Latex allergy

Latex allergy
Latex medical glove
SpecialtyImmunology

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

Signs and symptoms

Allergic reactions to latex range from Type I hypersensitivity, the most serious form of reaction, to Type IV hypersensitivity.[4] Rate of onset is directly proportional to the degree of allergy: Type I responses will begin showing symptoms within minutes of exposure to latex, while Type IV responses may take hours or days to appear.[5]

Most commonly, latex allergy presents with hives at the point of contact, followed by rhinitis. The most common physiological reaction to latex exposure is dermatitis at the point of contact, which gives way to soreness, itching, and redness. Angioedema is also a common response to oral, vaginal, or rectal contact.[6]

Symptoms of more severe hypersensitivity include both local and generalized hives; feelings of faintness or impending doom; angioedema; nausea and vomiting; abdominal cramps; rhinitis; bronchospasm; and anaphylaxis. Type IV responses typically include erythema, blistering (forming vesicles and papules), itching, and crusting at the point of contact.[7] This irritant contact dermatitis is considered a nonimmune reaction to latex.[8] The degree of reaction is directly proportional to the duration of exposure, as well as skin temperature.

Among sufferers of latex allergy, 40% will experience irritant contact dermatitis; 33.1% will experience a Type I allergic reaction; 20.4% will experience Type IV allergic contact dermatitits; and 6.5% will experience both Type I and Type IV symptoms.[9]

Causes

Occupational exposure

Compared to the general population, occupational populations that frequently utilize latex gloves as barrier protection[10] (such as healthcare professionals and hospital staff) see disproportionately high levels of allergy.[11] Workers in these environments are exposed to latex allergens both through direct skin contact and from contaminated aerosolized powder from gloves, toy balloons, or any other dusted latex material.[12] Occupational settings where employees are frequently putting on and pulling off powdered latex gloves, such as hospitals and other health care settings, increase the rate of airborne latex allergens and subsequent sensitivity.[13] Hospital workers are particularly at risk due to the prevalence of latex not just in gloves but in a number of other hospital implements, such as tourniquets, elastic bandages, bag valve masks, and urinary catheters.[14] Other occupations that see increased exposure to latex gloves and other supplies, and have higher rates of latex allergy or irritation compared to the general population, include hairdressers,[15] housekeeping personnel,[16] food service workers, and manufacturers in the industrial rubber industry.[17][18][19]

Alternative latex exposure

While most reported allergic reactions to latex have occurred in medical settings, non-healthcare workers show similar levels of latex antibodies, suggesting that they are sensitized to natural rubber latex through other sources, both inside the home and as medical patients.[20] In particular, individuals with chronic health concerns that lead to repeated surgeries or catheterizations thus experience greater exposure to latex allergens and may develop an allergy.[21] Outside of hospital environments, latex allergy may develop in amateur and professional athletes whose sports equipment includes natural rubber, such as swimsuits or running shoes. Rubber basketballs, in particular, may lead to contact dermatitis on the hands and fingertips.[22] The sensitization to latex in athletes may be accelerated by the use of topical analgesics and other agents that diminish the skin barrier and increase contact.[23] It has also been hypothesized that young children may develop a latex allergy due to exposure in the home and school environment from objects such as rubber balloons, boots, gloves, and toys.[24][25]

Spina bifida

People with spina bifida often have latex allergies. Up to 68% of children with this condition will have a reaction to latex.[26]

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.[27] Fruits (and seeds) involved in this syndrome include banana, avocado, chestnut, kiwifruit, mango, passionfruit, fig, strawberry, papaya, apple, melon, celery, potato, tomato, carrot, and soy. The proteins in these fruits are similar to latex proteins. Hevein-like protein domains [28] are a possible cause for allergen cross-reactivity between latex and banana[29] or fruits in general.[30]

Natural rubber latex contains several conformational epitopes located on several enzymes such as Hev b 1,[31] Hev b 2,[32] Hev b 4,[33] Hev b 5[34] and Hev b 6.02.[35][36]

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.[37]

Prevention

The most effective form of primary prevention towards latex sensitization is limiting or completely avoiding contact with latex, particularly among children with risk factors such as spina bifida.[38][39] The limitation of powdered latex glove use in hospital settings has also proven an effective primary prevention strategy among adult health care workers,[40] and as secondary prevention for sensitized individuals.[41][42]

Epidemiology

Latex allergy is uncommon in the general population, at least compared to high-risk groups such as hospital workers and spina bifida patients. Estimates suggest a worldwide prevalence of around 4.3% among the general population.[43] Between 1% and 6% of the general population in the United States has latex allergy; assays of antibody levels in the blood suggest that 2.7 million to 16 million Americans are affected by some form of latex sensitivity.[44] Females are approximately three times as likely as males to have latex allergies.[45] Possible risk factors for the female population include increased employment in high-risk occupations and enhanced histamine release caused by female hormones.[46]

Alternatives

Alternatives to latex include:

  • Synthetic rubbers (such as elastane, neoprene, nitrile) and artificially synthesized polyisoprene latex, which do not contain the proteins from the Hevea brasiliensis tree.[47]
  • Products made from guayule natural rubber emulsions, which also do not contain the proteins from the Hevea rubber tree, and do not cause allergy in persons sensitized to Hevea proteins.[26][48][49]
  • Alternative materials like Vytex which reduce exposure to latex allergens while otherwise retaining the properties of natural rubber; these are made using chemical treatment to reduce the amount of antigenic proteins in Hevea latex.
  • Polyurethane.

The first polyurethane condoms, designed for people with latex allergies, were produced in 1994.

Some people are so sensitive that they may still have a reaction to replacement products made from alternative materials. This can occur when the alternative products are manufactured in the same facility as latex-containing products, leaving trace quantities of natural rubber latex on the non-latex products.[49]

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. ↑ Sussman, Gordon L.; Tarlo, Susan; Dolovich, Jerry (June 5, 1991). "The Spectrum of IgE-Mediated Responses to Latex". JAMA: The Journal of the American Medical Association. 265 (21): 2844–2847. doi:10.1001/jama.1991.03460210090035. PMID 2033741. Retrieved December 29, 2021.
  5. ↑ Hamilton, Robert G. (May 2002). "Diagnosis of natural rubber latex allergy". Methods. 27 (1): 22–31. doi:10.1016/S1046-2023(02)00048-8. PMID 12079414. Retrieved December 29, 2021.
  6. ↑ Turjanmaa, K.; Alenius, H.; Mäkinen-Kiljunen, S.; Reunala, T.; Palosuo (1996). "Natural rubber latex allergy". Allergy. 51 (9): 593–602. doi:10.1111/j.1398-9995.1996.tb04678.x. ISSN 0105-4538. PMID 8899110. S2CID 9316811. Retrieved December 29, 2021.
  7. ↑ Reddy, Sumana (January 1, 1998). "Latex Allergy". American Family Physician. 57 (1): 93–100. PMID 9447217. Retrieved December 29, 2021.
  8. ↑ Hepner, David L.; Castells, Mariana C. (April 2003). "Latex Allergy: An Update". Anesthesia & Analgesia. 96 (4): 1219–1229. doi:10.1213/01.ANE.0000050768.04953.16. PMID 12651689. S2CID 2753609. Retrieved December 29, 2021.
  9. ↑ Heese, A.; Peters, K. P.; Koch, H. U. (January 1, 1997). "Type I allergies to latex and the aeroallergenic problem". The European Journal of Surgery Supplement. 579 (579): 19–22. PMID 9195178. Retrieved December 29, 2021.
  10. ↑ Rolland, J. M.; O'Hehir, R. E. (May 22, 2008). "Latex allergy: a model for therapy". Clinical and Experimental Allergy. 38 (6): 898–912. doi:10.1111/j.1365-2222.2008.02984.x. PMID 18498539. S2CID 39850468. Retrieved December 29, 2021.
  11. ↑ Bousquet, Jean; Flahault, Antoine; Vandenplas, Olivier; Ameille, Jacques; Duron, Jean-Jacques; Pecquet, Corine; Chevrie, Karine; Annesi-Maesano, Isabella (August 2006). "Natural rubber latex allergy among health care workers: A systematic review of the evidence". Journal of Allergy and Clinical Immunology. 118 (2): 447–454. doi:10.1016/j.jaci.2006.03.048. PMID 16890771. Retrieved December 29, 2021.
  12. ↑ Vandenplas, Olivier; Raulf, Monika (March 1, 2017). "Occupational Latex Allergy: the Current State of Affairs". Current Allergy and Asthma Reports. 17 (3): 14. doi:10.1007/s11882-017-0682-5. PMID 28251426. S2CID 207324395. Retrieved December 29, 2021.
  13. ↑ Raulf, Monika (April 2020). "Current state of occupational latex allergy". Current Opinion in Allergy and Clinical Immunology. 20 (2): 112–116. doi:10.1097/ACI.0000000000000611. PMID 31850921. S2CID 209409953. Retrieved December 29, 2021.
  14. ↑ Crippa, Michela; Belleri, Luca; Mistrello, Gianni; Tedoldi, Chiara; Alessio, Lorenzo (February 9, 2006). "Prevention of latex allergy among health care workers and in the general population: latex protein content in devices commonly used in hospitals and general practice". International Archives of Occupational and Environmental Health. 79 (7): 550–557. doi:10.1007/s00420-005-0080-5. PMID 16468057. S2CID 22755157. Retrieved December 29, 2021.
  15. ↑ van der Walle, Henk B.; Bunsveld, Vida M. (March 1995). "Latex allergy among hairdressers". Contact Dermatitis. 32 (3): 177–178. doi:10.1111/j.1600-0536.1995.tb00816.x. PMID 7774197. S2CID 7085872. Retrieved December 29, 2021.
  16. ↑ Sussman, G. L.; Lem, D.; Liss, G.; Beezhold, D. (May 1, 1995). "Latex allergy in housekeeping personnel". Annals of Allergy, Asthma & Immunology. 74 (5): 415–418. PMID 7749973. Retrieved December 29, 2021.
  17. ↑ Tarlo, S. M.; Wong, L.; Roos, J.; Booth, N. (March 1, 1990). "Occupational asthma caused by latex in a surgical glove manufacturing plant". The Journal of Allergy and Clinical Immunology. 85 (3): 626–631. doi:10.1016/0091-6749(90)90103-b. PMID 2312994. Retrieved December 29, 2021.
  18. ↑ Orfan, Nicholas A.; Reed, Roberta; Dykewicz, Mark S.; Ganz, Michael; Kolski, Gerald B. (November 1, 1994). "Occupational asthma in a latex doll manufacturing plant". The Journal of Allergy and Clinical Immunology. 94 (5): 826–830. doi:10.1016/0091-6749(94)90149-x. PMID 7963151. Retrieved December 29, 2021.
  19. ↑ Caballero, María Luisa; Quirce, Santiago (June 23, 2015). "Identification and practical management of latex allergy in occupational settings". Expert Review of Clinical Immunology. 11 (9): 977–992. doi:10.1586/1744666X.2015.1059754. PMID 26099284. S2CID 30524644. Retrieved December 29, 2021.
  20. ↑ Condemi, John J. (August 2002). "Allergic reactions to natural rubber latex at home, to rubber products, and to cross-reacting foods". Journal of Allergy and Clinical Immunology. 110 (2): 107–110. doi:10.1067/mai.2002.124968. PMID 12170250. Retrieved December 29, 2021.
  21. ↑ Kumar, R. Pradeep (January 2012). "Latex Allergy in Clinical Practice". Indian Journal of Dermatology. 57 (1): 66–70. doi:10.4103/0019-5154.92686. PMC 3312665. PMID 22470217.
  22. ↑ Kockentiet, Brett; Adams, Brian B. (June 2007). "Contact dermatitis in athletes". Journal of the American Academy of Dermatology. 56 (6): 1048–1055. doi:10.1016/j.jaad.2006.12.025. PMID 17307275. Retrieved December 29, 2021.
  23. ↑ Ventura, M. T.; Dagnello, M.; Matino, M. G.; Di Corato, R.; Giuliano, G.; Tursi, A. (April 2001). "Contact dermatitis in students practicing sports: incidence of rubber sensitisation". British Journal of Sports Medicine. 35 (2): 100–102. doi:10.1136/bjsm.35.2.100. PMC 1724305. PMID 11273970. Retrieved December 29, 2021.
  24. ↑ Ylitalo, L.; Alenius, H.; Turjanmaa, K.; Palosuo, T.; Reunala, T. (November 2000). "Natural rubber latex allergy in children: a follow-up study". Clinical and Experimental Allergy. 30 (11): 1611–1617. doi:10.1046/j.1365-2222.2000.00924.x. PMID 11069571. S2CID 32522055. Retrieved December 29, 2021.
  25. ↑ Sorva, R.; Mäkinen-Kiljunen, S.; Suvilehto, K.; Juntunen-Backman, K.; Haahtela, T. (February 1995). "Latex allergy in children with no known risk factor for latex sensitization". Pediatric Allergy and Immunology. 6 (1): 36–38. doi:10.1111/j.1399-3038.1995.tb00255.x. PMID 7550763. S2CID 20620438. Retrieved December 29, 2021.
  26. 1 2 "Protect Yourself from Latex Allergies". Ivanhoe Broadcast News. December 2008. Archived from the original on July 9, 2015. Retrieved June 12, 2015.
  27. ↑ 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.
  28. ↑ 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.
  29. ↑ 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.
  30. ↑ Wagner, S.; Breiteneder, H. (2001). "The latex‒fruit syndrome". Biochemical Society Transactions. 30 (6): 935–40. doi:10.1042/BST0300935. PMID 12440950. S2CID 9053520.
  31. ↑ 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.
  32. ↑ 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.
  33. ↑ 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.
  34. ↑ 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.
  35. ↑ 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.
  36. ↑ 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.
  37. ↑ 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.
  38. ↑ Niggemann, Bodo (October 26, 2010). "IgE-mediated latex allergy – An exciting and instructive piece of allergy history". Pediatric Allergy and Immunology. 21 (7): 997–1001. doi:10.1111/j.1399-3038.2010.01006.x. PMID 20977498. S2CID 8236367. Retrieved December 30, 2021.
  39. ↑ Nieto, Antonio; Mazón, Angel; Pamies, Rafael; Lanuza, Amparo; Muñoz, Alberto; Estornell, Francisco; García-Ibarra, Fernando (March 1, 2002). "Efficacy of latex avoidance for primary prevention of latex sensitization in children with spina bifida". The Journal of Pediatrics. 140 (3): 370–372. doi:10.1067/mpd.2002.122732. PMID 11953738. Retrieved December 30, 2021.
  40. ↑ Allmers, Henning; Schmengler, Jörg; Skudlik, Christoph (August 2002). "Primary prevention of natural rubber latex allergy in the German health care system through education and intervention". Journal of Allergy and Clinical Immunology. 110 (2): 318–323. doi:10.1067/mai.2002.126461. PMID 12170275. Retrieved December 30, 2021.
  41. ↑ Allmers, Henning; Brehler, Randolph; Chen, Zhipping; Raulf-Heimsoth, Monika; Fels, Hubert; Bauer, Xaver (November 1998). "Reduction of latex aeroallergens and latex-specific IgE antibodies in sensitized workers after removal of powdered natural rubber latex gloves in a hospital". Journal of Allergy and Cllnical Immunology. Vol. 102, no. 5. pp. 841–846. doi:10.1016/s0091-6749(98)70026-0. PMID 9819303. Retrieved December 30, 2021.
  42. ↑ Ruëff, F.; Thomas, P.; Reißig, G.; Przybilla, B. (April 1998). "Natural rubber-latex allergy in patients not intensely exposed". European Journal of Allergy and Clinical Immunology. 53 (4): 445–449. doi:10.1111/j.1398-9995.1998.tb03921.x. PMID 9574891. S2CID 27245106. Retrieved December 30, 2021.
  43. ↑ Wu, Miaozong; McIntosh, James; Liu, Jian (March 20, 2016). "Current prevalence rate of latex allergy: Why it remains a problem?". Journal of Occupational Health. 58 (2): 138–144. doi:10.1539/joh.15-0275-RA. PMC 5356959. PMID 27010091.
  44. ↑ Neugut, Alfred I.; Ghatak, Anita T.; Miller, Rachel L. (January 8, 2001). "Anaphylaxis in the United States: An Investigation Into Its Epidemiology". Archives of Internal Medicine. 161 (1): 15–21. doi:10.1001/archinte.161.1.15. PMID 11146694. Retrieved December 29, 2021.
  45. ↑ Tomazic, Vesna J.; Withrow, Thomas J.; Fisher, Benjamin R.; Dillard, Sharon F. (August 1992). "Latex-associated allergies and anaphylactic reactions". Clinical Immunology and Immunopathology. 64 (2): 89–97. doi:10.1016/0090-1229(92)90185-Q. PMID 1643748. Retrieved December 29, 2021.
  46. ↑ Warshaw, Erin M. (July 1998). "Latex allergy". Journal of the American Academy of Dermatology. 39 (1): 1–24. doi:10.1016/S0190-9622(98)70397-4. PMID 9674393. Retrieved December 29, 2021.
  47. ↑ "Why do polyisoprene condoms work as latex allergy condom choices?". Std.about.com. Retrieved 2014-07-31.
  48. ↑ Anderson, Christopher D.; Daniels, Eric S. (2003). Emulsion Polymerisation and Latex Applications. ISBN 9781859573815.
  49. 1 2 "Don't be Misled by 'Latex Free' Claims". FDA. March 30, 2015.
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