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Asthma & Allergy
Aeroallergen Avoidance: Is it
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Allergic disease: on the increase
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Home Health Professionals Health Professional Information Asthma & Allergy Latex Allergy

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Latex Allergy

Latex allergy has become an important health concern in recent years especially in the

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occupational setting with health care workers. The adoption of universal precautions in

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infection control has promoted the widespread use of latex barrier products. This has

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been associated with an increase in the diagnosis of latex allergy as well as awareness

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of the extent of this problem. While specific treatment is not available, awareness of
the problem and avoidance in sensitised individuals are important cornerstones of

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management.

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Definition of latex allergy

As with other types of immediate type hypersensitivity, the diagnosis of latex allergy
requires both a history of symptoms on exposure to latex and the demonstration of

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latex-specific IgE (either by skin prick or in-vitro tests). Either criteria alone is
insufficient to diagnose latex allergy.(Figure 1).

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What are specific latex allergens?

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Natural rubber latex is derived from the rubber tree, Hevea brasiliensis, with the basic
unit being a low molecular weight compound, cis-1,4-isoprene. Native latex coagulates
by forming polymers of isoprene several thousand units in length, and is coated with a
layer of protein, lipid and phospholipid which provides structural integrity. Proteins

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Allergic Reactions to Australian

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comprise only about 2% of the total content of raw latex, but are the source of

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identified, with different allergens being important in the different risk groups. The

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these may function as enzymes.

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Who is susceptible to latex allergy?

Aug 7, 2015 - First National

Allergy Strategy released

Latex Allergy

The prevalence of latex allergy in the general population is low, and estimated to be

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less than 1%. However, there are certain distinct groups who have an increased risk for

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with allergy are often being
poorly manage...

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allergens causing clinical reactions. A number of latex protein allergens have now
functional roles of these proteins in the native rubber plant are unclear, but some of

latex allergy. These include health care workers, children with spina bifida, and rubber
workers.
The prevalence of latex allergy in patients with spina bifida is between 24% to 60%, and

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among health care workers, the reported prevalence is between 5% and 15%.

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Diseases

Health care workers at particular risk are those with frequent use of latex gloves or

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products, such as operating theatre, intensive care or dental staff.

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now more prevalent in older
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April 30, 2015 - ASCIA and

Choosing Wisely Australia

What are the factors promoting sensitisation to latex?

In all risk groups, the likelihood of sensitisation increases as exposure to latex increases.

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Hence, health care workers at the beginning of their training have the same likelihood
of latex allergy as the general population, but the likelihood of developing latex allergy
increases as with time in the profession. Similarly, in children with spina bifida, the
prevalence of latex allergy is directly related to the number of surgical procedures they
have had. Conversely, there appears to be no increased risk associated with age or sex.
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Atopy has been found to be a risk factor for health care workers in some studies, but
not in children with spina bifida.

How does sensitisation occur?

Latex exposure can occur through direct contact with the skin, mucosal surfaces (such
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as eyes, nose and airways, oral cavity or the genitourinary tract), or parenterally (such
as intravenously, or intraoperatively). Latex allergens appear readily able to cross skin
and mucosal surfaces on direct contact to initiate the sensitisation process.
Cornstarch glove powder has an important role in the sensitisation process. Latex
allergens can be leached from rubber gloves by normal skin moisture and be adsorbed to
cornstarch powder within gloves. They can also be directly adsorbed to powder in gloves
which have not been worn. When gloves are donned or removed, the latex-allergen
coated cornstarch particles become aerosolised, and are a source of respiratory

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sensitisation and triggering of attacks.

What are the symptoms of latex allergy?

The typical symptoms of latex allergy are related to IgE-mediated mast cell release of
inflammatory mediators. Initial symptoms include irritation on contact with itching,
redness and swelling. Typically, these symptoms occur within minutes on skin contact
with latex gloves, or other rubber products. As exposure and sensitivity increases, the
severity of symptoms increases and may include contact urticaria and spread to
adjacent areas of skin. Up to 6-8% of these individuals may have serious generalised
systemic reactions with latex exposure. Contact of skin with latex or oral, vaginal, or
rectal exposure also results in the development of localised allergic manifestations,
which may progress to generalised reactions.
Airborne exposure, particularly to aerosolised latex allergen laden cornstarch from
powdered latex gloves may lead to nasal, ocular and respiratory symptoms. Ocular
symptoms may begin with conjunctival itching, tearing, chemosis and oedema. Nasal
symptoms include sneezing, watery rhinorrhoea and congestion. Respiratory symptoms
range from throat irritation and cough to life-threatening asthma. Gastrointestinal,
cardiovascular and genitourinary symptoms have also been well documented. Although
severe systemic reactions have occurred after cutaneous and respiratory exposure,
direct mucosal and parenteral exposure poses the greatest risk of anaphylaxis. While
uncommon, latex induced anaphylaxis is the most severe manifestation, and fatalities
have been reported.
There is an association between latex allergy and allergy to a variety of fruits, including
banana, avocado, potato, tomato, chestnut and kiwi fruit, probably because latex
protein allergens are structurally homologous with other plant proteins. Latex allergic
patients may describe oropharyngeal itching and swelling when eating some of these
fruits.

How to diagnose latex allergy?

As with all aspects of allergy, the foundation of diagnosis is a careful and detailed
clinical history. Important elements of the history include timing and duration of latex
exposure; the relationship of exposure to the onset of symptoms; the types of
symptoms, including any suggestion of a systemic reaction, and the progression of
symptoms over time.
Other history which may be helpful in supporting the diagnosis include a background
history of atopic disorders such as hayfever, asthma or eczema, and oral reactions to
the cross-reacting fruits listed above.
Although the history alone may be strongly suggestive, diagnosis requires confirmatory
testing. Worldwide, skin prick testing is the most common method used to diagnose
latex allergy. A commercial extract is available for skin prick testing, but is not
registered by the Therapeutic Goods Administration. Systemic reactions are also more
frequent with latex skin prick tests than for aeroallergens. Hence, latex skin prick
testing is recommended only in specialist or hospital clinics with appropriate
resuscitation facilities. In vitro blood tests are also commercially available for latex
specific serum IgE. These are less sensitive than skin tests, but are not associated with
provoking systemic reactions. They are the diagnostic tests of first choice if there is a
history of anaphylaxis.
Patients with a strong history of allergic reactions and negative skin or in-vitro tests
may need a challenge test (such as a glove donning test) to further clarify the diagnosis.
As with latex skin prick tests, these should only be done in specialist or hospital clinics.
A negative test in this case may allow the worker to return to the work place.

What is the treatment of latex allergy?

To date, avoidance of latex products is the only means of preventing serious reactions in
allergic individuals. There are some reports of successful desensitisation
immunotherapy, but this remains an investigational form of treatment, and avoidance is
the mainstay of therapy.
In health care workers with only mild symptoms, the use of non-powdered latex gloves
may reduce the frequency or severity of symptoms, but non-latex alternatives are
preferable.
In more severely allergic patients, total avoidance is necessary, including preventive
measures such as wearing a medical identification bracelet. Surgical procedures should
only be carried out in latex-free operating theatres. Being prepared for inadvertent
exposure by carrying antihistamine and oral steroid tablets, and possibly an adrenaline
autoinjector (EpiPen or Anapen), is also an important aspect of management.
The widespread use of non-powdered latex gloves in health care settings significantly
reduces the acquisition of latex allergy in health care workers and should be widely
advocated.

References and further reading

Poley GE, Slater JE. Latex allergy. J Allergy Clinical Immunology 2000;105:1054-62
Kurup VP, Fink JN. The spectrum of immunologic sensitization in latex allergy.
Allergy 2001; 56:2-12

ASCIA 2010
The Australasian Society of Clinical Immunology and Allergy (ASCIA) is the peak
professional body of Clinical Immunologists and Allergists in Australia and New Zealand.
Website: www.allergy.org.au
Email: education@allergy.org.au
Postal address: PO Box 450 Balgowlah, NSW Australia 2093

Disclaimer
ASCIA Education Resources (AER) information is reviewed by ASCIA members and
represents the available published literature at the time of review. Information
contained in this document is not intended to replace professional medical advice and
any questions regarding a medical diagnosis or treatment should be directed to a
medical practitioner.
Content updated January 2010

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