What to avoid if you have a latex allergy

In most cases, a diagnosis of latex allergy can be made from an precise history and clinical examination. There are a number of skin tests which can confirm latex sensitivity, includingpatch tests(for allergic contact dermatitis type reactions),skin prick test(for contact urticaria type reactions) and radioallergosorbent assay blood test (RAST), which is not as precise as the skin tests.


What are the reactions to latex

The common reactions of latex-sensitive individuals exposed to latex are contact urticaria,dermatitisand asthma.

Contact urticaria generally presents with itching and swelling of the skin at the site of contact with latex, for example, hands from wearing gloves, genitals from contact with condoms, and so on.

The symptoms generally start within 5–15 minutes after coming into contact with the latex article, although it can be delayed for several hours. Symptoms can continue for a variable period, from several hours to days after the latex contact has ceased.

Contact dermatitisfrom latex may take several days to appear. It presents with an itchy, scalyrash, although there may be little blisters if the reaction is acute. The rash will generally final several days to weeks but if exposure to latex continues, the rash will final longer.

Contact dermatitis is not generally caused by sensitivity to latex protein but rather to the chemicals used in the manufacture of the latex product, including antioxidants andrubber acceleratorsthiuram, carbamates, and mercaptobenzothiazole.

Immediate-type hypersensitivity requires a previous sensitisation and is the most potentially dangerous reaction to latex. Clinical presentations vary but may includecontact urticaria, coryza,conjunctivitis, stinging or burning, asthma, and, with mucosal or parenteral exposure,anaphylaxis.

A common cause for the asthmatic reaction is powdered gloves. The starch powder picks up the latex proteins and when the gloves are removed the powders can then be inhaled or come into contact with the skin on the face where it can cause an allergic reaction.


Exposure methods

Contact through the skin, mucous membranes, parenteral, intravenous and inhalation.


What causes latex allergy?

For reasons not yet clearly understood, some individuals can become allergic to certain constituents of the latex molecule.

Once allergic, sensitivity remains lifelong.

The onset of recommendations for universal precautions resulted in increased use of latex gloves; to meet the increased demand, manufacturing processes may own changed resulting in a more highly allergic product.


Who is at risk of latex allergy?

Anyone who is exposed to latex may become sensitised; fortunately, the majority of individuals do not. However, certain populations are more at risk:

  1. Individuals who own undergone multiple medical/surgical procedures
  2. Individuals with congenital urinary anomalies (from use of catheters and other latex devices) such as children with spina bifida.
  3. Healthcare workers(from wearing rubber gloves)
  4. Rubber-industry workers
  5. Individuals with a history of sensitivity to certain foods such as banana, avocado, chestnut, tomato, peach or kiwifruit
  6. Individuals with a history of non-medication relatedanaphylactic reactionsduring anaesthesia.


Latex is used in the manufacture of a large number of consumer products.

Natural rubber latex products

Am I likely to grow out of it?

No treatment is yet available to 'cure' a latex allergy. So far the best treatment is to avoid exposure to latex, in tandem with using medications to temporarily alleviate symptoms.

Latex allergies can, however, get worse. There is evidence to propose that the more you are exposed, the more allergic you become.

How is latex allergy diagnosed?

Swelling and itching after medical examinations, contact with rubber gloves, mouth discomfort after blowing up a balloon or undergoing a dental examination are every signs of latex allergy.

Itching in the mouth and throat after eating banana, chestnuts or avocados is sometimes a signal that a latex allergy exists.

See a doctor if you suspect latex allergy, preferably one with experience in allergies. Your doctor will take a detailed history, and may confirm the diagnosis with a blood test. Skin testing is another option, but because it involves a little exposure to latex, most doctors prefer the risk-free blood test as a first step.

What about other warning signs?

Other warning signs include hives under rubber gloves, hand dermatitis related to gloves, allergic conjunctivitis after rubbing eyes with a recently degloved hand, vaginal burning after pelvic exams or contact with condom, and occupational asthma.

What precautions should latex-allergic people take?

  1. When travelling, carry a variety of non-latex sterile gloves in case of emergency medical or dental work.
  2. Don't be bashful — make your allergy known to family, friends, employers and co-workers.
  3. If you can't avoid latex exposure, make certain you carry medicine you can take to reduce allergy symptoms.
  4. Warn doctors and dentists of your allergy to latex before any examinations or procedures.
  5. Discuss your allergy with your employer if you work in a high latex exposure area and suffer from skin, hayfever or asthma symptoms.
  6. Avoid every contact with natural latex products
  7. Obtain and wear a MedicAlert bracelet.
  8. Carry an adrenaline kit with you at every times, making certain the needle protector and syringe stopper are not made of latex.
  9. In addition, if your allergy is severe:
  10. Avoid eating bananas, avocados and any other fruit if these cause allergic symptoms, such as oral itching, swelling, hives or shortness of breath.

If you are allergic to the everyday items that contain latex, don't despair.

There are alternatives now available, such as polyurethane condoms, and powder-free latex or non-latex gloves. See the table under for more ideas.

What is latex allergy?

The protein in latex rubber causes allergic reactions in some people. The thin, stretchy rubber in gloves, condoms and balloons is high in this protein, which means these items cause more reactions than products made of hard rubber, such as tyres.

Products made from rubber latex generally contain a number of chemicals, and some people are not so much allergic to the rubber but the synthetic chemicals found in it.

Because people can be allergic to diverse natural or synthetic materials in rubber, we speak of latex allergies generally, but those affected should attempt to identify the specific components involved in their reactions.

When a latex-allergic person touches rubber, his or her body thinks the rubber is trying to attack it and perceives it as foreign. The immune system launches a counter-attack that can cause a host of unpleasant and, in some cases, life-threatening symptoms.

Who is at risk?

Latex products are everywhere, and anyone can become allergic to it.

Healthcare workers who frequently use latex gloves and constantly touch products containing latex are at higher risk than average, as are people with medical conditions that require frequent procedures or surgery.

Those who work in manufacturing of latex products are also at greater risk, as well as children with congenital neurological abnormalities such as spina bifida and people with bladder problems. It is estimated that up to 65 per cent of American children with spina bifida own latex allergy.

Other risks pinpointed by medical experts are less defined but include a history of hay fever, a history of food allergies to tropical fruits, hazelnuts, chestnuts or rock fruits, or hand dermatitis that is severe.

What are the symptoms?

Latex allergy often begins with a rash on the hands following use of rubber gloves, but can also manifest itself through respiratory distress, eczema or oedema.

Other signs include hay fever, itchy and swollen eyes, a runny nose and sneezing following latex exposure. Some patients can develop asthma symptoms such as chest tightness, wheezing, coughing and shortness of breath.

Other symptoms can include rashes, swelling, facial flushing or hives, rapid breathing, anxiety and confusion, feeling faint or shock.

Some people who work in latex gloves get bumps, sores, cracks or red raised areas on their hands over days or weeks.

What to avoid if you own a latex allergy

These reactions can be caused from frequent hand washing, antiseptics, constant covering of the hands or chemicals, and are not related to latex allergy.

Can it be fatal?

While it is extremely unusual, some individuals can suffer a serious allergic reaction called anaphylaxis when they come into contact with latex rubber. This can happen in the mouth when blowing up a balloon, undergoing dental surgery, using a condom, during a rectal or colon examination or via catheterisation.

Anaphylactic shock occurs within minutes and is characterised by generalised hives, breathing difficulties and low blood pressure.

Can food allergies be involved?

Yes, they can.

Numerous of the proteins that cause latex allergy are found in fruit, vegetables, nuts and cereals. This phenomenon is known as 'cross-reactivity'. Kiwifruit, passionfruit, cherries, potatoes, paw-paw, papaya, banana, avocado, fig, peaches, nectarines, plums, tomatoes, celery and chestnuts are every foods that can sometimes be linked with latex allergy. If you own a latex allergy, you don't own to avoid every of the foods that can potentially cross-react with latex — only those cause an allergic reaction for you.

Dr Vincent St Aubyn Crump, from Auckland Allergy Clinic gives a further insight into some of the idiosyncrasies of fruit, latex and birch pollen cross-reactions.

In my practice, I own seen several patients with kiwifruit allergy. Every the patients I've seen with kiwifruit allergy were allergic to birch pollen and get birch pollen hay fever. Every the patients I see own a positive skin test to the unused kiwifruit. The commercial extracts for fruits are renowned for being unreliable (giving untrue negative results) because of the short shelf life.

About half of the patients I see with kiwifruit allergy own systemic reactions (anaphylaxis) to kiwifruit and most of these will get oral allergy syndrome (itching and swelling in the mouth and throat).

The other half will get the oral allergy syndrome only. A few of them will be positive to latex, but only one of my patients, from memory, has clinical latex allergy.

I tell every my patients with kiwifruit fruit allergy to reduce latex exposure, especially if they are atopic or allergic, as this makes them a high risk for latex allergy.

I offer desensitisation to birch to every of them, as the literature shows improvement in kiwifruit allergy after immunotherapy to birch. I own not rechallenged any of my patients, so can't comment on the improvement of kiwifruit allergy after this desensitisation.

Often these patients with kiwifruit allergy are allergic to apple and hazelnut as well.

Substitutes

For babies Pacifiers, feeding nipples Silicone products
For school and office Erasers, craft supplies, make-up and Halloween masks, adhesives Look for products labelled 'vinyl' or 'silicone'
Clothing Elastic fabric, diapers, underwear Many elastic fabrics are not rubber (for instance 'Spandex' and 'Lycra') but elastic webbing often contains rubber
Housework Cleaning gloves Gloves are a major source of exposure because they are in direct contact with the skin for a endless time and may give off an allergic dust — use nitrile, neoprene, vinyl or copolymer gloves.
Toys and Sporting Goods Balloons, Koosh balls, rubber ducks, soccer balls, volleyballs, coated or taped racquet handles Mylar (foil type) balloons, leather balls
Furnishings Rubber mats, carpet backing, foam rubber Rubber mats, carpet backing, foam rubber Most foam rubber is poly-urethane foam and will not cause problems
Medical Products

Condoms, female condoms, diaphragms

Medical gloves, dental dams
First-aid tape, bandages

Synthetic rubber or natural membrane condoms

Synthetic rubber or natural membrane condoms

As with household gloves above, use only gloves made with synthetic materials

Only some brands contain natural rubber latex

No latex is allowed in the children's wards of numerous hospitals.

Some will let you decorate a waiting room or the "Day room", but none of the patient's rooms. And no balloons at every in ICU'S. Latex balloons are the leading cause of paediatric choking deaths in the US. An increasing number of patients and staff own developed an allergy to latex. Symptoms of latex allergy may be mild or severe and range from hives and swelling to respiratory failure. Mylar/Foil balloons will only be accepted in numerous hospitals.

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Background

Over 90% of natural rubber comes from the latex, or milky sap, of the rubber tree,Hevea brasiliensis.

Latex is used in a large number of products including adhesives, foam, carpet backing and in a number of dipped products includingsurgical gloves, household gloves, catheters, condoms, and balloons. Natural latex rubber is also found in toys, erasers, sports equipment, clothing, elastic bands, and numerous medical and dental devices.


Guidelines for health care workers

Help prevent latex sensitivity

  1. Learn to recognise the symptoms of latex allergy: skin rash;urticaria;flushing; itching; nasal, eye or sinus symptoms; asthma; and (rarely) shock.
  2. When wearing latex gloves, use only approvedbarrier cream.

    After removing latex gloves, wash hands thoroughly and dry thoroughly.

  3. Wear nitrile or polyurethane gloves where practical. If wearing latex gloves, select non-powdered options.
  4. Use appropriate work practices to reduce the chance of reactions to latex.
  5. Practice excellent housekeeping: frequently clean areas and equipment contaminated with latex-containing dust.
  6. Care should be exercised when removing latex gloves to reduce the risk of exposure of latex allergens to self and/or colleagues.


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