Latex allergy, what is it?
The article below comes from the Parkstad Medical Center website. So don't think about latex allergy too easily. Are you going to make latex clothing for other people? Check if you have an allergy!
Not only the latex but also the dyes in latex clothing / products can sometimes cause allergic reactions.
Latex allergy
By: K. Vissers-Croughs, dermatologist.
Allergy to natural rubber latex is an increasing problem in healthcare. prevalence is high (7-10%), particularly in the (para) medical professions. Latex hypersensitivity can lead to local skin problems (usually caused by a type IV allergy to rubber additives), but also to type I allergic reactions ranging from urticaria and rhinoconjunctivitis, to asthma and even anaphylactic shock. The cause is largely due to the use of cheap gloves with a high content of latex proteins.
What is latex?
Natural latyex is a milky liquid that is obtained from the rubber tree Hevea brasiliensis that grows in tropical areas. The milk juice consists of 36% rubber, 1.5% proteins, 2.5% sugars, lipids and minerals and 65% water. Many chemical auxiliaries are added to this in the production process of rubber articles, such as accelerators, antioxidants and vulcanization agents. It is the natural proteins and the chemical auxiliaries that have allergenic properties.
Allergy to latex
Most allergic reactions are the result of a Gell and Coombs type IV allergy (delayed type allergy, contact allergy). Apart from a few exceptions, this contact allergic reaction is not caused by latex itself, but by the excipients (such as thiuram, paraphenylene diamine, mercapto derivatives and carbamates).
The allergic reactions to latex protein itself, which are the subject of this article, are the result of a type I allergy (direct type of allergy) mediated by IgE antibodies specific to the different latex proteins. Irritation and contact allergy to rubber gloves are considerably more common than type I allergic reactions to natural latex.
Method of exposure to latex allergen
Exposure to the allergen can take place through the skin and mucosa. The allergen can be transmitted through direct contact, but also through inhalation of rubber-containing particles. For example, powdered latex gloves have been shown to be capable of acting as a carrier for the latex allergen in the glove powder (corn starch) and such latex particles can therefore be measured in the air.
Symptoms of latex protein allergy
The clinical picture of allergic reactions to latex is very different and depends, among other things, on the method of contact with latex and the amount of bioavailable latex antigen. The symptoms can range from a mild reaction with itching, redness, blisters or localized urticaria to severe and sometimes life-threatening anaphylactic shock.
Because many latex-sensitized individuals are atopic and / or have hand eczema, local symptoms due to wearing latex gloves are often not recognized and interpreted as worsening of eczema. Glove-containing latex powder containing airborne dust generally gives rise to conjunctivitis, rhinitis, asthma and, in severe cases, to anaphylactic shock.
The most serious reactions are usually caused by contact of latex with mucous membranes. Oral, vaginal or rectal exposure to latex gloves can give rise to urticaria, angioedema and shock. Contact with gloves during a surgical operation or delivery can also cause serious allergic symptoms. In the event of a misunderstood (anaphylactic) reaction during surgery, a possibility of latex allergy should always be considered (10% of the anaphylactic reactions during anesthesia are based on latex allergy).
Epidemiology
The prevalence of latex allergy in the general population is less than 1%. In certain risk groups, however, the frequency is considerably higher, such as:
● Healthcare workers (7 to 10%) who regularly have to wear gloves, such as dentists and dental assistants, cutting doctors, operating theater and IC staff and cleaning staff; predisposing factors here are atopic predisposition and hand eczema;
● Patients who undergo repeated surgical interventions, catheterisations or manual faeces removals, in particular patients with spina bifida, urogenital disorders or paraplegia;
● Production staff in the latex processing industry.
Explanations for the rapid increase in prevalence are sought in the following factors:
● Increasing sensitivity of the Western population to allergies;
● The tap of young rubber trees that supply unripened latex with an increased protein content, together with a sharp reduction in the washing times of the end products (higher and cheaper production) in order to meet the fast-growing demand at the start of the AIDS crisis;
● Switching from steam vulcanization (hot water or steam makes proteins harmless) to vulcanization in hot air tunnels with a lower temperature in the same time;
● The increased use of tropical fruits whose allergens (eg banana, avocado, kiwi) show cross-reactivity with latex allergens.
Which rubber products contain latex?
It is important to make a distinction between:
Natural rubber products made from raw rubber. These contain no or negligibly little latex protein.
Natural rubber products made from liquid latex. The amount of latex proteins in these products strongly depends on the way in which the latex has been treated and on the care with which the end products have been washed in the final phase of the production process. Serious allergic reactions can only be expected on products from the second group.
The vast majority of reactions are caused by latex gloves. Other items that regularly cause allergic reactions are condoms, balloons, patches, catheters, catheters with rubber balloons used in bowel examinations, dental and orthodontic materials and anesthesia systems.
Food allergies in patients with latex allergies
Of all patients with an IgE-mediated latex allergy, 50% also have allergic reactions to certain types of fruit and nuts, in particular banana, avocado, kiwi and sweet chestnut. This is based on a cross-reactivity. For other fruit types (melon, pineapple, peach, passion fruit, papaya, fig), nuts (walnut), vegetables (tomato, potato) and buckwheat, an allergy has been described in connection with latex. The clinical manifestations of these food allergies may be limited to stimuli and swellings in the lips and in the oral cavity. But extensive urticaria, bronchospasm, gastrointestinal symptoms and anaphylactic shock also occur.
Diagnostics
A careful history is crucial to detect a latex allergy. A latex allergy is suspected when a patient has had itching, urticaria, edema, rhinitis, or conjunctivitis when exposed to gloves, condoms, balloons, or other latex-dipped items.
Suspicion also exists when patients report a food allergy for, for example, banana, avocado, kiwi and sweet chestnut. In atopic patients with a hand eczema, patients who have had an anaphylactic reaction during an operative procedure and patients from high-risk groups with a positive or doubtful history, the existence of a latex allergy must be demonstrated or excluded.
The following tests are available:
Latex IgE-Rast: the antigen is incubated with the patient's serum. The sensitivity of this test is low, 40 to 70%; a negative Rast therefore does not exclude a latex allergy;
A prick test with latex antigen. We use standardized extracts from the company ALK for this at the outpatient clinic. This test is considered very reliable;
Glove provocation: only in exceptional cases, when the tests are negative and there is nevertheless a strong suspicion of latex allergy. This provocation is not without anaphylactic hazards and should only be performed in a department with experience in the treatment of anaphylaxis. Patients with hand eczema and suspicion of latex allergy must also always undergo an epicutan allergological examination to rule out a concomitant contact allergy to rubber additives.
Secondary prevention
Patients with a proven latex allergy should carry a medical warning card. They must consistently avoid latex-containing products. For emergencies, they must be in possession of an antihistamine and possibly even an Epipen.
There are suitable gloves on the market that are made of vinyl, chloroprene, nitrile or tactylon. Examples are:
Surgical gloves: Allergard, Dermaprene, Duraprene, Elastyren, Neolon, Tactylon and Neotech;
Examination gloves: Ethiparat, Tru touch, Glovex, Tactylon and Sensicare;
Household gloves: Sempersoft and Semperstar.
A suitable condom is EZON, which is made of polyurethane.
Caregivers with a serious latex allergy should avoid areas where powdered gloves are used regularly. An alternative possibility is that colleagues use (latex) gloves without powder.
The following measures should be taken in surgical patients who are familiar with latex allergies:
● Plan to be the first patient on the surgery program;
● Eliminate as many latex sources as possible, especially those with which the patient will come into contact;
Possible preventive pre-treatment (clemastine, dexamethasone) if above conditions are not met optimally. This does not, however, preclude the occurrence of an anaphylactic reaction.
● Primary prevention
In health care, this should primarily be sought in a safe glove policy. For non-sterile procedures, especially when mucosal contact takes place (oral, vaginal, rectal), use vinyl or plastic gloves. Use sterile latex gloves with a low protein content for sterile handling.
Latex and Atrium MC
For a safe glove policy, a DMU (Decision Making Unit) was established in 1998 with the assignment to search for high-quality gloves that meet the above requirements, among other things. Based on their findings, the following gloves will be tested in some departments during the course of this year:
● Supreme: a powder-free latex protein-poor surgical glove;
● SensiCare PowderFree: powder-free vinyl examination glove;
● Neotech: a powder-free non-latex glove, only for use with proven latex allergy.
Work is also underway on the creation of a latex-safe operating room for the treatment of patients with latex allergies. Acute trauma patients whose reliable history is not possible, and patients with a greatly increased risk of developing latex allergies (such as children with spina bifida, urogenital disorders and the like) will then preferably also be treated in such an operating room.
