen otras técnicas que han ido adquiriendo un rol más importante para comprender mejor los alérgenos involucrados en la alergia al látex. Estas técnicas son ImmunoCAP® y immuno-solid phase allergen chip (ISAC). ...
... Es importante considerar que una persona puede ser asintomática, pero estar sensibilizada con resultados positivos en el estudio de laboratorio. Sin embargo, esto no significa el diagnóstico de alergia al látex 4,6,17 . ...
... No existe un consenso universal y cada centro dispone de protocolos internos que aplican con los pacientes o personal de salud alérgicos al látex. La cirugía dermatológica es considerada de bajo riesgo ya que la mayoría de los casos de anafilaxia ocurren en pacientes que requieren anestesia general pero esto puede presentarse, aunque infrecuente, en cualquier tipo de intervención quirúrgica.Dentro de las recomendaciones más importantes a aplicar en un servicio de dermatología que realiza procedimientos tanto en pabellón como en sala de procedimientos menores son:6,20,21 ...
Article
Full-text available
El látex o caucho natural es un producto vegetal que se obtiene de la savia de la Hevea brasiliensis. Ampliamente utilizado para la fabricación de productos de uso doméstico (guantes, preservativos, globos, etc.) y del área de la salud, donde se estima que el 50% de los artículos médicos contienen látex.La alergia al látex es un problema de salud mundial. Se estima que la prevalencia de sensibilización al látex en población general es del 1%. Clínicamente, puede generar una reacción de hipersensibilidad tipo I, IgE mediada, en respuesta a las proteínas del látex que se manifiesta como una urticaria hasta la anafilaxia. También se describe dermatitis de contacto irritativa y la dermatitis de contacto alérgica, 12 a 96 horas luego del contacto, por una reacción de hipersensibilidad retardada tipo IV, secundaria a los aditivos del látex. El diagnóstico se basa en la sospecha clínica, confirmado con pruebas cutáneas y medición de IgEs específicas. Realizar una anamnesis que permita sospechar una alergia al látex y si se determina que el paciente tiene riesgo, realizar el estudio complementario para confirmar el diagnóstico. El enfrentamiento se basa en la prevención de la exposición y el tratamiento de la reacción aguda. Es necesario conocer los alérgenos y procesos implicados en la alergia al látex pues de este modo se podrá sospechar e identificar a pacientes o funcionarios que puedan sufrir o estar en riesgo de presentarla, disminuyendo de este modo las posibles complicaciones.
... El diagnóstico complementario se basa en pruebas cutáneas y en determinaciones de IgE específicas. (Tabla 1) 4,6,[15][16][17] Según un reciente estudio 18 , aún se recomienda realizar como primer estudio el prick test, pero existen otras técnicas que han ido adquiriendo un rol más importante para comprender mejor los alérgenos involucrados en la alergia al látex. Estas técnicas son ImmunoCAP® y immuno-solid phase allergen chip (ISAC). ...
... Es importante considerar que una persona puede ser asintomática, pero estar sensibilizada con resultados positivos en el estudio de laboratorio. Sin embargo, esto no significa el diagnóstico de alergia al látex 4,6,17 . ...
... No existe un consenso universal y cada centro dispone de protocolos internos que aplican con los pacientes o personal de salud alérgicos al látex. La cirugía dermatológica es considerada de bajo riesgo ya que la mayoría de los casos de anafilaxia ocurren en pacientes que requieren anestesia general pero esto puede presentarse, aunque infrecuente, en cualquier tipo de intervención quirúrgica.Dentro de las recomendaciones más importantes a aplicar en un servicio de dermatología que realiza procedimientos tanto en pabellón como en sala de procedimientos menores son:6,20,21 ...
Article
Full-text available
El látex o caucho natural es un producto vegetal que se obtiene de la savia de la Hevea brasiliensis. Ampliamente utilizado para la fabricación de productos de uso doméstico (guantes, preservativos, globos, etc.) y del área de la salud, donde se estima que el 50% de los artículos médicos contienen látex.La alergia al látex es un problema de salud mundial. Se estima que la prevalencia de sensibilización al látex en población general es del 1%. Clínicamente, puede generar una reacción de hipersensibilidad tipo I, IgE mediada, en respuesta a las proteínas del látex que se manifiesta como una urticaria hasta la anafilaxia. También se describe dermatitis de contacto irritativa y la dermatitis de contacto alérgica, 12 a 96 horas luego del contacto, por una reacción de hipersensibilidad retardada tipo IV, secundaria a los aditivos del látex. El diagnóstico se basa en la sospecha clínica, confirmado con pruebas cutáneas y medición de IgEs específicas. Realizar una anamnesis que permita sospechar una alergia al látex y si se determina que el paciente tiene riesgo, realizar el estudio complementario para confirmar el diagnóstico. El enfrentamiento se basa en la prevención de la exposición y el tratamiento de la reacción aguda. Es necesario conocer los alérgenos y procesos implicados en la alergia al látex pues de este modo se podrá sospechar e identificar a pacientes o funcionarios que puedan sufrir o estar en riesgo de presentarla, disminuyendo de este modo las posibles complicaciones.
... • Realización de medidas para el mantenimiento de quirófano libre de látex, entre las cuales destaca retiro de productos de látex, limpieza del quirófano con materiales libres de látex, correcto equipamiento del quirófano con medicamentos de uso en caso del desarrollo de anafi laxia (epinefrina, corticoides, antihistamínicos, etcétera). 28 La inmunoterapia no se encuentra indicada en las guías ofi ciales, sin embargo, una revisión sobre inmunoterapia identifi có 11 ensayos clínicos, de los cuales en tres se empleó la forma subcutánea y en ocho la forma sublingual (SLIT); el uso de inmunoterapia subcutánea (SC) y SLIT puede representar una opción en ciertos individuos con síntomas severos quienes no pueden evitar la exposición al látex. 28,29,30 Tolci et al. reportaron desensibilización oral al látex en tres trabajadores de la salud con síntomas severos, quienes pudieron retornar a sus actividades laborales y a exposición posterior. ...
... 28 La inmunoterapia no se encuentra indicada en las guías ofi ciales, sin embargo, una revisión sobre inmunoterapia identifi có 11 ensayos clínicos, de los cuales en tres se empleó la forma subcutánea y en ocho la forma sublingual (SLIT); el uso de inmunoterapia subcutánea (SC) y SLIT puede representar una opción en ciertos individuos con síntomas severos quienes no pueden evitar la exposición al látex. 28,29,30 Tolci et al. reportaron desensibilización oral al látex en tres trabajadores de la salud con síntomas severos, quienes pudieron retornar a sus actividades laborales y a exposición posterior. 29 Pereira et al. reportaron el tratamiento con inmunoterapia sublingual al látex en un técnico radiólogo, en quien los síntomas clínicos remitieron rápidamente y fue posible la reincorporación laboral. ...
Article
Full-text available
Antecedentes: La prevalencia de alergia al látex oscila entre 0.8 y 6.5 % y es la segunda causa de anafilaxia perioperatoria. Los principales factores de riesgo son ser trabajador de la salud o productor de látex, horas de utilización de guantes o productos de látex, exposición a otros irritantes de manos, antecedente de atopia, defectos del cierre del tubo neural o numerosas cirugías a edad temprana. Objetivo: Determinar la frecuencia de sensibilización al látex en médicos residentes del área quirúrgica del Hospital General de México. Métodos: Estudio clínico prospectivo, transversal, descriptivo, mediante la realización de prueba de punción cutánea a residentes del área quirúrgica del Hospital General de México, Secretaría de Salud, Ciudad de México. Resultados: Se incluyeron 92 sujetos a los cuales se les realizó pruebas cutáneas, participando 11 especialidades quirúrgicas. La sensibilización al látex en esta población fue de 11.9 % y la presencia de alergia al látex de 10.8 %. Conclusiones: Se demuestró alta frecuencia de sensibilización y alergia al látex en los residentes quirúrgicos del Hospital General de México, lo que indica la necesidad de desarrollar políticas y procedimientos para los trabajadores de salud con alergia al látex y la capacitación continua de empleados sobre alergia al látex.
... Determinan anticuerpos IgE específicos para las proteínas del látex en el plasma del paciente, lo que confirma la sensibilización alérgica al látex 18 . La medición de la IgE específica al látex presenta sensibilidad entre 97% y 100%, pero con especificidad de sólo 80% 16 . ...
... El manejo consiste en buscar dirigidamente a pacientes con factores de riesgo o sensibilizados, previniendo complicaciones y manejando las eventuales emergencias 18 . Los pacientes que sólo poseen factores de riesgo pueden ser manejados sin precauciones específicas, pero con una monitorización estrecha. ...
Article
Full-text available
Latex or natural rubber latex is a processed plant-based product, extracted from the tropical tree Hevea Brasiliensis. This raw material is widely used in about 40.000 medical and daily-used products. Latex allergy is a relevant pathology in surgical environments that arose after the establishment of universal precautions during the nineties. Risk groups include health-care workers and children with spine bifida who have a prevalence ranging between 2.9-17% and 30-70%, respectively. Latex allergy occurs in a variety of ways in health facilities including hypersensitivity reaction type IV or type I. In the former, chemical substances added to latex trigger the allergic reactions; where allergic dermatitis is the most-frequently found case. In the latter, the reactions are triggered by the contact with latex proteins causing from urticarial to anaphylactic shock and death. Diagnosis of latex allergy is based on a clinical history and/or physical examination associated with a confirmatory test as prick test (latex allergy type I) or cutaneous patches (latex allergy type IV). Nowadays, there is no definitive cure for the latex allergy and its treatment is based on allergen avoidance.
... Due to the presence of loosely-bound talc, the powdered gloves are not suitable for use in certain fields, e.g., electronic and biomedical applications [1]. Moreover, the indigenous non-rubber substances such as proteins, and the residual vulcanizing agents, might cause allergy in some hypersensitive users [2]. To mimic talcum powder and to prevent direct contact between the rubber and human skin, latex of negatively charged poly (methyl methacrylate) (PMMA) nanoparticles were synthesized and firmly attached onto positively charged, polyacrylamide-grafted SPNR film using the Layer-by-Layer (LbL) technique [3,4]. ...
... The natural rubber latex Natural rubber latex is an extract of sap which derived from the rubber tree (HeveaBrasiliensis) 4 , one of the lactifer plants in worldwide, including Ponsettia (Euphorbia pulcherrima) and Castor Bean (Ricinuscommunis) 5 . These lactifer plants species have special cells that secrete milky substance which is the latex, circulating in the branched tubes throughout the plant tissues. ...
Article
Full-text available
Introduction: Latex hypersensitivity is one of the problems in healthcare workers. This problem affects the productivity of the workers due to the hypersensitivity symptoms. In Dental Polyclinic USIM, there have been complaints by dental personnel regarding the usage of latex glove. However, there was no data that have been documented. Aim: The aim of this study is to determine the prevalence of self-reported latex glove hypersensitivity among dental personnel in Dental Polyclinic of UniversitiSains Islam Malaysia. Methodology: A cross-sectional study was conducted using purposive non-probability sampling technique. 196 dental personnel in Dental Polyclinic USIM who used natural latex gloves in their work were selected. Questionnaire on respondent's information on latex glove hypersensitivity was sent by email to the respondents and data collection was done from August to September 2015. Nevertheless, only 91% response was obtained. Result: From 175 returned questionnaires, 55 (31.4%) respondents showed to have latex hypersensitivity symptoms. The most type of hypersensitivity symptoms was irritant contact dermatitis in 35 (20.1%) respondents, followed by Type IV response with delayed hypersensitivity in 14 (8.05%) respondents and immediate hypersensitivity Type I reaction in 6 (3.4%) respondents. Data analysis was done using Chi-Square test and there was a significant association between the latex allergy and the hours of exposure (p <0.05). Conclusion: Approximately one third (31.5%) of the dental personnel in Dental Polyclinic USIM has latex glove hypersensitivity through this questionnaire based study. Further study and further medical assessments need to be done to confirm the latex hypersensitivity among dental personnel, followed by specific measures in order to manage the hypersensitivity symptoms in clinical setting.
Article
La alergia al látex es un problema importante en el mundo debido a la gravedad de la sintomatología que produce y a los grupos de riesgo expuestos. La evitación completa es difícil, casi imposible, dada su ubicuidad. El látex de caucho natural (LCN) es un polímero secretado por el árbol Hevea brasiliensis (Hev b), que funciona como sellador protector. Actualmente se usa para fabricar productos para el cuidado de la salud como tapones para tubos, pistones, mascarillas y cánulas. El objetivo de esta revisión es resaltar los aspectos epidemiológicos, clínicos y diagnósticos de la alergia al LCN, y realizar una revisión de la literatura sobre su manejo, mediante una búsqueda bibliográfica de artículos en bases de datos como PubMed, Cochrane, UpToDate y Google Académico, hasta septiembre del 2021. Se revisaron aproximadamente 121 artículos, de los cuales se utilizaron 76 como referencia. Concluimos que la alergia al látex es una entidad cuyo tratamiento aún hoy en día es la evitación, a pesar de tener una prevalencia mundial de 4.3 % y representar una complicación quirúrgica de cerca de 20 % de las cirugías con una reacción anafiláctica y una mortalidad que puede llegar a 9 %. El único tratamiento que podría modificar la evolución de esta enfermedad es la inmunoterapia, pero aún no se cuenta con extractos estandarizados y no se ha podido determinar la vía más segura y efectiva.
Article
A case report of a Caucasian female born in 1927 is presented in which rapid recovery from vulvar extramammary Paget's disease (EMPD) without surgical intervention occurred following an abrupt change from fluoridated/chlorinated tap water (0.9- 1.0 mg F-/L) to low-fluoride spring and well water (both <0.1 mg F-/L) for drinking, cooking, bathing, and laundry purposes. Within weeks of switching from the tap water her condition completely cleared, with no recurrence after three years except when re-exposed to fluoridated tap water. EMPD primarily affects postmenopausal Caucasian women, but occasionally it also occurs in men. The condition presents as an itchy, rash-like condition that can be accompanied by invasive malignant changes to underlying dermal tissue, for which surgical excision of the affected region is the most common treatment. Possible reasons for recovery without surgery in this case are discussed.
Article
IgE-mediated sensitivity (true allergy) to latex occurs in well-defined groups. The common feature is a high degree of repeated exposure to latex. Approximately one percent of the total U.S. population and five to 17 percent of health care workers are affected. The objective of this article is to provide a rational approach to managing latex allergy in health care workers. Information is provided on the basis of a review of recent literature (primarily since 1986) and on the basis of work by the University of Iowa Hospitals and Clinics Multidisciplinary Latex Allergy Committee. This article summarizes a proactive, hospital-wide approach to effective management of latex allergy in health care workers. The approach incorporates recommendations from several review articles, including a position statement from the American College of Allergy, Asthma, and Immunology and work done by the University of Iowa Hospitals and Clinics Multidisciplinary Latex Allergy Committee. Health care administrators, allergists, dermatologists, and occupational health personnel must work together to develop guidelines and implement policies to curb rising latex sensitization rates in health care workers. Many situations can be managed through medical, personal, and household avoidance of latex antigen and through modifications to the work environment. This article also presents an algorithmic approach to care management strategies that enhances documentation and yields more accurate data about incidence and prevalence of latex hypersensitivity among health care professionals.
Previously we have found occasional patients with delayed hypersensitivity to latex (in rubber gloves) in the absence of allergy to any chemicals in the rubber chemical screen. There are many reports of contact urticaria to latex and isolated reports of delayed hypersensitivity to latex, usually in the presence of contact urticaria. To establish if latex ruber is a more common cause of delayed hypersensitivity than is currently recognized, we patch tested all patients attending our contact dermatitis clinic, over a 6-month period, with latex. Of 822 patients, 16 (1.9%) demonstrated positive cutaneous reactions to latex. Six exhibited contact urticaria to latex, five contact urticaria and allergic contact dermatitis, and five allergic contact dermatitis alone. Of the five with delayed hypersensitivity to latex in the absence of contact urticaria, only one was atopic and the sensitivity was thought to be relevant or possibly relevant in four. Of our patients, 1.2% exhibited positive patch-test reactions to latex. Patch testing with latex should be considered where contact dermatitis to a latex rubber-containing product is suspected, e.g. gloves and footwear.
Article
Background: In the absence of Food and Drug Administration–approved natural rubber latex skin testing reagents, latex-specific IgE antibody immunoassays are used in the diagnosis of latex allergy. Comparative diagnostic performance of these tests has not been definitively determined. Objective: We sought to study the predictive value of available Food and Drug Administration (510K)–cleared latex-specific IgE antibody immunoassays in the diagnosis of latex allergy. Methods: Subjects (n = 312) were classified as having a positive (n = 117) or a negative (n = 195) latex allergy history (Hx) or having a positive (n = 131) or a negative (n = 181) puncture skin test (PST) response (Greer reagent). The 14 subjects with a negative Hx and a positive PST response had negative responses to glove provocation testing and thus were considered sensitized but asymptomatic. Sera from 22 subjects were split to evaluate intra-assay variation. All 334 coded sera were analyzed for latex-specific IgE antibodies in the Diagnostic Products Corporation microplate AlaSTAT, Hycor HY-TEC EIA System, and Pharmacia-UpJohn CAP System. Variance and diagnostic performance parameters of each test were computed with 95% confidence intervals in relation to the subjects’ Hx and PST status. Results: Intra-assay concordance of split sera results was 96.0% for all 3 assays, with coefficients of variation of less than 25% and between-assay coefficients of variation of less than 21%. The diagnostic performance of the CAP and AlaSTAT assays were equivalent in comparison with PST results: sensitivity, CAP 76.3% and ALASTAT 73.3% and specificity, CAP 96.7% and AlaSTAT 97.2% (P = NS). The HY-TEC assay was more sensitive (91.6%) and less specific (73.3%) than the CAP and AlaSTAT assays (P < .001). From 9% to 25% of the sera were discordant, being positive in at least 1, but not all 3, assays. Conclusion: The CAP and AlaSTAT assays produce 24% and 27% of false-negative results, respectively, whereas the HY-TEC produces 27% of false-positive results when compared with the PST. (J Allergy Clin Immunol 1999;103:925-30.)
Article
In sensitized subjects, provocation tests to latex may induce severe systemic reactions and even anaphylactic shock. It is probable that part of the risk is due to the difficulty in grading the stimulating dose and in starting from very low levels of exposure. To identify the aetiological agent of work-related asthma in four nurses with previous allergic contact urticaria to latex surgical gloves dusted with cornstarch powder, we performed a specific bronchial provocation test study, based on exposure on three different days to nonpowdered latex surgical glove extract, powdered latex surgical glove extract and cornstarch powder extract, respectively. Extracts were nebulized in increasing concentrations in a 7 m(3) challenge room, in the absence of the patients. The initial extract concentration was a tenfold dilution of the predetermined skin test end-point in the individual undergoing challenge, and the highest concentration was the undiluted extract. After exposure, the patients' forced expiratory volume in one second (FEV(1)) was monitored for 2 h. If FEV(1) decreased by at least 15%, the next scheduled exposure was not carried out and FEV(1) was monitored over a period of 24 h. Whereas nebulization of cornstarch powder extract caused no bronchial reaction in the patients, nebulization of nonpowdered latex surgical glove extract induced immediate bronchoconstriction in two subjects as an undiluted solution, and nebulization of powdered latex surgical glove extract induced immediate bronchoconstriction in all subjects at the 1:10 dilution. No systemic reaction was elicited by the bronchial provocation challenges. Our results demonstrate that airborne powder from latex gloves can be an inhalative occupational hazard. Latex, absorbed by the cornstarch powder and then airborne when gloves were handled, was the causative agent of the respiratory events in our patients. The standardized method that we used minimizes the risk of eliciting systemic reactions when performing specific bronchial provocation tests to latex.
Article
Oral allergy syndrome (OAS) is a complex of clinical symptoms in the mucosa of the mouth and throat, that result from direct contact with food allergens in an individual who also exhibits respiratory allergy to inhaled allergens, usually pollens, and especially birch pollen. Symptoms include itching and irritation of oral tissues, swelling of the lips, tongue, and sometimes papules or blistering of these tissues. Because many systemic allergic reactions start with oral symptoms, confusion and concern have arisen regarding the limitations and application of this definition of the syndrome, and the degree to which cross-reacting food should be avoided in individuals with pollen allergy. Profilins and pathogenesis-related proteins, common to many plants that are botanically unrelated have been identified as allergens responsible for OAS. Latex allergy and its associated food allergy is another example of cross-reacting allergens in botanically unrelated plants; in this case the component responsible has been identified as a hevamine. In the management of food allergy, the subject of cross-reactivity of allergens is becoming increasingly complex. This review examines the problems of OAS, cross-reacting allergens and co-existing allergies in light of recent research into the characteristics of allergens and the factors that predispose to food allergy. Some suggestions are provided for the application of this information in the clinical setting.
Article
Summary Previously we have found occasional patients with delayed hypersensitivity to latex (in rubber gloves) in the absence of allergy to any chemicals in the rubber chemical screen. There are many reports of contact urticaria to latex and isolated reports of delayed hypersensitivity to latex, usually in the presence of contact urticaria. To establish if latex rubber is a more common cause of delayed hypersensitivity than is currently recognized, we patch tested all patients attending our contact dermatitis clinic, over a 6-month period, with latex. Of 822 patients, 16 (1.9%) demonstrated positive cutaneous reactions to latex. Six exhibited contact urticaria to latex, five contact urticaria and allergic contact dermatitis, and five allergic contact dermatitis alone. Of the five with delayed hypersensitivity to latex in the absence of contact urticaria, only one was atopic and the sensitivity was thought to be relevant or possibly relevant in four. Of our patients, 1.2% exhibited positive patch-test reactions to latex. Patch testing with latex should be considered where contact dermatitis to a latex rubber-containing product is suspected, e.g. gloves and footwear.
Article
1. The increased use of natural rubber latex barrier protection to prevent exposure to bloodborne pathogens has led to an increase in latex related health reactions, particularly associated with glove use. 2. The three types of reactions to latex in order of frequency include irritant contact dermatitis, allergic contact dermatitis, and immediate systemic/anaphylaxis reactions. 3. The management goal for all reactions is to avoid unnecessary restriction from the appropriate use of latex (gloves) which provides the best barrier protection, while protecting individual workers from exposure that results in sensitization or causes sensitized individuals to have serious reactions. 4. Choose non-latex gloves when barrier protection from bloodborne pathogens is not an issue. When selecting a latex glove, choose a glove that is low in proteins and powder free to control airborne latex exposure.