Latex Allergy

Allergy to Latex: What do We Really Know?

Much attention has been given to latex allergy in recent years. Some things are known about natural rubber latex (NRL) allergy, and there is a lot that isn’t yet known about this topic. Because of its potential importance as a public health issue, due to the prevalence of NRL in our modern environment, questions about latex allergy are likely to continue to arise. The following discussion is by no means complete. There are a number of web sites and other places that have additional information on this topic. Some are listed below and others appear on the Patient Questions page. Patients are cautioned to read this information with more than a little skepticism. Remember that as with so many other medical issues our knowledge is subject to change as new information is revealed, and generalizations about large groups of patients don’t always apply equally to each person.

Natural Rubber Latex (NRL)

	NRL is a milky fluid obtained from the rubber tree, Hevea brasiliensis.
	It was discovered in Brazil in the 17th century. It now mostly comes from Asia.
	Ammonia is often added as a preservative, and a variety of accelerators and antioxidants are added in processing.

History of Latex Allergy

As you can see, latex has been in use in health care, since the 19^th century. Despite this, as well as the use of latex in a variety of products, latex allergy was not recognized, other than a few isolated cases in the early part of the last century, until 1979. The first modern report from the United States came in 1989. It was not until the early to mid 90’s that this problem began to be understood.

	1896--Halsted, a famous surgeon, introduced latex surgical gloves.
	1927-- Stern described generalized urticaria from a dental prosthesis
	1979-- Nutter described contact urticaria from household gloves
	1980-- Forstrom described contact urticaria from surgical gloves

Why are people now becoming more “sensitized to latex”, or having more problems with exposure?

The short answer is “Nobody really knows”. A simple explanation is that with increased concerns about blood borne illnesses like AIDS, there is a lot more latex used and a lot more latex exposure. That might explain an increased incidence of symptoms due to latex allergy, but that alone cannot explain why latex allergy was essentially nonexistent for most of the 20^th century. It also doesn’t explain why scientific studies have failed to show a consistent relationship between latex glove use and “sensitization”. Doctors are still trying to figure this out. This list of possible explanations is likely to grow, and it may not even include the true reason that we are now having a problem, but some theories to explain this include:

	There had been changes in manufacturing to meet the increased demand brought on by concerns over blood body fluid borne diseases.
	The latex from Asia is somehow different than that from South America.
	There is increased allergy (the medical term for this is atopy) in the general population. Some scientists believe that as we have treated infections more promptly, beginning with the introduction of antibiotics in the 1940’s, our immune systems have become less “defense” oriented, creating more problems with allergies in general. This is supported by what appears to be an overall increase in a variety of allergic diseases.
	There is more generalized exposure to latex. For example, radial tires, which have become popular in recent years, have been thought by some to put more latex into the air than the old bias ply tires, but other scientists have not been able to confirm those results.
	Exposure to other foods or plants, such as avocado, kiwi, chestnut and banana, has lead to sensitization to latex. Latex is also a plant product. Several plants “cross react” with latex in the laboratory, and patients who are allergic to latex may react when they eat certain foods.

How do I prevent latex allergy?

Again, nobody is really sure. Atopic people (those who tend to become allergic) seem to also be more likely to make antibodies (become sensitized) to latex. While some studies initially suggested that health care workers were more commonly sensitized to latex, many subsequent investigators have not found that. If there is an increased risk for health care workers over others in the population, that risk is small and has yet to be quantitated. Healthcare workers also live with the knowledge that they work with blood and body fluids that can transmit potentially serious and even fatal illness. The doctor, nurse, or technician often must handle potentially infected material to do their jobs. Selection of an alternative protective barrier, which may not offer the same level of protection as latex, is not a casual decision to make.

At least one study at a large health care center found that latex sensitivity was no higher among workers who used latex regularly than those who did not. Factory workers involved in latex product manufacturing in Asia do not display a particularly high incidence of latex related problems. Many more people have evidence of latex allergy by skin test or blood test than have symptoms on exposure. It seems likely that healthcare workers have had more symptoms because they have had more opportunity for exposure. This is similar to a ragweed allergic forest ranger being more likely to have trouble from ragweed allergy than her equally allergic sister who works in an air-conditioned office. The National Institutes of Occupational Safety and Health (NIOSH) issued guidelines in 1997, which can be found at http://www.cdc.gov/niosh/98-113.html. These are not the final answer, but they may be a useful starting point.

Where else can I learn about latex allergy?

As with other healthcare problems, ask your doctor. There is nothing “magical” about latex allergy. A few patients have severe problems, while in most cases sensitized individuals have moderate, little or no difficulty. Often just switching gloves to a non-latex substitute will eliminate symptoms. Several medical centers have reported markedly decreased problems with changes to gloves that are less or not powdered or have lower protein content. Just as with allergy to cat, milk, dust mite, or ragweed, your individual sensitivity, lifestyle, and the way your body reacts to what you are allergic to will determine how you should approach the issue of latex allergy.

If you are a patient of Asthma, Allergy & Pulmonary Associates P.C. or would like to make an appointment to see Dr. John Cohn, contact our office. The Occupational Safety and Health Administration (OSHA) has a useful web site, http://www.osha-slc.gov/SLTC/latexallergy/index.html, with information on this topic. Our Patient Questions page contains links to professional organizations, which have educational sections. Latex Allergy Links also maintains an unedited directory of web sites that offer information about latex allergy—read them but with care!

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