The clinical manifestations include general urticaria, rhinitis, conjunctivitis, bronchospasm and anaphylaxis. These reactions are elicited by proteins present in natural rubber. Latex allergy occurs for the most part in well-defined risk groups. These include health workers, rubber industry workers and children with spina bifida (meningomyelocele) and urogenital abnormalities. Health workers and rubber industry workers are exposed to latex during their occupation while patients with spina bifida or urogenital abnormalities are exposed to latex during multiple surgeries and repeated introduction of latex catheters.
The risk for developing latex allergy is higher among atopic individuals as compared to non atopics. Health care workers appear to have a 5% to 10% risk of latex allergy. Several reports have highlighted a potential cross reactivity between latex and banana, chestnut, avocado and other fruit. The diagnosis is based on a careful history (high risk group, "unexplained" systemic or anaphylactic reaction) and skin and/or RAST testing using latex extracts. The treatment is based entirely on prevention. Complete avoidance of latex may be impossible due to the ubiquity of latex in house hold and medical devices.
In the FDA series 79% of reported reactions to medical devices (excluding barium enema catheters, condoms and diaphragms) were due to latex gloves or bladder catheters. Patients with known latex allergy should be protected from any direct contact with latex containing devices. Powder latex products (such as powder latex gloves) are especially dangerous because of possible aerosolization of latex allergen.
Health care providers with latex allergy should use non latex gloves and ask their colleagues to use powder-free gloves. Premedication with antihistamines may reduce the severity of potential antigen-induced reaction but by no means used as an alternative to prevention. Current recommendations of both the American Academy of Allergy and Clinical Immunology and the American College of Allergists are as follows: Questions about latex allergy should become a routine part of the patient history for primary care physicians, surgeons, obstetricians, radiologists, anesthesiologists, allergists and dermatologists. Patients in a high risk group should be identified and should be offered diagnostic testing especially before medical or dental procedure that would entail latex exposure.
Patients with spina bifida should avoid latex exposure from birth. Patients with known systemic reactions to latex should be counseled to wear a Medic Alert bracelet, carry a supply of non latex gloves and autoinjectable epinephrine. Health care institutions should be prepared to care for the patients with latex allergy. The FDA should establish labeling guidelines for latex-containing medical devices.
Schedule an appointment today!