Risk Factors for Latex Allergy

  • Children with multiple surgeries, spina bifida, neural tube defects, urogenital malformations
  • Adults with multiple surgeries
  • Health care workers
  • Food allergy to avocado, banana, chestnut, kiwi, etc. (see below)
  • Atopy





Latex Cross-reactivity


Latex-fruit Syndrome

  • 30-50% with latex allergy are allergic to fruits due to cross-reactive IgE
  • Proteins involved include β-1,3-glucanase, chitinase, patatin, profilin, and lipid transfer protein
These foods most frequently cause clinical allergy in latex-allergic persons:
By SPT or specific IgE immunoassay,
latex-allergic persons may be cross-sensitized to the following foods, but clinical allergy is less common:
  • Avocado
  • Kiwi fruit
  • Banana
  • Potato
  • Tomato
  • Chestnut
  • Papaya
  • Passion fruit
  • Fig
  • Melon
  • Mango
  • Pineapple
  • Peach
  • Pear
  • Celery
  • Pineapple
  • Cantaloupe
  • Apple
  • Cherry
  • Wheat
  • Turnip
  • Spinach
  • Bell pepper
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Middleton Box 58.1 (7th Ed.)

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Latex-related food cross-reactivity


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Other Latex Clinical Issues


Dental work in latex-allergic patients

  • Gutta-percha (Paliquium gutta) and Gutta-balata (Mimusops globsa) are trees whose latex saps are used in dental work (fillings, root canals). They are in the same botanical family as the natural rubber latex tree (Hevea brasiliensis).
  • Cross reactivity has been demonstrated between natural rubber latex (H. brasiliensis) and gutta-balata, but not between natural rubber latex and gutta-percha; therefore gutta-balata should be avoided in latex-allergic patients requiring dental work.

Latex in vial stoppers or syringe plungers (Kelso)

  • Medication/vaccine vial stoppers or syringe plungers may be dry natural rubber latex or synthetic rubber. Those made with latex pose a theoretical and improbable risk to the latex allergic
    • Extremely small amounts of leeched latex allergens have been found in the contents of vials with rubber stoppers
  • Management
    • If the patient requires a medication/vaccine that is only available with a latex stopper, the stopper should be removed and the vaccine drawn up directly from the vial without passing the needle through the stopper
    • If the only available formulation contains latex in the packaging that cannot be avoided, such as in a prefilled syringes, the vaccine can still be administered but the patient should be observed for at least 30 minutes afterward
  • CDC latex in vaccine packaging table


Latex Contact Dermatitis

  • Among healthcare workers, allergic contact dermatitis (type IV delayed type hypersensitivity), primarily on hands, may occur as part of the spectrum of immunoreactivity to natural rubber latex in latex gloves





Testing


In-vivo Glove Test

  • Lieberman:
    • Soak a latex glove in saline for one hour, then do an epicutaneous test with the extract. If positive, we go no further. If negative...
    • A wet latex glove is applied to the forearm for 30 minutes. If this is a positive test, we go no further, but if negative...
    • Prick the skin through the wet latex glove.
    • Latex sIgE (ImmunoCap) for corroborative purposes and to fortify the diagnosis.
  • Kelso: soak 2 fingers of latex glove or a toy balloon in 5 mL of saline to create a prick skin test solution


Specific IgE


  • Phadia ImmunoCap available to:
    • Latex (complete allergen)
    • Latex (component allergens)
      • rHev b 1
      • rHev b 3
      • rHev b 5
      • rHev b 6.01
      • rHev b 6.02
      • rHev b 8 (profilin)
      • rHev b 9
      • rHev b 11
  • Phadia ImmunoCap ISAC available to:
    • rHev b 1
    • rHev b 3
    • rHev b 5
    • rHev b 6
    • rHev b 8 (profilin)

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  • Note that as with other allergies, sensitization does not equal clinical allergy
    • 12.5% of asymptomatic anesthesiologists have elevated latex sIgE
    • In one study, 30% and 9% of asymptomatic atopic and nonatopic patients had a positive latex sIgE, but latex skin testing and nasal challenge were negative in all


Treatment

  • Avoidance of natural rubber latex gloves, balloons, condoms and other natural rubber products
  • Latex glove alternatives include vinyl, nitrile rubber, neoprene, and kevlar gloves. There should be no cross-reactivity between nitrile and neoprene or Kevlar, therefore if the patient's rash is due to the vinyl or nitrile, you can consider substitution with neoprene, and if needed, Kevlar.
    • SemperSure gloves are latex and accelerator free nitrile gloves
    • Consider further contact dermatitis evaluation if glove additives (rubber accelerants, etc.) are suspected
    • It has been reported that nitrile gloves can be contaminated with latex
  • Vytex NRL condoms made of NRL without antigenic proteins



References






American Latex Allergy Association