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OMG! Information about latex allergy!

Worldwide there is no natural latex without allergic properties! Regardless of what a latex sheet or fashion designer told you. Every natural latex sheet/clothing can cause allergic reactions. In natural latex there are proteins which can cause that allergic reaction.  If you are allergic to latex condoms and gloves, you probably are allergic to our latex as well. If you want more information about latex allergy please contact your general practitioner. We cannot be held responsible for any allergies caused by the use of our latex.

We translated this Dutch information with Google Translate from Dutch to English. So there will be mistakes in it. It is writen with K. Vissers-Croughs, dermatologist and we found it on the website of Medial Center Parkstad.

If you are not sure you (or your clients) have a latex allergy, please contact your general practitioner!

Latex allergy

By: K. Vissers-Croughs, dermatologist.

Allergy to natural rubber latex is an increasing problem in health care. in the (para) medical professions in particular, the prevalence is high (7-10%). Latex hypersensitivity can lead to local skin problems (usually caused by a type IV allergy to rubber additives), but also to type I allergic reactions, ranging from urticaria and rhinoconjunctivitis, to asthma and even anaphylactic shock. The cause is for an important part in the use of cheap gloves with a high content of latex proteins.

What is latex?

Natural latyex is a milky liquid obtained from the rubber tree Hevea brasiliensis that grows in tropical areas. The milk juice consists globally of 36% rubber, 1.5% proteins, 2.5% sugars, lipids and minerals and 65% water. To this, many chemical additives are added to the production process of rubber articles, such as accelerators, antioxidants and vulcanization agents. It is the natural proteins and chemical auxiliaries that possess allergenic properties.

Allergy to latex

Most allergic reactions are the result of a type IV allergy according to Gell and Coombs (delayed type of allergy, contact allergy). With a few exceptions, this contact-allergic reaction is not caused by latex itself, but by the excipients (such as thiuram, paraphenylene diamine, mercapto derivatives and carba sizes).

The allergic reactions to latex protein itself, which this article deals with, are the result of a type I allergy (direct type allergy) mediated by IgE antibodies specific for the different latex proteins. Irritation by and contact allergy to rubber gloves, incidentally, are significantly more common than type I allergic reactions to natural latex.

Mode of exposition to latex allergen

Exposition to the allergen can take place via skin and mucosa. The allergen can be transmitted by direct contact, but also by inhalation of rubber allergen-containing particles. For example, powdered latex gloves have shown that the glove powder (maize starch) can function as a carrier for the latex allergen and such latex particles can therefore be measured in the air.

Symptoms of latex-protein allergy

The clinical picture of allergic reactions to latex is very different and depends, among other things, on the manner of contact with latex and the amount of bioavailable latex antigen. Symptoms can range from a mild reaction with itching, redness, blisters or localized urticaria to severe and sometimes life-threatening anaphylactic shock.

Because many latex sensitized individuals are atopic and / or have hand eczema, local symptoms are often not recognized and interpreted as exacerbation of the eczema by wearing latex gloves. Latex allergen-containing glove powder that floats through the air generally leads to conjunctivitis, rhinitis, asthma and in severe cases to anaphylactic shock.

The most serious reactions are usually caused by contact of latex with mucous membranes. Oral, vaginal or rectal exposure to latex gloves may give rise to urticaria, angioedema and shock. Contact with gloves during a surgical operation or delivery can also cause serious allergic symptoms. In the event of misunderstood (anaphylactic) reaction during surgery, a possibility of latex allergy should always be considered (10% of the anaphylactic reactions during anesthesia are based on latex allergy).

Epidemiology

The prevalence of latex allergy in the general population is less than 1%. In certain risk groups, however, the frequency is considerably higher, as with:

  • Health care workers (7 to 10%) who regularly wear gloves, such as dentists and dental assistants, cutting doctors, OR and IC staff and cleaning staff; predisposing factors in this are atopic predisposition and hand eczema;
  • Patients who undergo repeated surgical interventions, catheterization or manual faeces, especially patients with spina bifida, urogenital disorders or paraplegia;
  • Production workers in the latex processing industry.

Explanations for the rapid increase in prevalence are sought in the following factors:

  • Increasing sensitivity of the Western population to allergies;
  • The tap of young rubber trees that deliver unripened latex with an elevated protein content, together with a strong reduction of the washing times of the end products (higher and cheaper production) in order to meet the fast-growing demand at the beginning of the AIDS crisis;
  • In the same period, switching from steam vulcanization (hot water or steam makes proteins harmless) to vulcanization in hot air tunnels with a lower temperature;
  • The increased use of tropical fruits whose allergens (eg banana, avocado, kiwi) have cross-reactivity with latex allergens.

Which rubber products contain latex?

It is important to distinguish between:

Natural rubber products made from raw rubber. These contain no or negligible little latex protein.

Natural rubber products made from liquid latex. The quantity of latex proteins in these products depends strongly on the way in which the latex has been treated, and on the care with which the end products have been washed in the final phase of the production process. Serious allergic reactions are only to be expected on products from the second group.

By far the most reactions are caused by latex gloves. Other items that regularly cause allergic reactions are condoms, balloons, patches, catheters, catheters with rubber balloons used in intestinal examination, dental and orthodontic materials and anesthesia systems.

Nutritional allergies in patients with latex allergies

Of all patients with an IgE-mediated latex allergy, 50% also have allergic reactions to certain fruits and nuts, especially banana, avocado, kiwi and chestnut. This is based on a cross reactivity. Also for other fruits (melon, pineapple, peach, passion fruit, papaya, fig), nuts (walnut), vegetables (tomato, potato) and buckwheat an allergy has been described in connection with latex. The clinical signs of these food allergies may be limited to irritations and swelling of the lips and in the oral cavity. But extensive urticaria, bronchospasm, gastrointestinal symptoms and anaphylactic shock also occur.

Diagnostics

A careful history is crucial to detect a latex allergy. Suspicion of a latex allergy exists when a patient has had itching, urticaria, edema, rhinitis, or conjunctivitis when exposed to gloves, condoms, balloons or other latex dip products.

Suspicion also exists when patients indicate a food allergy for, for example, banana, avocado, kiwi and sweet chestnut. In atopic patients with a hand eczema, patients who have had an anaphylactic reaction during an operative procedure and patients from groups with an increased risk with a positive or dubious history, the existence of a latex allergy must be demonstrated or excluded.

The following tests are available:

Latex IgE-Rast: the antigen is incubated with the serum of the patient. The sensitivity of this test is low, 40 to 70%; a negative Rast therefore does not exclude a latex allergy;

A prick test with latex antigen. At the outpatient clinic we use standardized extracts from ALK. This test is considered very reliable;

Glove provocation: only in exceptional cases, when the tests are negative and there is a strong suspicion of latex allergy. This provocation is not without anaphylactic hazards and should only be performed on a ward with experience in treatment of anaphylaxis. In patients with hand eczema and suspicion of latex allergy, epicutaneous allergic examination should always be performed to rule out concomitant contact allergy to rubber additives

Secondary prevention

Patients with a proven latex allergy should carry a medical warning card. They must consistently avoid latex-containing products. For emergencies they must be in possession of an antihistamine and possibly even an Epipen.

There are suitable gloves on the market made of vinyl, chloroprene, nitrile or tactylon. Examples are:

  • Operation gloves: Allergard, Dermaprene, Duraprene, Elastyren, Neolon, Tactylon and Neotech;
  • Examination gloves: Ethiparat, Tru touch, Glovex, Tactylon and Sensicare;
  • Household gloves: Sempersoft and Semperstar.

A suitable condom is EZON, made of polyurethane.

Caregivers with severe latex allergies should avoid areas where powdered gloves are regularly used. An alternative possibility is that the colleagues (latex) use gloves without powder.

In surgery patients who are familiar with a latex allergy, the following measures must be taken:

  • Patient is the first to plan for the operation program;
  • To eliminate as many latex sources as possible, especially those that the patient will come into contact with;
  • Possibly preventive pretreatment (clemastine, dexamethasone) if optimal conditions are not met. This does not exclude the occurrence of an anaphylactic reaction.

Primary prevention

In healthcare, this should primarily be sought in a safe gloves policy. In non-sterile procedures, especially when mucosal contact occurs (oral, vaginal, rectal), use vinyl or plastic gloves. In sterile operations use unpowdered latex gloves with a low protein content.

Latex and Atrium MC

For a safe gloves policy, a DMU gloves (Decision Making Unit) was set up in 1998 with the assignment to look for high-quality gloves that meet the above-mentioned requirements. Based on their findings, the following gloves will be tested in a few departments during the course of this year:

  • Supreme: a powder-free latex protein-poor surgical glove;
  • SensiCare PowderFree: unpowdered vinyl examination glove;
  • Neotech: a powder-free non-latex glove, only for use with proven latex allergy.

Work is also being done to establish a latex-safe operating room for the treatment of patients with a latex allergy. Acute trauma patients in whom a reliable history is not possible, and patients with a strongly increased risk of development of a latex allergy (such as children with spina bifida, urogenital disorders, etc.) will then preferably be treated in such an operating room as well.

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