Latex Allergy

Erin M. Warshaw, MD

Disclosures
In This Article

Management

Avoiding direct contact with products made of natural rubber latex products is the mainstay of latex allergy management. As rubber products are ubiquitous in the home and workplace, this is not always an easy task. Emphasis should be placed on strict avoidance of thin, stretchable, membrane-like, natural rubber latex products (made via a dipping process) such as gloves, condoms, and balloons, as well as any rubber product that is likely to directly contact mucosal surfaces. Substitutes for such products are listed in Table III . If respiratory symptoms are prominent, coworkers may need to switch from powdered to nonpowdered latex medical equipment.[38,39]

New labeling has helped decrease confusion regarding the term "hypoallergenic," which refers only to a product's likelihood to produce delayed-type allergic reactions. On September 30, 1998, the US Food and Drug Administration banned the term "hypoallergenic" on labels of products containing natural rubber latex and mandated that labels of natural rubber latex medical devices contain the following warning: "Caution: This product contains natural rubber latex which may cause allergic reactions."

In the health care environment, the single most important step in creating a latex-safe environment is the elimination of powdered latex medical devices. The latex allergy position statement of the American Academy of Dermatology[40] defines a "latex-safe" environment for a patient as follows:

  1. Only nonpowdered latex gloves are used

  2. Only nonlatex gloves are used to directly examine the patient

  3. All natural rubber latex objects that routinely directly or indirectly contact mucosa, nonintact skin, or internal body spaces are removed

  4. Products made of dry molded natural rubber latex (tires, tool handles) do not need to be removed but should be covered, so that the patient does not have direct contact with rubber

  5. Hospitals provide latex-safe meals that lack cross-reacting foods

  6. Hospitals have latex-safe crash carts and a latex-safe operating room.

Key recommendations and resources for patients are listed in Table IV and Table V .

Because of the importance in the health care setting, five major glove alternatives are briefly discussed. Polyvinyl chloride vinyl gloves are probably the least expensive and most widely used nonlatex exam glove alternative. Their main disadvantages are inflexibility and permeability to fluids and infectious agents.[41] Vinyl gloves may also contain colorants and formaldehyde, which may produce delayed-type allergy, accounting for approximately 1% (5/542) of occupational allergic glove dermatitis in one series.[42] Polychloroprene (neoprene) gloves may contain accelerators such as isodiphenylthiourea, carbamates, and mercaptobenzothiazoles, which are also found in natural rubber latex products. Carbamates may be found in both sterile and nonsterile exam gloves made of styrene butadiene block polymers (Elastyren). Nonsterile acrylic nitrile butadiene polymer (nitrile) examination gloves may also contain added chemicals such as mercaptobenzothiazoles and dyes. Sterile and nonsterile triblock copolymer (polystyrene-b-[ethylene-cobutylene]-b-polystyrene) gloves (Tactylon) were found to be safe in patients with immediate sensitivity to natural rubber latex.[43]

Hyposensitization for treatment of latex allergy is experimental and has produced mixed results.[44–47] Immunotherapy, while still experimental, holds promise for future therapy. Slater et al.[48] found vaccines with cloned Hev b 5 DNA sequences inhibited IgE responses to Hev b 5 in mice sensitized to this antigen. These results suggest that DNA vaccines with encoded allergens may offer a new mode of allergen immunotherapy for individuals with latex allergy.

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