The ABC’s of Latex Allergy
Table of Contents
Latex is a milky white sap which drips from the Brazilian rubber tree when the bark is cut. It is a major ingredient in most rubber products.
Rubber made with latex (called “natural rubber latex,” or NRL) is very popular because of its strength, flexibility, tear resistance and elasticity. Thousands of common household items contain NRL, from shoes to pacifiers to rubber bands. Because it is also an effective barrier against bacteria and viruses, NRL is routinely used in products such as surgical gloves and condoms to stop the spread of infectious disease.
Depending on how the latex is manufactured, two kinds of NRL can be produced. Crepe rubber is hardened, and is used in products such as tires and rubber balls. Liquid latex, on the other hand, is used to make thin stretchy products such as rubber bands, balloons, and surgical gloves.
The good news is that the vast majority of latex sensitive people are only allergic to liquid latex products. The bad news is that – with infectious disease control so prevalent in health care settings – the use of liquid latex products has skyrocketed during the past ten years. During that same ten year period, latex allergy has become increasingly common, especially among health care workers. Today it is estimated that 5 to 10% of all health care workers have latex allergy.
There are two kinds of latex allergy symptoms: delayed and immediate.
The most common symptom of delayed latex allergy is an itchy, red, mildly swollen rash which appears only on areas of the skin which actually touched the latex. Symptoms typically emerge l 0 to 30 hours after contact. In severe cases, blisters may appear. These symptoms are usually caused not by the latex itself, but by certain chemicals added to rubber during processing. (The exact substance which causes the allergic reaction – in this case, the chemical – is called an allergen).
Symptoms occurring within minutes of exposure to the latex are usually immediate reactions. Immediate allergic reactions may involve parts of the body which did not actually touch the NRL. For example, contact with latex gloves during a dental exam or surgery may cause hives over the entire body. In the most severe cases, immediate allergic reactions may involve the airways, lungs, and heart, leading to life-threatening situations. Symptoms to immediate allergic reactions include:
- Hives, or itchy welts that may appear on any part of the body.
- Hay fever-like symptoms, including nasal stuffiness, sneezing, a runny nose, and itching of the nose, eyes, or roof of the mouth.
- Wheezing, coughing and shortness of breath.
- Anaphylaxis, a life-threatening reaction which includes blocked airways, swelling of the throat, and a drop in blood pressure.
The allergens at fault in immediate allergic reactions are proteins which are actually part of the latex as it occurs in nature.
Gloves which are labeled “hypo-allergenic” rarely cause delayed allergic reactions. However, “hypo-allergenic” gloves may cause immediate reactions.
Your doctor will first take your medical history to get a complete understanding of your symptoms and their possible causes. For instance, you will be asked where you were and what you were doing when you first noticed your symptoms. You will probably also be asked whether you have asthma or any other allergies, whether you frequently come in contact with latex products at home or on the job, whether you have been hospitalized, and how often you have had surgery.
Your doctor will then give you a physical examination, paying special attention to the skin, head and chest.
To confirm a diagnosis of latex allergy, your doctor may give you a skin test or perform a blood test. For a skin test, a small drop of your suspected allergen is lightly pricked into your skin to see whether you have a reaction. However, since severe reactions can result from an extremely tiny amount of allergen, most doctors currently base their diagnosis of latex allergy on the results of a thorough medical history, physical exam, and blood tests.
The tendency to develop allergies is inherited. If you are like most people with latex allergy, you probably have other allergies as well. As a matter of fact, people with latex allergy are often also allergic to banana, avocado, chestnut and other foods!
As with all allergies, you must be repeatedly exposed to latex before you develop a sensitivity to it. The more frequently and intensely you come in contact with latex, the more likely you are to develop the allergy.
For this reason, health care workers – who are surrounded by NRL items in their workplace – often develop latex allergy. Those same health care settings put patients who have multiple surgeries at high risk. In particular, nearly half of all children with spina bifida (who have numerous surgeries) are allergic to latex.
Unfortunately, no. You may react after you touch fluids that have been in contact with latex. This is especially important in health care settings, since you may be given medication from a drug vial or IV tube containing latex parts. IV tubing may have latex parts, but the tubing is not latex.
Some people are so sensitive that they have a reaction when they simply inhale air which carries latex allergen. For instance, sensitive people may react to inhaling the corn starch powder which comes off of latex gloves. People react to rubber balloons: sometimes when they are at a party which is decorated with balloons and, in rare cases, after driving in a car which recently transported latex balloons.
The best way to prevent an allergic reaction from latex is to reduce your latex exposure as much as possible.
Medications may help relieve your symptoms, but there are no medicines that will prevent you from having an allergic reaction to latex. Doctors are still experimenting to see whether giving someone medicine before exposure to latex will reduce the severity of the reaction.
If you have a red, itchy rash of a delayed reaction, your doctor may suggest rubbing a corticosteroid cream or ointment on your skin. Over-the-counter preparations should relieve most rashes. If your symptoms do not disappear, ask your doctor for a stronger prescription-only cream or ointment. In rare cases when the rash is severe, an oral corticosteroid (which is not the same thing as anabolic steroids used illegally by some athletes) may be prescribed.
If you have hay fever-like symptoms or hives, over-the-counter antihistamines (for sneezing, itching, hives and runny nose) or decongestants (for nasal stuffiness) may provide the relief you need. Or your doctor may prescribe stronger, or non-sedating, anti-histamines or decongestants. In some cases, your doctor may also prescribe cromolyn nasal spray or corticosteroid nasal sprays to reduce swelling in your nasal passages.
If your symptoms include wheezing, coughing and shortness of breath, your doctor may prescribe anti-asthma medications. These may include both anti-inflammatory medicine and bronchodilators. Ask your doctor for more details.
A major concern about using these types of medications is that, by reducing symptoms, people may continue to expose themselves to latex. The more often a latex-sensitive person comes into contact with their allergen, the more sensitive they may become. And the more sensitive they become, the higher the likelihood that they will develop a life-threatening anaphylactic reaction.
We do not know whether allergy shots (allergen immunotherapy) can help people with latex allergy. As mentioned previously, a very small amount of latex allergen can cause severe reactions in some people. For tbat and other technical reasons, experts do not currently recommend immunotherapy for this allergy.
Why did my doctor give me a prescription for injectable epinephrine (EpiPen®, EpiPen Jr.®, Twinject®, Twinject Jr.®)?
Your doctor is concerned that you may have an anaphylactic reaction from latex exposure. The only medication which can help you during a life-threatening reaction like that is epinephrine (adrenaline). To be effective, epinephrine must be given within minutes after the first sign of allergic reaction, and it must be given by injection. Epi-Pen®, Epi-Pen Jr®, Twinject® and Twinject Jr.® are all brand names for epinephrine that come in a pre-measured, self-injectable container. There are three very important points to remember about epinephrine:
- The sooner the medication is injected, the better your chances of stopping the anaphylactic reaction.
- It is better to be safe than sorry. Taking epinephrine when it is not needed will probably not cause serious problems.
- Epinephrine provides only temporary relief. Immediately after injecting the medicine, have someone take you to the nearest hospital emergency department.
Your doctor or nurse will talk to you about when and how to use your epinephrine. Basically, epinephrine should be taken any time symptoms show that important organs – such as the heart or lungs – are affected.
For instance, if you blow up a latex balloon and your lips swell up and itch, there is no need for epinephrine. But if you begin to have trouble breathing, if your voice changes, or if it feels like your throat is swelling, take epinephrine immediately! All of these symptoms indicate that the allergic reaction involves your airways. If the reaction is not stopped, it may quickly and totally block your ability to breathe.
The only way to prevent your symptoms is to avoid contact with latex. Unfortunately, that will not be easy, since NRL is found virtually everywhere today. However, unless you are highly allergic, you will not react to most latex household items unless they touch broken skin, or mucus membranes (such as lips, the vagina, etc.). The following lists should give you an idea of the kinds of products which you should avoid because they contain latex. If you are ever unsure about a particular product, contact the manufacturer directly, and ask whether the product contains NRL
AT HOME AND WORK:
- Baby bottle nipples
- Carpet backing
- Douche bulbs
- Elastic in clothing and disposable diapers
- Eye dropper bulbs
- Hot water bottles
- “Koosh” balls
- Rubber hand grips on racquets, bicycles, garden tools, etc.
- Rubber bands
- Rubber clothing (such as rain coats)
- Rubber gloves
- Rubber toys
- Anesthesia masks
- Bandages for burns
- Bite blocks
- Blood pressure cuffs
- Breathing circuits
- Catheters: arterial, epidural, Foley, Texas, venous
- Cervical caps
- Cervical dilators
- Dental dams
- Elastic bandages
- Electrode pads
- Endotracheal tubes
- Injection adapters
- Esophageal dilators
- Esophageal protective covers
- Eye dropper bulbs
- Face masks with elastic bands
- Feeding tubes
- Finger cots
- Gloves: examination and surgical
- Hot water bottles
- Instrument mats
- IV injection ports
- Nasal-pharyngeal airways
- Orthodontic elastics
- Prophy cups
- Reservoir breathing bags
- Rubber sheeting or pillows
- Rubber stoppers in meds
- Syringe stoppers
- Tooth protectors
- Ultrasound covers
- Urine bags and straps
- Ventilator bellows
- Ventilator tubing
- Warming blankets
- Wheelchair tires
- Wound drains
*Most “latex” paints will not cause allergic reactions, but some waterproofing paints will. Check with the manufacturer to be sure.
The word about latex allergy is quickly spreading among health care professionals, but not everyone has had patients with the problem. Most latex-sensitive people who take the following steps should be able to receive care in any doctor’s office:
- Warn your doctor about your latex allergy. If necessary, ask the doctor who diagnosed your allergy for a letter documenting it.
- Discuss which items containing latex would normally be used for your care.
- You may need to bring your own non-latex gloves to your appointment. Ask the doctor who diagnosed your allergy for an up-to-date list of suppliers of non-latex gloves.
- Ask to be the first patient in the morning to minimize your exposure to airborne latex particles (such as the corn starch on latex examining gloves). Ask your doctor to make sure that no one uses latex products until you have left the office.
Presently, we know very little about how latex allergy develops or whether or not it will go away. For most other forms of allergy, people who carefully avoid their allergen may find that they experience a gradual loss of allergic sensitivity over several years. Unfortunately, we do not know yet whether this is also true for latex.
If your doctor thinks you could have a life-threatening allergic reaction to latex make sure you:
- Wear a Medic-Alert ID bracelet at all times.
- Carry your injectable epinephrine With you at ALL TIMES.
- Understand when and how to give yourself an injection of epinephrine (Ask your doctor or health care provider if you are not sure).
- Explain your allergy and your immediate need for epinephrine in case of a life-threatening reaction to your family, close friends, and co-workers.
- Call your local hospital emergency department and ambulance service before you ever need their services to ask them to develop “latex free protocols.”
If you have a latex allergy, make sure you:
- Are familiar with common items that contain latex.
- Have a personal supply of non-latex gloves to bring to your doctor or dental appointments in case they do not stock them.
- Have a card or letter from your doctor documenting your latex allergy (for your school, employer, or other doctors).
This booklet was developed and written by the Division of Allergy and Clinical Immunology at Henry Ford Health System in Detroit, Michigan and The Asthma and Allergy Foundation of America.
This booklet was funded by the D. Clark Swalm, Jr. Allergy and Immunology Education and Research Endowment Fund.
The Asthma and Allergy Foundation of America is a private, not-for-profit organization dedicated to helping people with asthma and allergic diseases through education, support for research, and an array of services offered by a national network of chapters and affiliated support groups. For a free information packet about asthma and allergies, call: 1-800-7-ASTHMA
Asthma and Allergy Foundation of America
1125 15th Street, NW, Suite 502
Washington, DC 20005
Fax: (202) 466-8940
HENRY FORD HEALTH SYSTEM
Division of Allergy and Clinical Immunology
Department of Pediatrics 1 Ford Place
Detroit, MI 48202-3450
Fax: (313) 876-2094
© Henry Ford Health System 1995, 5M, PP, 1-95