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For people who have a latex allergy, a visit to a restaurant, hotel, or health care facility can be frightening. According to estimates from the National Institute of Allergy and Infectious Diseases, up to 6% of Americans have latex allergy. Latex, a natural rubber manufactured from the milky fluid in the rubber tree (Hevea brasiliensis), is used in a multitude of settings, especially where latex gloves are required for protection. Latex allergy is an immunologic reaction to certain proteins retained in the finished latex rubber product. Between 1988 and 1992, the Federal Drug Administration (FDA) received more than 1000 reports of adverse health effects from exposure to latex, including 15 deaths due to such exposure.

Kevin Kelly, MD, the chair of the Latex Allergy Committee for the American Academy of Asthma, Allergy & Immunology, and formerly Professor of Pediatrics and Internal Medicine (Allergy & Immunology) and Associate Dean of Clinical Affairs at the Medical College of Wisconsin, explains the dangers of latex allergy: "Health care workers who have a latex allergy can develop hives or nasal symptoms when exposed to latex. Of health care workers who have a latex allergy, about half develop asthma, which can affect them for life. And children who are allergic to latex can develop even more severe symptoms when exposed, such as anaphylactic shock." The amount of latex exposure needed to produce sensitization, or an allergic reaction, is unknown. Symptoms usually begin within minutes of exposure, but they can occur hours later and can be quite varied.

The use of latex is widespread in health care settings. The latex products that are most likely to cause medical problems are those that are made by a dipping process; about 12% of the latex products in the world are made this way. Because these products require lower heat to cross-link the rubber, there is significantly higher protein allergen content in them. Dipped latex is found mainly in latex gloves, but can also be found in other products. "Latex gloves are used in multiple situations," says Dr. Kelly. "They are used inside most operating rooms, and in many device kits. Latex is found in the tops of multiple-use medication vials, such as those used by the pharmacy for injectable medications, in bladder catheters or gastrostomy tubes, to name just a few examples."

In non-health care settings, latex is being used more frequently as well. Workers in restaurants, housekeeping, food service companies and even airports are required to wear gloves, which are usually made of latex. "The average consumer is getting more exposure to latex, and we're very concerned about that," reports Dr. Kelly.

Many latex gloves used in health care settings and elsewhere are coated with cornstarch powder, which makes the gloves easier to put on and remove. Unfortunately, this powder binds the allergenic proteins from the gloves and when they are put on or removed, particles of latex protein powder become aerosolized and can be inhaled, affecting any number of people in the facility who are allergic to latex.

In addition to health care workers, those at high risk for allergic reactions to latex in a health care setting include those who have had multiple surgeries, or those who had surgery early in life. Patients with spina bifida fall into both these categories, and Dr. Kelly reports that in the mid-1990s, up to 68% of spina bifida patients were sensitized to latex. Because of their genetic makeup, people who have other allergies can also have a higher risk of developing a latex allergy. Other people at risk are patients who require frequent contact with latex, such as those with tracheostomies, premature infants, or others with frequent latex exposure.

Not all reactions to latex are allergic in nature. The most common reaction to latex products is irritant contact dermatitis, the development of dry, itchy, irritated areas on the skin, usually the hands. This reaction is caused by irritation from wearing gloves or by exposure to the powders added to them.

Allergic contact dermatitis (sometimes called chemical sensitivity dermatitis) can result from a delayed immune response to the chemicals added to latex during harvesting, processing, or manufacturing. These chemicals can cause a skin rash similar to that of poison ivy. Neither irritant contact dermatitis nor chemical sensitivity dermatitis cause life threatening allergy the same way that protein from latex does.

"There is no FDA-cleared skin test for latex allergy," says Dr. Kelly, "so we diagnose with a blood test, a full medical history, and a physical exam." Treatment, very simply, is avoidance of latex. Research has been done on desensitization to latex as well, but so far it has been plagued by adverse reactions to the desensitization material. "Desensitization involves giving a patient increasing exposure to the latex protein allergen, but there have been too many severe reactions to latex, so that process is very difficult."

The good news is that the number of patients and health care workers who have had allergic reactions to latex is down since the mid-1990s. At that time latex allergy cases peaked, and 8% to 12% of people who used latex were sensitized to it. Now, says Dr. Kelly, that number is down to about 1%. This is mainly due to a change in the way latex gloves are manufactured. The new process involves thoroughly washing the finished latex product or coating it to reduce the allergen content and release of the product. "This is very effective, and has led to a 1000-fold drop in the allergen content of the gloves," says Dr. Kelly. Manufacturers also offer powder-free latex gloves, which lessen the amount of allergen that is in the air in hospitals and other settings where latex is used.

There are also latex substitutes available, which are becoming more popular. Many hospitals and health care providers are using Nitrile gloves, which are very similar to latex as far as barrier protection. Dr. Kelly reports, "It's no longer uncommon to see Nitrile gloves being used in a hospital, especially if it's helpful to a patient with latex allergy." The Transportation Security Administration workers at airports frequently use Nitrile gloves for their inspections. PVC gloves are also available, but those have shown an inferior barrier protection than Nitrile or latex.

Dr. Kelly says that these developments have been a boon to those who use latex gloves. "A large number of health care workers are back to work now, with no fear of allergic reactions or asthma," he reports. "Hospitals are more familiar with latex allergy now, and patients don't have to be afraid to go into the hospital." If you have a latex allergy, it's important to remember to wear a medical alert bracelet or necklace. If you suspect you might be allergic to latex, be sure to get tested, and avoid contact with latex in the meantime.

This article includes information from the US Centers for Disease Control and Prevention, the US Department of Labor, Occupational Safety and Health Administration, and the National Institute of Allergy and Infectious Diseases.

Article Created: 2005-08-10

Article Reviewed: 2005-08-10 

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.