Latex Allergy

Once or twice a year I have a patient who is Latex allergic. I use it as a reminder to review the information. There is a wonderful article, Latex Allergy by Sumana Reddy, MD published by the American Academy of Family Physicians. I don’t think I can do a better review, so lets just hit some highlights.

The natural latex allergen is from the rubber tree Hevea brasiliensis. Those persons most susceptible to sensitivity are persons with significant cumulative latex exposure, such as those in the health care and rubber industries, as well as those undergoing repeated surgeries, especially if those surgeries are early in life (e.g. spina bifida patients).

Avoiding exposure to NRL (natural rubber latex) allergens is the only effective means for prevention of sensitization. Avoidance of powdered NRL gloves results in a decrease in sensitization and subsequent problems. It has been shown that continued avoidance can result in complete loss of sensitization. Avoidance can be hard to do, as a large number of medical and nonmedical products have NRL in them: elastic bandages, tourniquets, Foley urinary catheter, Penrose drains, tape, rubber innersoles of shoes, ballons, latex mattresses, household rubber gloves, and inflatable mattresses. There is also a cross reaction to other plants and foods: Poinsettia, banana, avocado, passion fruit, chestnut, kiwi fruit, melon, tomato, celery.

Important questions to ask patients if you suspect a latex sensitivity:
Allergy history:

• Do you have a history of hay fever, asthma, eczema, allergies or rashes?


• Are you allergic to any foods (remember those above)?


• Do you experience rash, oral itching, swelling or wheezing when exposed to these foods?

Occupation history:

• Are you exposed to any products that contain latex, including gloves, at work?


• If you have had a rash on your hands after wearing latex gloves, how long after putting on the gloves did the rash develop?


• What did the rash look like?

Hidden reactions to Latex:

• Do you ever have swelling, itching, hives, shortness of breath, cough or other allergic symptoms during or after blowing up a balloon, undergoing a dental procedure, using condoms or diaphragms, or following a vaginal or rectal exam?


• Have you ever had an allergic reaction of unknown cause, especially during a medical or dental procedure?

Surgical History:

• Have you ever had surgery? What kind?


• Do you have spina bifida or any urinary tract problem requiring surgery or catheterizations?
  

Surgical patients who are Latex-sensitive should be scheduled as the first case of the day, when aerosolized latex particles are at a low. If blood pressure cuffs and tubing are made of latex, the patient's extremities should be wrapped to prevent contact. While it has been recommended that medications not be drawn up through rubber-stoppered vials or allowed to sit in preloaded syringes that contain latex rubber, and that latex ports should not be used for intravenous injections, these precautions appear to be impractical for all but the most exquisitely latex-sensitive patient and are likely not necessary. Non-latex gloves should be worn by surgeons and staff. Premedication with antihistamines, steroids and histamine H2-blockers is sometimes carried out, but anaphylactic reactions have occurred despite such pretreatment.

If you are a latex-sensitive patient, please, wear a Medic-Alert identification. Consider carrying an epinephrine auto-injection kit. Maybe carry extra pairs of nonlatex gloves for emergency medical or dental care.