Latex Allergy

Erin M. Warshaw, MD

Disclosures
In This Article

Immediate-Type Hypersensitivity

Less common, but potentially more serious, are type I, IgE-mediated, allergic reactions to latex proteins from the sap of the Hevea brasiliensis tree. Susceptible individuals are those who have already been exposed to latex and have developed latex-specific IgE antibodies. Upon reexposure to latex, latex-specific IgE antibodies on the surface of mast cells are cross-linked by latex antigens. This triggers the release of inflammatory mediators such as histamine and arachidonic acid metabolites. Cutaneous exposure results in immediate itching, erythema, and urticarial wheals. Aerosolized exposure (such as occurs when latex proteins absorbed onto glove cornstarch particles are aerosolized) may result in conjunctivitis, rhinitis, angioedema, and asthma. Systemic symptoms and anaphylaxis may occur, especially after mucosal exposure to latex proteins.

Thin, membrane-like, stretchable, natural rubber latex products, such as condoms, balloons, and gloves, contain the highest amount of readily absorbable latex proteins and therefore are responsible for most of the serious reactions due to type I allergy. The most severe reactions occur when such products come into contact with abraded skin or mucosa (oral, respiratory, rectal, and vaginal), where antigens can be rapidly absorbed. Anaphylaxis has been reported from rubber vaginal vibrators,[9] Foley catheters,[10] condoms,[10] latex balloon tip catheters,[11] balloons,[12] dental cofferdams,[13] endotracheal tubing,[14] squash balls,[15] air expelled from a whoopee cushion,[16] and food prepared with latex gloves.[17]

Cornstarch powder is used in the manufacture of gloves to facilitate easy donning. While most of the latex proteins are removed during the manufacturing process, poorly processed gloves can contain significant amounts of proteins. Antigenic proteins from latex gloves may be absorbed by cornstarch powder particles. When the powder particles become airborne during donning, the absorbed latex proteins become aeroallergens and may result in symptoms of rhinitis, conjunctivitis, urticaria, asthma, and anaphylaxis.[18] While powdered gloves still are of concern, recent advances in technology are resulting in higher quality powdered natural rubber latex gloves with low allergen contents.[19]

Importantly, delayed-type and immediate-type allergies may coexist. For example, an individual may have a type I allergy to latex proteins and a type IV hypersensitivity to carbamates. As carbamates may be found in some nonlatex substitutes recommended for latex-sensitive individuals, dual allergy may present a confusing clinical course and complicate management.

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