The vast majority of people do not experience skin reactions, however it is wise to be knowledgeable about latex and how your skin reacts. You can learn about Latex Allergy from the American Latex Allergy Association or read the latex allergy fact sheet below from the ALAA.
- IgE mediated allergic reactions (Type I) – This allergy may be life threatening and is the clinical problem that clinicians and patients are most concerned about preventing. This reaction is mediated by allergic antibody called IgE directed against retained proteins in latex products. This reaction is triggered by direct skin contact, mucosal surface contact or inhalation. Symptoms include hives, angioedema, rhinitis, conjunctivitis, asthma, or anaphylaxis with or without death.
- Cell mediated contact dermatitis (Type IV) – This allergy is not life‐threatening but is a major concern for clinicians and patients. This reaction is usually limited to the skin where contact occurs with rubber products. Multiple chemicals used in the manufacturing of latex products may be retained in the finished product. These chemicals include thiuram, carbamate, and mercaptobenzothiazole classes of compounds which are used to accelerate the cross‐linking of isoprene in the manufacturing process. This contact dermatitis is a delayed type immune reaction mediated by T‐cell lymphocytes that occurs with exposure to these chemicals and may take 24‐48 hours to develop from the time of exposure to reaction. Symptoms of a rash with erythema, papules, vesiculation, and oozing are characteristic. Because the contact is usually repetitive, the rash may develop into a chronic problem and may even extend beyond the site of contact. It is important to note that this delayed‐type contact allergy to chemicals may occur concurrently with IgE mediated allergic latex allergy.
- Irritant dermatitis – Individuals who use rubber products frequently (e.g. health care workers who wear gloves) are subject to developing irritant dermatitis. This dermatitis is different from contact dermatitis. It is not mediated by an immune system sensitization and reaction. Rather, it is caused by frequent skin washing, sweating, and or irritation from powder lubricants from persistent irritant contact. This rash may be itchy but most commonly is dry, erythematous, and accompanied by skin cracking. There are rarely papules, vesiculation, or oozing of the skin. It never extends beyond the point of contact with the offending irritant.
Diagnosis: The diagnosis of latex allergy, contact dermatitis, and/or irritant dermatitis is made by a licensed independent medical provider who uses a medical history, physical exam and various laboratory and clinical tests. Laboratory testing alone is insufficient to make a diagnosis.
- Latex specific IgE antibody can be detected in a patient by skin testing or by blood tests. Latex skin testing reagents have not been cleared in the US Food and Drug Administration. Because skin testing has small but significant risk of adverse reactions in patients, careful consideration of the use of this technique for confirming a diagnosis of latex allergy is necessary when using uncharacterized skin test reagents.IgE antibody can be detected by blood serum testing. The sensitivity of the FDA‐cleared tests has been between 75‐90%. The specificity of these serological tests has ranged from 90‐98% based on testing in subjects known to have latex allergy. When using this method to confirm a clinical diagnosis made by history and physical exam, the clinician must note that one of every four patients with latex allergic symptoms may have a false negative serology test. In contrast, when a history and physical exam are compatible with latex allergy and the serum test is also positive, then 95% of those subjects will have clinical symptoms with latex exposure. One of the major concerns about the serum assays is their ability to accurately detect latex allergic subjects as opposed to sensitized but asymptomatic individuals. The performance characteristics of the assays have been evaluated using subjects with known latex allergy. Assay performance may have more false positive tests if the population studied has a very low prevalence (such as 1%).
- Contact dermatitis is confirmed by the use of patch testing to the offending chemical.
- Irritant dermatitis is made by a medical history and physical examination alone.
Unexpected Clinical Manifestation of IgE mediated latex allergy: One of the unexpected manifestations of latex allergy has been the clinically evident allergic responses after ingestion or contact with select fruits and vegetables. It appears that as many as half of those individuals with primary latex allergy may develop clinical symptoms following ingestion of select foods (e.g., avocado, banana, kiwi). These reactions should not be surprising given the established laboratory cross‐reactions seen between latex proteins and some food proteins. The converse appears to be true as well, in that those individuals with specific primary food allergies to certain fruits and vegetables may have allergic reactions to latex. This is estimated to occur in approximately 10% of food allergic individuals.
Treatment: Therapy for each of these conditions is individualized but essentially involves avoidance of the offending source that causes the reaction. In the case of IgE mediated allergy, personal contact with rubber products should be eliminated and a change of environment may be necessary if there is airborne exposure causing asthma. This is most prominent in settings that use cornstarch powdered latex gloves. Cornstarch powder serves as a carrier for allergenic proteins from latex. It may become airborne when the product is used. This may result in inhalation and subsequent allergic response in a sensitized patient. Thus, latex safety is complex. It is most important to note here that the latex products most likely to cause a reaction are those made by a dipping method (e.g. gloves, condoms, balloons) where the sulfur heat vulcanization process is relatively short and performed at a lower temperature. This allows the allergenic proteins to remain intact.