Rubber Latex Allergy

Skin problems associated with rubber contact have been known for many years. The commonest is Irritant Contact Dermatitis. It is due to maceration of the skin, often associated with sweating under occlusion. It is seen in association with the wearing of protective rubber gloves and can progress to a low grade eczema with itching, redness and scaling.

Allergy to the chemicals used to process rubber produces a skin reaction similar to eczemawhich is known as Allergic Contact Dermatitis. This is seen less commonly than irritant contact dermatitis and tends to be more florid, producing blistering and weeping as well as redness and itching. It progresses to dryness and scaling as it heals. It is caused by a Type 4 delayed immunological reaction. This type of reaction is not life threatening although it is extremely itchy and uncomfortable.

In the last fifteen years, we have seen an increasing number of immediate allergic reactions occurring very soon after contact with latex, due to allergy to the protein content of natural rubber, known as rubber latex.

This type of allergic reaction is the same type that occurs in hay fever, allergic asthma and peanut allergy. It can vary in severity from a mild nettlerash on contact, to severe anaphylaxis with respiratory symptoms and collapse. It is potentially fatal but deaths are fortunately very uncommon. Unlike the Type 4 reaction, it is not delayed and can occur within minutes of contact. This immediate type of reaction is caused by the production of allergic antibody known as IgE. We know that more than 6% of the general population have now developed allergic antibody to natural rubber latex protein and that approximately 10% of health personnel, who are occupationally exposed to rubber gloves and other rubber articles have been found to suffer symptoms on contact.

This fact sheet is mainly concerned with what you need to know about Type 1 immediate allergy to natural rubber latex.

Symptoms

In sensitive individuals, symptoms are variable and usually occur after skin or mucus membrane contact with rubber. They can also occur after inhalation. Severe itching, urticaria and nettle rash (hives) are produced, usually within minutes of contact. This may progress to sneezing, wheezing, dizziness and/or light headedness and collapse. Deaths have been recorded but are very rare.

Inhalation from particles in the air, such as latex adsorbed onto rubber glove powder or powder in balloons, may produce mainly respiratory symptoms, although progression to more serious symptoms may occur.

The severity of the symptoms varies from patient to patient depending on the level of allergic sensitivity suffered and the amount of latex protein with which the patient has been in contact. The potential for progression to a severe reaction should always be kept in mind even if initially a reaction appears mild. Reactions may vary in degree from patient to patient and from time to time in any particular patient.

Contact of natural rubber latex protein with mucus membranes is particularly hazardous since greater amounts of latex protein are absorbed into the system. This is of significance when medical examination of body cavities is carried out during dental examination and treatment, and during surgical operations when the personnel involved are wearing rubber gloves.

Who is at risk?

Certain groups of people are more likely to develop allergy to natural rubber latex than others and this depends on both their innate pre-disposition and the degree of exposure.

These groups are:

1. People predisposed to allergy (usually in the form of eczema, asthma, hayfever and food allergy). Natural rubber latex is obtained from the tropical tree Hevea brasiliensis, and many of the proteins it contains are found in other plants. Certain tropical fruits contain the same protein molecule as natural rubber latex and patients sometimes suffer allergic reactions by cross-reacting to these. The commonest fruits causing problems in this way are avocado, banana, kiwi fruit, melon and chestnut. Others such as peach and tomato have been reported, but it is not yet clear how many are true cross-reactions and how many are due to separate allergy.
2. Patient with hand eczema.
3. Workers in the rubber industry and health care workers.
4. Patients who have undergone multiple surgical operations or other invasive procedures. Patients with meningo-myelocele or urogenital abnormalities have a particularly high incidence of allergy to natural rubber latex.

If you have symptoms that are suggestive of allergy to rubber or rubber chemicals you should consult your doctor who may refer you to an allergy specialist.

How is it diagnosed?

The diagnosis is made by carefully assessing your history and the nature or your reactions along with either skin prick tests or blood tests or both. Prick testing is not painful. If a particular rubber article has caused problems, it will help your doctor and specialist if you take it along to the consultation with you, since rubber articles differ in their protein composition and you may be allergic to a protein not present in all of them. If you have a skin reaction, then you will probably have a patch test applied to your back to identify whether your reaction is irritant or allergic.

Management

Once the diagnosis of allergy to natural rubber latex is established, then avoidance is the best way to prevent reactions occurring. In practice, this is almost impossible since rubber is so widely used, although there are less likely to be problems from old rubber than new. The potential for rubber latex to elicit an allergic reaction (its allergenicity) decays with time and the most potent articles are those most recently produced, particularly if they are powdered.

A decision will be made as to whether you should carry Epinephrine (Adrenaline) for self-administration. If so, you will be shown how to use it and advised when it should be used. If an adrenaline auto-injector pen is used, you should always call an ambulance and go to hospital for observation and possibly additional treatment.

You may also be given antihistamines to carry and will be advised to wear an emergency bracelet, necklace or locket recognised as one worn by patients suffering from a life threatening medical condition. Medic-Alert bracelets and Talisman lockets are both easily recognised, well known and useful.

Your doctor, dentist, hairdresser, masseuse and anyone who may attend to you wearing rubber gloves should be informed of your problem and asked to use an alternative form of hand protection. If you have to attend hospital, you should inform staff in advance and again when you arrive. It is sensible to check with personnel before each procedure that they are aware of your allergy.

Some patients are advised to carry around a pair of large size of non-rubber sterile surgical gloves in case of emergency.

It is important to examine your home for rubber articles, such as gloves, rubber bands and erasers. Do not use rubber contraceptive diaphragms or rubber condoms.

Alternatives are available for many rubber products:-

• There are several types of synthetic materials used for protective gloves; PVC gloves for household use are widely available and safe. If you have been advised to carry non-latex gloves for use in an emergency, it is sensible to carry a large size. Suitable gloves are:-Ansells' Dermoprene, Elastryren, Johnson & Johnson Allergard, Neolon
• The female condom is made from polyurethane and is safe for you to use. Avanti non rubber condoms are available from chemist shops and are also safe
• Check before buying any article which could be rubber whether it contains rubber latex. This is particularly important for articles which will be in contact with your body
• Erasers, swimming hats, goggles and flippers are all available in non-latex materials

The Future

We know that in some types of allergy, the body can develop tolerance over time and the reaction will diminish. At present, we do not know whether this happens with allergic reactivity to rubber latex. You should therefore continue to take all necessary precautions to avoid rubber latex until more is known about this.

In the meantime, much research and active change is going on in the rubber industry to reduce latex allergenicity by modification of production methods. Areas where people could be at risk in hospitals, GP surgeries and elsewhere are being made safer. Current research is directed towards trying to prevent those people who are pre-disposed to allergy from developing allergic disease, and towards modification of allergic disease in those already suffering from it.