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 People have varying degrees of sensitivity to latex that depend on several factors including the amount and type of latex exposure. Those who are most at risk of suffering from latex allergies include individuals who come in frequent contact with latex, mainly health care workers, and those who suffer from other allergies. Physicians can help diagnose a latex allergy in their patients and advise them in prevention and treatment strategies. In general, a person's allergic reactions to latex become progressively worse with continued exposure, requiring less protein to trigger a reaction. Conversely, decreased exposure to latex can decrease a person's sensitization to latex.4 The severity of a particular allergic reaction to latex depends on several factors:
Because the mucosa and internal body tissues absorb more of the protein in latex, their exposure to latex can accelerate the development of sensitivity. Their susceptibility also helps account for the exceptionally high risk for latex allergies experienced by patients with spina bifida and others whose bodies regularly undergo invasive procedures with medical equipment that contains latex. This group also includes patients who have multiple surgeries or tracheotomies. The use of powder, such as the cornstarch often used to coat the inside of latex gloves, exacerbates latex exposure. The latex protein can adhere to the powder, and as gloves are snapped on and off, the latex-coated powder becomes airborne. As the latex particles are dispersed by the powder, they may contaminate entire rooms by lingering in the air and being inhaled, or by landing on people, equipment, and surfaces. As they are inhaled, they may cause respiratory problems such as asthma and allergic rhinitis, not to mention anaphylaxis. Particles may land on mucosal areas, which are particularly susceptible to latex sensitization. For these reasons, health care professionals, hospitals, policy makers, and even manufacturers are pushing the use of nonpowdered gloves. Individuals most at risk of suffering from latex allergy include those who are frequently exposed to latex and those who have other allergies.
The highly exposed
Most experts estimate that the number of health care workers with latex sensitization ranges from 8% to 17%, or as many as 935,000.5,6 Estimates of the number of patients with spina bifida who are allergic to latex run as high as 67%.7,8
People with other allergies Atopy is the increased tendency seen in some individuals to produce IgE antibodies to innocuous substances. The signs of allergic hypersensitivity to latex can include many of the allergic symptoms listed previously, especially if they occur after contact with balloons, rubber gloves, or other latex products, or after dental or other medical examinations or procedures. If latex allergy is suspected, people should consult their doctors about diagnosis and precautionary measures. Some physicians may perform various tests to see whether exposure to latex proteins causes allergic symptoms. These tests have not yet received formal FDA approval, however, and may carry the risk of severe allergic reactions. Consequently, they should be performed only in medical facilities that are prepared to treat anaphylaxis with epinephrine and are stocked with emergency resuscitation equipment. Several FDA-approved blood tests to detect latex antibodies are available and carry no such risk, but they may require waiting several days for the results. As with other potentially life-threatening allergies, the primary method of protection is avoiding contact with latex and being prepared to treat anaphylactic emergencies with epinephrine injections and prompt medical attention. Avoidance is crucial in guarding against further sensitization and severe allergic reactions to latex. People who have allergic symptoms after contact with latex should substitute latex-free versions of latex products in their homes and workplaces and should alert their health care providers that they have to be treated with latex-free equipment. Although latex seems to be everywhere and is difficult to avoid entirely, avoidance is becoming easier as health care facilities, professional organizations, consumer advocacy groups, policy makers, and even manufacturers are working to make latex substitutes or at least powder-free, low-protein latex products more readily available. Latex-free trays, examining and operating rooms, and dental and emergency equipment are becoming more standard. Vinyl gloves are available, though expensive, and manufacturers are working on better, more affordable synthetic substitutes. Since not all allergic reactions can be avoided, and because allergic reactions can progress quickly to deadly anaphylaxis, the American Academy of Allergy, Asthma and Immunology suggests that people who are allergic to latex consult their doctors about carrying a form of self-injectable epinephrine, such as EpiPen® or EpiPen® Jr epinephrine auto-injectors, and administering it at the first sign of a severe allergic reaction.16 Epinephrine, or adrenaline, works rapidly to reverse the symptoms of anaphylaxis by relaxing smooth-muscle tissue in the lungs, increasing the heart rate, combating urticaria, and reducing the swelling of the mouth, throat, and face. The side effects of epinephrine may include palpitations, tachycardia, sweating, nausea and vomiting, and respiratory difficulty. Cardiac arrhythmias may follow the administration of epinephrine. Physicians should instruct their patients about the circumstances under which this life-saving medication should be used. Many physicians also recommend that antihistamines such as diphenhydramine be administered to lessen the symptoms of an allergic reaction, but antihistamines should be taken only in addition to epinephrine for the treatment of anaphylaxis and should not be considered a substitute for it. Only epinephrine can halt the potentially deadly effects of anaphylaxis. Even after epinephrine has been administered, emergency medical treatment should be sought at once because severely allergic people who have experienced anaphylaxis may need emergency respiratory or cardiac care, or even to be resuscitated if they stop breathing altogether. More commonly, these patients will need professional care to determine whether additional epinephrine, steroids, antihistamines, or other treatments are required. In any case, follow-up diagnosis and care by medical professionals after the administration of epinephrine is critical to recovery. Delayed or secondary reactions do occur, and patients should remain under medical supervision for at least 4 hours after an episode of anaphylaxis.17 Additionally, wearing a medical identification bracelet describing the patient's allergies and susceptibility to anaphylaxis can help ensure prompt, proper treatment during an emergency.
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