Latex Allergy

The symptoms of latex allergy start within a few minutes to four days after exposure to latex. The classical symptoms include:

• Hives
• Itching
• Blisters on the back of the hand
• Runny nose
• Scratchy throat
• Sneezing
• Conjunctivitis

It can also cause asthma symptoms such as:

• Coughing
• Wheezing
• Chest tightness
• Difficulty in breathing

In the most severe cases, it can lead to anaphylaxis, which involves:

• Severe breathing difficulty
• Fall in blood pressure
• Shock

Understand the difference between allergies and anaphylaxis.

Latex is derived from the milky secretion of rubber trees, Hevea brasiliensis. These trees are predominantly found in Africa and Southeast Asia. Latex is used in various medical devices and consumer products.

Medical devices containing latex:

• Disposable gloves (the most common source of allergy)
• Dental dams
• Airway and intravenous tubing
• Syringes
• Stethoscopes
• Catheters
• Dressings
• Bandages
• Tourniquets (devices that are used to stop bleeding)
• Electrode pads (small adhesive pads that are placed on the skin to relieve pain)

Consumer products containing latex:

• Condoms
• Handbags
• Balloons
• Athletic shoes
• Tires
• Tools
• Underwear leg
• Waistbands
• Rubber toys
• Baby bottles
• Nipples
• Pacifiers

What causes latex allergy?

Allergies occur when the body’s immune system responds abnormally to an external trigger known as an ‘allergen,’ which typically does not provoke an immune response in most individuals. There are hundreds of allergens found in natural rubber latex. Additionally, the chemicals added to latex during its processing can also cause latex allergy.

How is a person exposed to latex?

An individual can be exposed to latex through:

• Direct exposure through the skin, mucous membranes, or intravenously
• Contamination of food through gloves used by food handlers during preparation or serving
• Inhaling latex powder through the lungs

What happens upon exposure to latex in hypersensitive individuals?

Once latex enters the bloodstream, it releases IgE antibodies (proteins that protect the body when an unwanted substance enters). These antibodies bind to the allergic proteins found in latex. This binding releases several chemicals that elicit an immune response characterized by the symptoms described in the next section.

The risk factors of latex allergy include:

1. Direct exposure to latex products
   People who are directly exposed to latex products (such as gloves) are more prone to develop latex allergy. Such individuals include:
   • Healthcare workers (such as doctors, nurses, and dentists)
   • Housekeepers
   • Hairdressers
   • Restaurant workers
   • Workers in the manufacturing of latex products
2. Food allergies
   Individuals with specific food allergies are at higher risk of developing latex reactions. Studies suggest that half of the population with latex allergy also has cross-reactive food allergies. Foods that may increase the chances of latex allergy include:
   • Avocado
   • Banana
   • Chestnut
   • Kiwi
   • Passionfruit
   • Plum
   • Strawberry
   • Carrot
   • Celery
   • Melons
   • Papaya
   • Tomato
3. Certain medical conditions
   Some medical conditions, particularly from an early age, require multiple surgeries. These conditions increase the risk of latex allergy due to frequent and repeated use of gloves, latex catheters, and tubing. Some of these conditions include:
   • Spina bifida (a condition affecting the spine, usually present from birth)
   • Urogenital abnormalities
   • Presence of an abnormal anal opening from birth
   • Abnormal connection between the food pipe and windpipe
   • Cerebral palsy
   • Quadriplegia (paralysis affecting all limbs and body from the neck down)
   • Preterm infants
4. Personal and family history of other allergic conditions
   Individuals with a family history of allergies, such as asthma or hay fever, are more likely to develop latex allergy. Any other allergy also increases the risk of latex allergy.

Latex allergy is diagnosed using a combination of medical history, physical examination, and several laboratory and clinical tests, as no single test is sufficient to confirm the allergy. The medical history involves understanding any past diseases along with the list of foods that have caused an allergy.

All procedures are performed with latex-free instruments, devices, and protective clothing.

• IgE Serum Testing: Immunoglobulin E (IgE) are antibodies produced by the immune system when exposed to an allergen. This test serves as a preliminary assessment to detect general allergies, but it is not specific to latex allergy.
• Skin Prick Test (SPT): This test involves pricking the skin and applying a latex extract, followed by a close examination for any signs of allergy, such as redness, itching, or other visual marks. Due to its specificity, it is considered the gold standard for diagnosing IgE-mediated latex allergy.
• Skin Patch Test: In this test, a latex extract is placed on a patch, which is then applied to the skin. The skin's reaction is monitored over 2 to 3 days.
• Radioallergosorbent Test (RAST): RAST is a blood test that detects specific IgE antibodies formed against a particular allergen.
• Flow Cytometry: This laser-based technique detects and analyzes the chemical and physical characteristics of cells. Latex allergy leads to the activation of specific white blood cells, which flow cytometry can identify.
• Genomic Profiling: This involves analyzing genetic information, which serves as an excellent tool for evaluating risk and understanding the type of allergy. This information helps guide the treatment plan. Genetic screening, a pivotal component of modern preventive medicine, systematically utilizes blood or skin samples to search for specific genotypes within defined populations.

Here is a complete guide on genetic screening.

Latex allergy can be prevented by limiting exposure to latex. The measures that help prevent latex allergy include:

A. Primary prevention

It refers to preventing allergy before symptoms appear. This type of prevention is mainly helpful to susceptible workers who are frequently exposed to latex products.

1. At an individual level

• Replacement of gloves: Gloves are used in several household chores that do not involve contact with infectious material, such as gardening, mixing paint, taking care of pets, and food preparation. Using powder-free low protein (PFLP) or synthetic gloves instead of natural rubber gloves (NRL) in such work proves beneficial in preventing latex allergy.
• Avoid oil-based creams/lotions: Using oil-based creams and lotions can cause latex gloves to break down, increasing the chances of an allergic reaction. Keeping the skin dry while wearing latex gloves can prevent this.
• Minimize the use of latex: Latex is present in various products used in daily life such as condoms, mats, masks, waistbands, and stockings. Latex allergy can be prevented by using latex-free products instead of these in daily life.
• Maintain hand hygiene: Hand washing with soap and water after using gloves is also helpful in preventing allergies.

2. At Workplace

• Formation of latex allergy task force: Latex allergy can be prevented by forming a task force in workplaces that use latex products, such as hospitals, clinics, and rubber industries. These task forces should focus on educating employees about latex allergy, including symptoms and preventive measures.
• Implementing a latex-safe environment: This is used in all healthcare facilities for high-risk individuals. It includes scheduling the surgery of such persons first on the day of surgery and keeping the room unused for 3–6 hours. This approach reduces the chances of developing latex allergy as latex can also be absorbed from contaminated surfaces and air.

B. Secondary prevention

This involves additional measures along with a latex-safe environment to prevent symptoms in sensitized individuals. One approach is to administer medications such as antihistamines before carrying out risky procedures.

The best way to manage latex allergy is to avoid it, as continued exposure can worsen the condition. Treatment varies depending upon the reaction – a mild sensitivity or a life-threatening allergic reaction.

The first step in irritant dermatitis is to remove latex and clean the affected area. Immediate monitoring and treatment for life-threatening conditions is needed for severe allergic reactions.

1. Medications

These may be taken after exposure to latex to control your reaction and help relieve discomfort. The common medications used to treat symptoms associated with latex allergy include:

• Antihistamines: These medications inhibit the release of histamine, a key mediator involved in allergic reactions. They are used to control most of the symptoms, such as hives, itching, runny nose, and sneezing, that are predominantly associated with latex allergy. Examples include diphenhydramine and cetirizine.
• Topical steroids: Topical steroids are used to reduce inflammation. Hydrocortisone is a commonly used medication.
• Injectable: Adrenaline is the first-line treatment for severe reactions.
• Anti-IgE therapy: Type 1 latex allergy is associated with an increase in the level of IgE, which triggers a cascade of events that cause symptoms. Omalizumab has been found to significantly reduce the symptoms by decreasing the level of IgE.

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2. Immunotherapy

Immunotherapy is used for severe allergies or allergies that do not respond to standard medication. This involves a series of allergen exposures via injections or tablets over a few years. With time, this helps desensitize the body’s immune system to the allergen and prevents severe allergic reactions.

Individuals who are frequently exposed to latex or have a very high sensitization to latex are more likely to develop anaphylaxis.

Anaphylactic shock is a severe condition that can block your airways and prevent you from breathing. This occurs due to a decrease in blood pressure, which prevents the heart from receiving enough oxygen. The complications of anaphylaxis include:

• Reduced oxygen supply to the brain
• Acute kidney failure
• Septic shock
• Collection of fluid in the air sacs of the lungs
• Arrhythmias
• Abnormal liver function

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While latex allergy necessitates conventional medical management, it's important to note that alternative therapies can potentially enhance immunity and provide additional support to the conventional treatment, offering a ray of hope for better management:

• Nutrition and supplements
  • Quercetin: A flavonoid and antioxidant found in many plants, known to reduce allergic reactions.
  • Vitamin C: Enhances the effect of quercetin by supporting the immune system.
  • Zinc: Some studies suggest that zinc may help protect against gastrointestinal symptoms accompanying anaphylaxis.
• Yoga: Breathing exercises such as pranayam may be beneficial, providing relief from respiratory symptoms of an allergy, such as nasal congestion, runny nose, and breathlessness. Learn about effective yoga poses to improve oxygen flow in your body.

• Take precautions while using gloves: Gloves are the primary source of allergens. The following measures should be taken to prevent allergy to latex gloves:
• Use non-latex gloves for everyday activities such as food preparation, routine housekeeping, and general maintenance, as they are unlikely to come into contact with infectious materials.
• Use powder-free latex gloves when appropriate barrier protection is necessary, such as while caring for a person with an infectious disease.
• Avoid the use of latex products: People who have experienced a trigger in the past should avoid products made from natural rubber, such as balloons, condoms, and shoe soles. They should also read the labels before using any product that they think might contain latex.
• Follow safe practices: Individuals with latex allergy should follow appropriate work practices to reduce the development of symptoms. These measures include:
• Avoid using oil-based hand creams while wearing gloves, as they can deteriorate the gloves.
• Wash hands thoroughly with soap and water after removing gloves.
• Clean areas and equipment contaminated with latex-containing dust frequently.
• Recognize the symptoms: Recognizing latex allergy symptoms, including skin rashes, hives, flushing, itching, nasal, eye, or sinus symptoms, and asthma is essential. This helps prevent a more severe reaction and a possible trigger.
• Wear medical identification: People who have experienced allergic symptoms to latex in the past should wear a bracelet or necklace indicating their latex allergy. This helps prevent exposure through another person, especially while traveling and at the workplace.
• Carry emergency essentials: A person with a latex allergy can experience episodes of anaphylaxis at any time, which can be fatal. Individuals should carry auto-injectable epinephrine and sterile, non-latex gloves for emergency use. It is also advisable to carry allergy medications, such as antihistamines, asthma medications, and inhalers.