Latex Allergy Treatments
The third, most serious, and least common syndrome is immediate (type I) hypersensitivity. It is mediated by an immunoglobulin E (IgE) response specific for latex proteins. As noted, latex proteins are highly allergenic, and they are variable between lots from different plantations, factories, and manufacturers. Cross-linking of IgE molecules on mast cell and basophil cell membranes by latex protein allergens triggers the release of histamine and other mediators of the systemic allergic cascade in sensitized individuals.
Exposure can occur following skin, mucous membrane, or visceral/peritoneal contact. It also can follow inhalation of latex-laden particles or bloodstream exposure to soluble latex proteins following intravascular access procedures. Powdered latex examination gloves have been the most frequent source of sensitization in adults, causing cutaneous and inhalational exposures. (Fortunately, their use is decreasing as many hospitals move toward powder-free, "low-allergen," or nonlatex glove products.)
Sensitization is more common in atopic individuals. Symptoms generally begin within minutes of exposure. The spectrum of clinical manifestations includes localized or generalized urticaria, rhinitis, conjunctivitis, bronchospasm, laryngospasm, hypotension, and full-blown anaphylaxis. Type I allergy has been implicated clearly in intraoperative and intraprocedure anaphylaxis, and it can be fatal without emergent treatment.
- In the US: Latex allergy is present in 1%-5% of the general population, with an increased prevalence in atopic individuals. Latex allergy is increased in populations with chronic occupational exposure to latex. It is found in 2%-17% of HCWs and in at least 10% of rubber industry workers. Symptoms of latex allergy have been described in 14% of a group of EMS providers and in 54% of a pediatric ED staff. Atopy raises the risk of occupational sensitization.
The highest prevalence of latex allergy (20%-68%) is found in patients with spina bifida or congenital urogenital abnormalities. Sensitization in these patients apparently follows multiple urinary tract, rectal, and thecal procedures, as well as multiple surgeries during early childhood. Patients with spina bifida also may have a genetic predisposition for latex sensitization. Patients with spina bifida and human leukocyte antigen (HLA) alleles DRB and DQB1 were more likely to have a specific IgE response to a common latex antigen. Again, within this risk group, atopic children are at increased risk.
Other patients with a history of multiple surgeries or other latex-exposing procedures are also at increased risk relative to the general population. Patients with cerebral palsy, mental retardation, or quadriplegia also appear to have increased risk of latex allergy, probably because of repeated medical exposures.
Finally, the prevalence of latex allergy is increased in persons with allergies to avocado, banana, chestnut, kiwi, papaya, peach, or nectarine. Cross-reacting antigens have been found between these tropical fruits and latex.
- Internationally: The risk patterns described above are similar in other developed countries. One study from Germany suggests that the incidence of type I latex allergy has risen faster recently among HCWs than Type IV hypersensitivity, possibly due to recent manufacturing changes that lessen exposure to accelerators but not to latex proteins. Workers with occupational exposure during harvesting and/or processing latex in developing countries where H brasiliensis is grown have an increased risk relative to the general populations.