How Does a Latex Allergy Develop?

Natural rubber latex allergies happen when a person develops hypersensitivity to the proteins in latex-containing products. More than 40,000 consumers, medical, and industrial products contain natural rubber latex. The allergy develops over time with exposure, making it important to be aware of symptoms so that future exposures can be avoided.

What is a latex allergy?

An allergy is the exaggerated response of the immune system to a substance. According to the Allergy and Asthma Network, approximately 1 to 6 percent of the general population has a natural rubber latex allergy, but the proportions are much higher among medical and dental workers where up to a third of the staff can have a documented latex allergy. Restaurant workers may also have a higher likelihood of developing a sensitivity to latex due to frequent contact with latex-containing gloves.

Reactions to natural rubber latex range from a rash to immediate anaphylaxis, usually caused by contact with a mucosal surface, such as the lungs, eyes, mouth, nose or urinary tract.

More than 40,000 household and industrial products contain latex. For those with a latex allergy, awareness of which personal and medical products contain latex is important. Strategies to communicate a latex allergy to medical staff can help reduce the likelihood of accidental exposure.

When did the latex allergy epidemic start?

Latex allergies began to increase in the 1980s with the introduction of universal precautions in healthcare. The need for personal protective gear triggered a surge in the demand for gloves.

As awareness increased, risk reduction strategies were implemented to reduce exposures in healthcare. Over the past 20 years, most surgical suites have become “latex free.” Despite efforts to promote precautions, exposures continue to happen, often during surgery.

Natural rubber latex medical products

While most people immediately think of surgical gloves, a study by the Pennsylvania Patient Safety Authority published in 2018 found that most inadvertent latex exposures occurred due to contact with tubing for urinary catheters. Latex is also found in:

• Intravenous delivery of medication;
• Airway tubes;
• Syringes;
• Physical therapy exercise bands and balls;
• Stethoscopes;
• Bandages;

Household products containing latex

Latex can also be found in many other household products including:

• Prophylactics. Condoms and femidoms.
• Baby products. Bottles, nipple protectors and pacifiers.
• Toys and party products. Balloons, rubber toys.
• Sports equipment. Sneakers, resistance bands.

Clothing can contain latex as well. Some examples include clothes with fitted cuffs, such as rain jackets or the elastic waistbands and leg openings of underwear.

Can foods contain latex?

Yes, certain foods are linked to latex reactions, such as bananas, kiwi, avocado, and chestnuts. This so-called “latex fruit syndrome” is the cross-reaction of latex allergens with plant allergens. In a study among 16 patients with a latex allergy, 8 reported symptoms after eating bananas or undergoing a skin prick test.

What healthcare procedures carry the highest risk for latex exposure?

The Pennsylvania Patient Safety Authority found that indwelling urinary catheters were associated with 7.7 times more latex exposures than gloves. This may be because contact with mucus membranes, such as the urinary tract, tends to cause more severe reactions than contact with the skin—such as with gloves.

In the surgical suite, latex exposure was the second leading cause of anaphylaxis during anesthesia.

Other exposures may include the rubber stoppers used in vials. The CDC maintains a list of latex in vaccine packaging.

Causes of an allergic reaction

When your body is exposed to the proteins in natural rubber latex, the immune system reacts as if the proteins are dangerous. Histamines are released, causing a range of symptoms, from a rash to life-threatening systemic reactions.

Who is at risk for a natural rubber latex allergy?

People who are born with a congenital defect in the development of the spine—spina bifida—have many medical procedures and are exposed to latex often and early in life.

Similarly, people who are exposed to latex frequently, such as those having multiple medical procedures or working in healthcare, may develop a latex allergy. Those with a family or personal history of allergies are also at an increased risk.

Symptoms of a natural rubber latex allergy

A range of symptoms can occur, from skin irritation to a more serious allergic reaction which can rarely be life-threatening. Three kinds of reactions can occur:

1. Irritant contact dermatitis. This looks like red, dry cracked skin, usually on the hands, and can be itchy. This reaction is not an immune-system response to the allergen but is due to frequent hand washing or irritation from contact with the powders used to help put on gloves.
2. Allergic contact dermatitis. This looks like a poison ivy rash and is caused by the chemicals in latex manufacturing. This type of reaction, also called a cell-mediated (Type IV) allergy, is not life-threatening but is still serious. A rash or blisters can arise within 24 to 48 hours.
3. Immediate hypersensitivity reactions. These are serious and include the potential for anaphylaxis, a life-threatening reaction in highly sensitive people. Symptoms to look for include hives, difficulty breathing, wheezing, hives, vomiting, dizziness, low blood pressure, loss of consciousness, confusion, and a rapid or weak pulse. Also called IgE-mediated (Type I) allergies, these reactions are due to the proteins in natural rubber latex. Anaphylaxis rarely happens on the first exposure, though. This is why it is important to note whether you have any symptoms when exposed to latex sensitivity because these reactions tend to build with repeated exposures.

What can patients and family members do to ensure safety during medical procedures?

• Communication. Better communication between patients and medical staff, increased awareness among staff, and better supply management are necessary to reduce healthcare-associated risks.
• Care teams. Failure to communicate allergies during handoffs between care teams is a risk for latex exposure. Patient medical records should include documentation of a latex allergy, and the presence of an allergy should be widely communicated during medical procedures.
• Visible signs. In addition to notation in the electronic records, visible alerts should be used, such as an allergy wristband, chart sticker, paper records, and door signs.

What can medical staff do to prevent an allergic reaction?

Staff perception is important. Many providers are aware of latex allergies but may not specifically ask patients if they have a latex allergy. Some clinicians may feel that latex allergies are not very serious, but forget that it is the cumulative exposure which matters.

Patients may also forget to mention their latex allergy and instead focus only on drug allergies. In a study conducted by the Royal College of Surgeons of England, 38% of patients forgot to disclose their latex allergy when asked a general question about having any allergies, but 100% reported when asked specifically if they were allergic to latex. In addition to drug allergies, clinicians should ask about latex, iodine, and elastoplast sensitivities.

Can a life-threatening reaction be treated?

Yes, medical facilities are equipped to treat anaphylaxis with epinephrine and anti-histamine if appropriate. Vital signs will be monitored and other treatments will be provided as needed, such as oxygen.

People who have a latex allergy should carry an epinephrine auto-injector and inform medical staff of their latex allergy.