Latex Allergy

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Latex Allergy

Allergy
Author Credentials 

Kristin Seiberling MD
American Academy of Otolaryngic Allergy

 

Module Learning Objectives 
  1. Explain the immunologic basis of latex allergy.
  2. Recognize the signs and symptoms of latex allergy and cross reactive foods.
  3. Review the risk factors to developing latex allergy. 

 

Basic Science

Learning Objectives 
  1. Recognize that natural rubber latex derived from H brasiliensis contains more than 200 polypeptides, 56 which have been identified as allergens associated with IgE-mediated reactions. 
  2. Explain the hypersensitive allergic reaction that occurs when people come in contact with latex allergic proteins and to help identify latex-containing products and sources of latex allergen exposure.
  3. Describe the difference between type I IE-mediated allergic reactions and type IV cell-mediated contact dermatitis.   

 

References 
  1. Posch A, Chen ZP, Wheeler  C, Dunn  MJ, Raulf-Heimsoth  M, Baur  X. Characterization and identification of latex allergens by two-dimensional electrophoresis and protein microsequencing. J Allergy Clin Immunol.1997;99 385- 395.
  2. Zak, HN, Kaste, LM, Schwarzenberger, K, Barry, MJ, Galbraith, GMP. Health care workers and latex allergy. Arch Envir Health 2000; 55: 336– 46.

 

Incidence

Learning Objectives 
  1. Cite and explain the current prevalence rate of latex allergy among healthcare workers, susceptible patients and the general population and to help identify latex-containing products and possible sources of latex allergen exposure.
References 
  1. Miaozong W, Mcintosh J, Liu J:  Current prevalence rate of latex allergy:  Why it remains a problem?  J Occup Health. 2016 Mar 20; 58(2): 138–144.

Genetics

Learning Objectives 
  1. Recognize that environmental factors may play a greater role in the development of latex allergy sensitization and overt allergic symptoms than specific genetic predisposition.
References 
  1. Monitto CL, Hamilton RG, Levey E, Jedlicka AE, et al. Genetic predisposition to natural rubber latex allergy differs between health care workers and high-risk patients. Anesthesia and Analgesia. 2010 May;110(5): 1310-1317.
  2. Brown RH, Hamilton RG, Mintz M, et al. Genetic predisposition to latex allergy: role of interleukin 13 and interleukin 18. Anesthesiology 2005; 102: 496-502.

 

Patient Evaluation

Learning Objectives 
  1. Recognize the risk factors for latex allergy on the basis of a thorough clinical history.
  2. Explain the importance of occupational information.
  3. Recognize the time course and magnitude of any localized or systemic allergic symptoms that might be associated with latex exposure.
  4. Explore confirmatory testing to detect the presence of latex-specific IgE antibody. 

 

Testing

  1. Review the diagnostic confirmatory test (skin test, IgE anti-latex serology) and provocation test (glove use test, inhalation challenge).

 

References 
  1. Hamilton RG, Peterson EL, Ownby D. Clinical and laboratory-based methods in the diagnosis of natural rubber latex allergy. Journal of Allergy and Clincal Immunology. 2002 Aug; 110(2): S47-S56.

Testing References

  1. Kelly KJ, Kurup V, Zacharisen M, Resnick A. Skin and serologic testing in the diagnosis of latex allergy. J Allergy Clin Immunol, 91(1993), 1140-1145.
  2.  Hamilton RG, Peterson EL, Ownby D. Clinical and laboratory-based methods in the diagnosis of natural rubber latex allergy. J Allergy Clin Immunol. 2002 Aug;110(2): S47-S56.

Case Studies

  1. Type 1 hypersensitivity reaction- A middle age laboratory technician wore latex gloves for approximately 13 years. She stopped wearing latex gloves after developing sneezing, pruritus, conjunctivitis, and facial swelling.  but continued working with colleagues who wore latex gloves. She was sent to an outpatient facility because of chronic rhinitis with sneezing, nasal congestion, and a runny nose. She underwent a radioallergosorbent test (RAST), with positive results for latex and banana.
  • Probable type 1 hypersensitivy to latex
  • Testing will confirm allergy using radioallergosorbent test to identify specific IgE latex antibody 
  • Food allergy testing helpful to identify cross reactivity between latex and food allergens
  1. A 25-year-old female nurse experienced intermittent asthma and allergic rhinitis for 3 years. She wore latex gloves at work and began noticing hives on her hands after sweating in the gloves. Ten minutes into her cesarean section, which was being performed by a surgeon wearing latex gloves, she experienced a severe drop in blood pressure. Heart rate increased, and signs of asthma, difficulty breathing, and nasal congestion were present. At that point, she received treatment for her reactions, and improvement was noted. After surgery, the patient was evaluated and found to have a positive RAST for latex.
  • Symptoms of latex allergy often start with delayed type IV reaction prior to developing type I immediate reaction
  • Testing using RAST technique to confirm diagnosis
  • Treatment is avoidance of natural rubber latex

Review

Review Questions 
  1. List risk factors for the development of latex allergy.
  2. Describe the difference between type I and type IV latex allergy.
  3. Discuss the different testing methods to diagnosis latex allergy and the risk factors associated with each.
  4. List foods that have been found to have some degree of cross-reactivity with latex.