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Am Fam Physician. 1999;60(2):616-618

Products containing natural latex rubber are ubiquitous in clinical settings; allergic reaction to these products is a growing problem for health care workers and patients. Reactions vary from mild skin irritation to fatal anaphylaxis and may result in significant morbidity, disability and financial costs. Hundreds of serious reactions and at least 15 deaths have been reported to the U.S. Food and Drug Administration. A review by Hagler emphasizes the prevalence of the problem and discusses management and prevention.

The industrial processes that convert natural rubber into latex result in the formation of multiple polymers and other compounds. About 1 percent of natural latex consists of proteins, but at least 240 different proteins have been identified. It is believed that one fourth of these proteins are capable of eliciting significant allergic responses. The potential for any specific latex product to elicit an allergic response is further modified by washing, enzymatic treatments and other manufacturing processes. Clinical latex exposure may occur through direct contact with a product or following the absorption of latex particles onto cornstarch particles, which results in potential allergens becoming airborne—especially when the gloves are removed and discarded.

Approximately 1 percent of the general population reports sensitivity to latex, but studies of antilatex IgE antibodies in blood donors have suggested that the prevalence may be as high as 6 percent. The prevalence is much higher in certain occupational groups, such as health care workers (10 to 17 percent) and workers in the rubber industry. Persons who have undergone multiple surgeries are also at increased risk, and those with a history of spina bifida have a reported prevalence as high as 68 percent. Latex sensitivity is increased in atopic and asthmatic persons and in those with food allergies. In some persons, cross reactions occur with foods containing shared allergens, such as apricots, avocados, bananas, celery, cherries, chestnuts, figs, grapes, kiwi, melons, nectarines, papayas, passion fruits, peaches, plums, pineapples, potatoes and tomatoes.

The most common reaction to latex is irritant contact dermatitis, usually presenting as dry crusted lesions. Delayed hypersensitivity also produces skin lesions, usually as a vesicular eruption (similar to poison ivy) up to four days after exposure. The least common form of latex sensitivity is immediate hypersensitivity, which may produce urticaria, asthma, rhinoconjunctivitis or anaphylaxis. A high index of suspicion may be needed to make the diagnosis. Confirmatory testing includes serologic testing for IgE, patch testing and various forms of skin and challenge tests.

The author concludes that, as no desensitization immunotherapy is currently available, avoidance of antigen exposure is crucial for persons vulnerable to latex reaction. Latex-free products are available, but the possibilities of aerosol exposure must be considered, as well as possible exposure to latex through household products or personal items such as condoms and diaphragms. It is not known if pretreatment with antihistamines, corticosteroids and ephedrine adequately protects sensitized patients during surgery or medical treatments. Persons known to have significant latex allergy should be advised to wear medical alert bracelets and carry epinephrine self-injection kits.

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