Latex allergy

Latex allergy is a medical term encompassing a range of allergic reactions to the proteins present in natural rubber latex.[1] Latex allergy 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. The immune system of some susceptible individuals produces antibodies that react immunologically with these antigenic proteins.[2] As 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, 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]

Latex allergy
Latex medical glove
SpecialtyImmunology

Types

Natural rubber latex is known to cause allergic reactions of Type I (e.g. anaphylaxis) and Type IV (e.g. allergic contact dermatitis) as well as non-allergic irritant contact dermatitis.

Type I

The most serious and rare form of latex allergy, Type I hypersensitivity can cause an immediate and potentially life-threatening reaction, not unlike the severe reaction some people have to bee stings. Such reactions account for a significant proportion of perioperative anaphylactic reaction, especially in children with myelomeningocele.[4][5] Type I natural rubber latex allergy is an IgE (immune) mediated reaction to proteins found in the Hevea brasiliensis tree, a type of rubber tree.

Testing for type I natural rubber latex allergy is through blood testing to determine if the patient is producing IgE antibodies to latex proteins.

Anaphylactic shock can be provoked in allergic persons by the previous use of latex in an area: latex is typically powdered to prevent sticking, latex proteins become attached to the particles of powder, and the powder becomes airborne when the latex item is used, triggering potentially life-threatening Type I reactions when the latex-contaminated powder is inhaled by susceptible persons.[6] In radiological units latex allergy may mimic contrast medium allergy[7]

Type IV (allergic contact dermatitis)

Type IV allergy, also known as allergic contact dermatitis, involves a delayed skin rash that is similar to poison ivy with blistering and oozing of the skin (see urushiol-induced contact dermatitis). It can be diagnosed through a positive skin patch test, although a negative test does not rule out a latex allergy.[8] Severe irritation takes place if a latex catheter is inserted in the urinary tract of a person allergic to latex. That is especially severe in case of a radical prostatectomy due to the open wound there and the exposure lasting e.g. two weeks. Intense pain may indicate such situation.[9]

Irritant contact dermatitis

Natural rubber latex can also cause irritant contact dermatitis,[10] a less severe form of reaction that does not involve the immune system. Contact dermatitis causes dry, itchy, irritated areas on the skin, most often on the hands.[11] Latex-glove induced dermatitis increases the chance of hospital-acquired infections, including blood-borne infections, being transmitted.[12]

Latex-fruit syndrome

People who have latex allergy also may have or develop an allergic response to some plants and/or products of these plants such as fruits. This is known as the latex-fruit syndrome.[13] Fruits (and seeds) involved in this syndrome include banana, pineapple, avocado, chestnut, kiwifruit, mango, passionfruit, fig, strawberry, papaya, apple, melon, celery, potato, tomato, carrot, and soy. The proteins in these are similar to the protein in latex. Hevein-like protein domains [14] are a possible cause for allergen cross-reactivity between latex and banana[15] or fruits in general.[16]

Natural rubber latex contains several conformational epitopes located on several enzymes such as Hev b 1,[17] Hev b 2,[18] Hev b 4,[19] Hev b 5[20] and Hev b 6.02.[21][22]

FITkit is a latex allergen testing method for quantification of the major natural rubber latex (NRL) specific allergens: Hev b 1, Hev b 3, Hev b 5, and Hev b 6.02.[23]

Risk factors
  • Children with spina bifida. Up to 68% will have a reaction.[24]
  • Industrial rubber workers, exposed for long periods to high amounts of latex. About 10% develop an allergic reaction.[12]
  • Health care providers. Given the ubiquitous use of latex products in health care settings, management of latex allergy presents significant health organizational problems. Those healthcare workers—such as physicians, nurses, aides, dentists, dental hygienists, operating room employees, occupational therapists, laboratory technicians, and hospital housekeeping personnel—who frequently use latex gloves and other latex-containing medical supplies are at risk for developing latex allergy.[25] Between about 4% to 17% of healthcare workers have a reaction, which usually presents as Irritant Contact Dermatitis. This contact dermatitis can develop further through allergic sensitivity to a status of full anaphylactic shock. Apart from the uncomfortable and in some cases life-threatening health implications, this will effectively hinder the person from working with any amount of latex and could impede their chance of maintaining their vocation.[26] In the surgical setting, the risk of a potentially life-threatening allergic reaction by a patient has been deemed by Johns Hopkins Hospital to be sufficiently high to replace all latex surgical gloves with synthetic alternatives.[27]

Epidemiology

Estimates of latex sensitivity in the general population range from 0.8% to 8.2%.[28]

Alternatives
  • Synthetic rubbers such as elastane, neoprene, nitrile and artificially synthesized polyisoprene latex do not contain the proteins from the Hevea brasiliensis tree.[29]
  • Products made from guayule natural rubber emulsions also do not contain the proteins from the Hevea rubber tree, and do not cause allergy in persons sensitized to Hevea proteins.[24][30][31]
  • Chemical treatment to reduce the amount of antigenic proteins in Hevea latex has yielded alternative materials, such as Vytex, which reduce exposure to latex allergens while otherwise retaining the properties of natural rubber.
  • In 1994, the first polyurethane condoms were produced, designed for people with latex allergies.

For some people, the sensitivity is so extreme that replacement of latex products with products made from alternative materials may still result in a reaction if the products are manufactured in the same facility as the latex-containing products, due to trace quantities of natural rubber latex on the non-latex products.[31]

See also

References
  1. "Safety and Health Topics | Latex Allergy". Osha.gov. Retrieved 2014-07-31.
  2. "Allergy to Latex Rubber". American Dental Association.
  3. Taylor, J.S. & Erkek, E. (2004). "Latex allergy: diagnosis and management". Dermatologic Therapy. 17 (4): 289–301. doi:10.1111/j.1396-0296.2004.04024.x. PMID 15327474. S2CID 24748498.
  4. Rendeli, C.; Nucera, E.; Ausili, E.; Tabacco, F.; Roncallo, C.; Pollastrini, E.; Scorzoni, M.; Schiavino, D.; Caldarelli, M.; Pietrini, D.; Patriarca, G. (2005). "Latex sensitisation and allergy in children with myelomeningocele". Child's Nervous System. 22 (1): 28–32. doi:10.1007/s00381-004-1110-4. PMID 15703967. S2CID 20208122.
  5. Banta, JV; Bonanni, C; Prebluda, J (1993). "Latex anaphylaxis during spinal surgery in children with myelomeningocele". Developmental Medicine and Child Neurology. 35 (6): 543–8. doi:10.1111/j.1469-8749.1993.tb11686.x. PMID 8504897. S2CID 20114039.
  6. Tarlo, Susan M.; Sussman, Gordon; Contala, Anne; Swanson, Mark C. (1994). "Control of airborne latex by use of powder-free latex gloves". Journal of Allergy and Clinical Immunology. 93 (6): 985–9. doi:10.1016/S0091-6749(94)70045-1. PMID 8006320.
  7. Böhm, Ingrid (2010). "Latex allergy in patients suspected for contrast medium hypersensitivity: A neglected differential diagnosis". Acta Radiologica. 51 (6): 709–10. doi:10.3109/02841851.2010.482105. PMID 20438290. S2CID 28690810.
  8. Latex Allergy~workup at eMedicine
  9. http://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/radical_prostatectomy_92,p09111/
  10. Reddy, Sumana (January 1, 1998). "Latex Allergy". American Family Physician. 57 (1): 93–100. PMID 9447217.
  11. "Latex Allergy: Latex Allergy Infographic". LatexMattress.org. Retrieved 2014-11-12.
  12. Latex Allergy at eMedicine
  13. Brehler, R.; Theissen, U.; Mohr, C.; Luger, T. (1997). "'Latex-fruit syndrome': frequency of cross-reacting IgE antibodies". Allergy. 52 (4): 404–10. doi:10.1111/j.1398-9995.1997.tb01019.x. PMID 9188921. S2CID 27995880.
  14. Diaz-Perales, A.; Sanchez-Monge, R.; Blanco, C.; Lombardero, M.; Carillo, T.; Salcedo, G. (2002). "What is the role of the hevein-like domain of fruit class I chitinases in their allergenic capacity?". Clinical & Experimental Allergy. 32 (3): 448–54. doi:10.1046/j.1365-2222.2002.01306.x. PMID 11940077. S2CID 26003685.
  15. Mikkola, Jari H.; Alenius, Harri; Kalkkinen, Nisse; Turjanmaa, Kristiina; Palosuo, Timo; Reunala, Timo (1998). "Hevein-like protein domains as a possible cause for allergen cross-reactivity between latex and banana". Journal of Allergy and Clinical Immunology. 102 (6): 1005–12. doi:10.1016/S0091-6749(98)70339-2. PMID 9847442.
  16. Wagner, S.; Breiteneder, H. (2001). "The latex‒fruit syndrome". Biochemical Society Transactions. 30 (6): 935–40. doi:10.1042/BST0300935. PMID 12440950. S2CID 9053520.
  17. Chen, Zhiping; Cremer, Reinhold; Posch, Anton; Raulf-Heimsoth, Monika; Rihs, Hans-Peter; Baur, Xaver (1997). "On the allergenicity of Hev b 1 among health care workers and patients with spina bifida allergic to natural rubber latex". Journal of Allergy and Clinical Immunology. 100 (5): 684–93. doi:10.1016/S0091-6749(97)70174-X. PMID 9389300.
  18. Barre, Annick; Culerrier, Raphaël; Granier, Claude; Selman, Laetitia; Peumans, Willy J.; Van Damme, Els J.M.; Bienvenu, Françoise; Bienvenu, Jacques; Rougé, Pierre (2009). "Mapping of IgE-binding epitopes on the major latex allergen Hev b 2 and the cross-reacting 1,3β-glucanase fruit allergens as a molecular basis for the latex-fruit syndrome". Molecular Immunology. 46 (8–9): 1595–604. doi:10.1016/j.molimm.2008.12.007. PMID 19185347.
  19. Kolarich, Daniel; Altmann, Friedrich; Sunderasan, Elumalai (2006). "Structural analysis of the glycoprotein allergen Hev b 4 from natural rubber latex by mass spectrometry". Biochimica et Biophysica Acta (BBA) - General Subjects. 1760 (4): 715–20. doi:10.1016/j.bbagen.2005.11.012. PMID 16403599.
  20. Beezhold, Donald H.; Hickey, Vicky L.; Slater, Jay E.; Sussman, Gordon L. (1999). "Human IgE-binding epitopes of the latex allergen Hev b 5". Journal of Allergy and Clinical Immunology. 103 (6): 1166–72. doi:10.1016/S0091-6749(99)70194-6. PMID 10359901.
  21. Reyes-López, César A; Hernández-Santoyo, Alejandra; Pedraza-Escalona, Martha; Mendoza, Guillermo; Hernández-Arana, Andrés; Rodrı́guez-Romero, Adela (2004). "Insights into a conformational epitope of Hev b 6.02 (hevein)". Biochemical and Biophysical Research Communications. 314 (1): 123–30. doi:10.1016/j.bbrc.2003.12.068. PMID 14715255.
  22. Pedraza-Escalona, Martha; Becerril-Luján, Baltazar; Agundis, Concepción; Domínguez-Ramírez, Lenin; Pereyra, Ali; Riaño-Umbarila, Lidia; Rodríguez-Romero, Adela (2009). "Analysis of B-cell epitopes from the allergen Hev b 6.02 revealed by using blocking antibodies". Molecular Immunology. 46 (4): 668–76. doi:10.1016/j.molimm.2008.08.282. PMID 18930549.
  23. 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.
  24. "Protect Yourself from Latex Allergies". Ivanhoe Broadcast News. December 2008. Archived from the original on July 9, 2015. Retrieved June 12, 2015.
  25. "Preventing Allergic Reactions to Natural Rubber Latex in the Workplace". The National Institute for Occupational Safety and Health. June 1997. Retrieved June 12, 2015.
  26. Wheatley, Chris (September 2002). "Latex allergy may be seen as the latest 'issue'; but it isn't going to just go away".
  27. Lynn, Kellye (January 15, 2008). "Hopkins ceases use of latex gloves during surgery". Baltimore: WJZ 13 (CBS). Archived from the original on October 11, 2008.
  28. Grzybowski, M; Ownby, D; Rivers, E; Ander, D; Nowak, R (2002). "The prevalence of latex-specific IgE in patients presenting to an urban emergency department". Annals of Emergency Medicine. 40 (4): 411–9. doi:10.1016/S0196-0644(02)00063-X. PMID 12239498.
  29. "Why do polyisoprene condoms work as latex allergy condom choices?". Std.about.com. Retrieved 2014-07-31.
  30. "Archived copy". Archived from the original on 2013-10-12. Retrieved 2016-10-18.CS1 maint: archived copy as title (link)
  31. "Don't be Misled by 'Latex Free' Claims". FDA. March 30, 2015.
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