Natural rubber latex allergy

Related Terms

Allergen, allergic, allergic reaction, allergic response, allergy, allergy shots, anaphylactic reaction, anaphylaxis, antibodies, antibody, antihistamines, decongestants, histamine, hives, hypersensitivity, Ig, IgE, immune, immune defense system, immune-mediated, immune response, immune system, immunoglobulin, immunoglobulin E, immunotherapy, inflammation, irritant contact dermatitis, latex, leukotriene inhibitors, radioallergosorbent test, RAST, rubber, rubber tree, sensitized, sensitization, skin test, trigger, white blood cells.

Background

Latex allergy occurs when the body's immune system overreacts to proteins found in natural rubber latex. These proteins, also called allergens, are most often found in certain types of rubber gloves and latex condoms.
Latex comes from the rubber tree, which grows in Africa and Southeast Asia. Nearly half of patients who are allergic to latex are also allergic to certain plants that are related to the rubber tree, including avocado, banana, kiwi, and chestnuts.
Symptoms of a latex allergy may include runny nose, sneezing, watery eyes, hives, and skin rashes. Some patients may experience a severe allergic reaction called anaphylaxis. This reaction, which may lead to low blood pressure, difficulty breathing, and loss of consciousness, is potentially life threatening. According to the American Academy of Allergy Asthma & Immunology (AAAAI), about 220 cases of anaphylaxis and three deaths per year are attributed to latex allergies.
There are two main types of latex: hardened rubber and dipped latex. Hardened rubber is found in products, such as sneakers, tires, and rubber balls. Hardened rubber does not cause allergies in most people. Dipped latex is typically found in stretchy products, such as rubber gloves, balloons, rubber bands, and condoms. Dipped latex products trigger most allergic reactions because they are often used directly against the skin.
Not all latex products are made from natural sources. For instance, products containing man-made latex, such as latex paint, do not usually trigger allergic reactions because they do not come into contact with the skin.
Some individuals who wear latex rubber gloves often, such as medical doctors, nurses, dentists, orthodontists, or personal care assistants, may develop a skin reaction called irritant contact dermatitis. This rash, which causes red, dry, and cracked skin on the hands, is not an allergic reaction because it does not involve the immune system. Irritant contact dermatitis is most likely caused by sweating or rubbing under the gloves or from soap or detergents left on the hands before wearing gloves. However, frequently wearing latex gloves also increases the risk of developing latex allergies.
The best treatment for latex allergies is to avoid products that contain latex. There are more than 40,000 products that contain latex. Many of these products have labels clearly stating that they contain latex or natural rubber. However, if there is ever any doubt, patients should call the manufacturer to determine whether or not a product contains latex. Patients should tell their healthcare providers if they are allergic to latex, and they should always wear a medical alert bracelet. Although many types of medical equipment and supplies may contain latex, most healthcare facilities in the United States have latex-free protocols. This means they are required to have latex-free products available for patients and employees who are allergic to latex.
Treatments, including antihistamines and corticosteroids, may help alleviate symptoms of an allergic reaction. If patients develop a severe and life-threatening allergic reaction called anaphylaxis, immediate medical attention should be sought. Administration of ephedrine is necessary to avoid circulatory collapse and death. Individuals who have a history of anaphylaxis should carry a prescription epinephrine auto-injector (EpiPen?) with them at all times.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

American Academy of Allergy Asthma & Immunology. .
Asthma and Allergy Foundation of America. Rhinitis and Sinusitis. .
Bayrou O. Latex allergy. Article in French. Rev Prat. 2006 Feb 15;56(3):289-95.
Bonalumi S, Barbonaglia P, Bertocchi C. Prevention of adverse effects in latex allergic patients: organizing a latex safe operating theatre. Article in Italian. Prof Inferm. 2006 Jan-Mar;59(1):8-12.
Centers for Disease Control and Prevention (CDC). .
Gandini P, Gennai R, Bertoncini C, et al. Experimental evaluation of latex-free orthodontic elastics' behaviour in dynamics. Prog Orthod. 2007;8(1):88-99.
Hain MA, Longman LP, Field EA, et al. Natural rubber latex allergy: implications for the orthodontist. J Orthod. 2007 Mar;34(1):6-11.
National Institute of Allergy and Infectious Diseases. .
Navarrete MA, Salas A, Palacios L, et al. Latex allergy. Article in Spanish. Farm Hosp. 2006 May-Jun;30(3):177-86.
Natural Standard: The Authority on Integrative Medicine. .
The American Latex Allergy Association.

Causes

General: Typically, an allergic response is not triggered the first time the body encounters an allergen. The first, or several times after the body is exposed to an allergen, the immune system becomes sensitized. During this process, the body's white blood cells develop immunoglobulin E (IgE) antibodies to the latex allergen. Once sensitized, the antibodies quickly detect and bind to the allergens in the body. Allergy symptoms develop because the antibodies trigger the release of chemicals, such as histamine. The antibodies may also trigger a severe and potentially life-threatening reaction called anaphylaxis, which may cause difficulty breathing, shortness of breath, and loss of consciousness.
Direct contact: Most latex allergies are triggered by direct contact with latex (e.g. wearing latex gloves).
Inhalation: Inhaling latex allergens may also trigger a latex allergy. Latex products release latex particles into the air. This is especially common in latex gloves that are coated with cornstarch powder. The latex particles stick to the cornstarch powder and are released into the air when the gloves are removed or snapped. This can cause a serious allergic reaction.

Symptoms

General: Latex allergy symptoms vary among patients from mild to severe. Mild symptoms may include runny nose, sneezing, cough, difficulty breathing, wheezing, itchy eyes, and hives (itchy, red welts on the skin). A severe rash may develop in response to direct contact with latex. The most serious allergic reaction, called anaphylaxis, is potentially life threatening.
Allergic contact dermatitis: Some patients may develop allergic contact dermatitis, an allergic skin rash in response to direct contact with latex. The rash usually develops 24-48 hours after exposure. The rash usually starts on the areas of skin that came in direct contact with latex, and it may spread to other body parts. Some patients may develop blisters.
Anaphylaxis (anaphylactic shock): Anaphylaxis is a serious systemic allergic reaction that can be life threatening. Symptoms of anaphylaxis can vary from mild to severe and may even lead to death. Signs of an anaphylactic reaction may include itching and hives over large areas of the body, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea, or diarrhea. The most dangerous symptoms are low blood pressure, difficulty breathing, shock, and loss of consciousness, all of which can be fatal. The time lapse between inhalation or contact with the latex allergen and symptoms varies among individuals. Symptoms may appear immediately or may be delayed from 30 minutes to one hour after exposure. Symptoms may also disappear and then come back hours later. Once symptoms arise, they usually progress quickly. Patients who experience symptoms of anaphylaxis should be taken to the nearest hospital immediately or call 911.

Diagnosis

General: A skin test is the standard diagnostic tool for latex allergies. However, since a skin test involves applying small amount of latex onto the patient's skin, caution is warranted if the patient has experienced anaphylaxis. In these patients, an allergen-specific immunoglobulin (IgE) test may be performed instead to prevent a severe allergic reaction from occurring.
Skin test: A skin test is used to determine whether a patient is allergic to latex. During the test, the skin is exposed to latex allergens. The skin is then observed for an allergic reaction. If the latex triggers an allergic reaction, the patient will develop reddening, swelling, or a raised, itchy red wheal (bump) that looks similar to a mosquito bite. The healthcare provider will measure the size of the wheal and record the results. The larger the wheal, the more severe the allergy. A skin test is typically conducted in a healthcare provider's office. Skin tests cause minimal, if any, discomfort. The needles used barely penetrate the skin's surface and will not cause bleeding.
Allergen-specific immunoglobulin (IgE) test: An allergen-specific immunoglobulin E (IgE) test, commonly referred to as radioallergosorbent test (RAST?), may also be used to determine whether the patient is allergic to latex. However, this test is less accurate than a skin test. It is usually performed in patients who have coexisting severe skin diseases (such as eczema or psoriasis) that make it difficult to interpret a skin test. It may also be performed in patients who have a history of anaphylaxis.
During the procedure, a sample of blood is taken from the patient and sent to a laboratory that performs specific IgE blood tests. The blood is combined with a latex allergen to see if the patient has developed immunoglobulin antibodies to the allergen. Patients that test positive for immunoglobulin E (IgE) are diagnosed with latex allergies.
A qualified healthcare provider will interpret the results of the test. In general, the sensitivity of these tests range from 50-90%, with the average being about 70-75%. The patient will usually receive test results in about 7-14 days.

Treatment

General: There is no cure for allergies. The best way to prevent symptoms from recurring is to avoid exposure to latex. Treatments, such as antihistamines and corticosteroids, may help alleviate symptoms of an allergic reaction. If patients develop a severe and life-threatening allergic reaction called anaphylaxis, immediate medical attention should be sought. Administration of epinephrine may be necessary to avoid circulatory collapse and death.
Most healthcare facilities in the United States have latex-free products available for patients and employees who are allergic to latex. Patients should tell their healthcare providers if they are allergic to latex and always wear a medical alert bracelet.
Antihistamines: Antihistamines like diphenhydramine (Benadryl?) reverse the actions of histamine and help reduce allergy symptoms. Diphenhydramine is injected when quick action is needed during a severe allergic reaction. It may be given by mouth for a less severe allergic reaction.
Corticosteroids: Corticosteroids have been used to treat severe allergic reactions. Corticosteroids are usually given through an IV (intravenously) at first in order to quickly relieve symptoms. These drugs reduce swelling and many other symptoms of allergic reactions. Patients may also need to take a corticosteroid in pill form for several days after the initial treatment. These drugs are often given for less severe reactions.
Epinephrine: Epinephrine is only used to treat anaphylaxis. Epinephrine is injected into the patient. This drug acts as a bronchodilator because it opens the breathing tubes. It also constricts the blood vessels, which increases blood pressure. Patients who experience anaphylaxis may be admitted to the hospital to have their blood pressure monitored and possibly to receive breathing support. Other emergency interventions may also include placing a tube through the nose or mouth and into the airway (called endotracheal intubation) or emergency surgery to place a tube directly into the trachea (called atracheostomy or cricothyrotomy).
Individuals with a history of severe allergic reactions or anaphylaxis should carry a prescription epinephrine auto-injector (EpiPen?). If symptoms of anaphylaxis begin to appear after exposure to an allergen, the patient uses the device to inject the epinephrine into his/her thigh. A trained family member or friend may help the patient administer the epinephrine, if necessary.
Less severe allergic reactions that affect breathing may be treated with an inhaled epinephrine bronchodilator.
Hydrocortisone cream: Hydrocortisone 1% cream, which is available over-the-counter, has anti-inflammatory effects and relieves swelling and redness, as well as itching. Prescription hydrocortisone has been used to relieve itching, redness, dryness, crusting, scaling, inflammation, and discomfort associated with allergic reactions.

Integrative therapies

Note: Anaphylaxis is considered a medical emergency that requires immediate medical care. Therefore, integrative therapies should not be used in place of conventional medicine when an individual has a serious allergic or anaphylactic reaction.
Unclear or conflicting scientific evidence:
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific points that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. Acupuncture plus point-injection has been found beneficial for the treatment of hives, although more research is needed to confirm these findings.
Needles must be sterile in order to avoid disease transmission. Avoid with heart valve disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Avoid if taking drugs that increase the risk of bleeding. Avoid on areas that have received radiation therapy. Use cautiously with pulmonary disease (such as asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers. Avoid if pregnant.
Onion: Early study suggests that application of an alcoholic onion extract on the skin may reduce allergic responses, such as wheals (hives) and flares. More research is needed.
Avoid if allergic or hypersensitive to onion (Allium cepa), its constituents, or members of the Lilaceae family. Use cautiously with hematologic (blood) disorders, diabetes, hypoglycemia (low blood sugar), and hypotension (low blood pressure). Use cautiously if taking anticoagulants or antiplatelets (blood thinners). Avoid medicinal doses if pregnant or breastfeeding.
Traditional or theoretical uses lacking sufficient evidence:
Burdock: Burdock is a plant that is native to Europe and northern Asia. The root is most often used in herbal preparations. Traditionally, burdock has been used to treat hives. However, there is currently no human evidence on its safety and effectiveness for this use.
Avoid if allergic to burdock or other plants of the Asteraceae/Compositae family (such as ragweed, chrysanthemums, marigolds, or daisies). Avoid with a history of dehydration, diabetes, heart disease, cancer, high blood pressure, or HIV. Stop use before and immediately after surgeries or dental or diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
Chamomile: Chamomile is an herb that has an apple-like smell and taste. It is commonly taken as a tea. Although chamomile has traditionally been used to treat hives, scientific evidence is lacking. Currently, no human trials have evaluated the safety or effectiveness of chamomile for this use.
Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
Detoxification therapy (cleansing): Detoxification is a broad concept that encompasses many different modalities and substances used in cleansing the body's systems and organs. Detoxification has been suggested as a possible treatment for hives. However, there is currently no scientific evidence of its safety or effectiveness for this use.
In cases of illness, the various forms of detoxification should be used under professional guidance. See specific monographs for precautions and warnings associated with modalities of detoxification.
Ephedra: Ephedra is a natural stimulant. Traditionally, ephedra has been used to treat hives. However, there is currently no evidence on the safety and effectiveness of ephedra for this use.
Even though this herb has been suggested as a potential treatment for hives, it is unsafe for humans. Serious reactions, including heart attack, stroke, seizure, and death have occurred. The U.S. Food and Drug Administration (FDA) has banned sales of ephedra dietary supplements. The FDA has collected more than 800 reports of serious toxicity, including more than 22 deaths. Avoid use in individuals younger than 18 years old. Avoid use for prolonged periods (longer than seven days) due to risk of abuse or toxicity. Discontinue use at least one week prior to major surgery or diagnostic procedures. Use cautiously with cardiovascular disease, including structural heart disease, arrhythmia, coronary artery disease, high blood pressure, cerebrovascular disease, and a history of stroke or transient ischemic attack. Use cautiously with depression, anxiety disorders, anorexia/bulimia, a history of suicidal ideation, insomnia, tremors, urinary retention, enlarged prostate, diabetes, kidney disease, glaucoma, thyroid disease, and peptic ulcer disease. Use cautiously with monoamine oxidase inhibitor (MAOI) or stimulant use. Avoid if pregnant or breastfeeding.
Kudzu: Kudzu is an herb that has been used in Chinese medicine for many years. Traditionally, kudzu has been used to treat hives. However, there is currently no scientific evidence on the safety and efficacy for this use.
No well-designed studies on the long-term effects of kudzu are available. Avoid if allergic or hypersensitive to Pueraria lobata or members of the Fabaceae/Leguminosae family. Use cautiously with blood thinners and blood pressure-lowering agents, hormones, antiarrhythmics, benzodiazepines, bisphosphonates, diabetes medications, drugs that are metabolized by the liver's cytochrome P450 enzymes, mecamylamine, neurologic agents, and methotrexate. Avoid if pregnant or breastfeeding.
Moxibustion: Moxibustion is a therapeutic method in traditional Chinese medicine, classical (five element) acupuncture, and Japanese acupuncture. During the therapy, an herb (usually mugwort) is burned above the skin or on the acupuncture points in order to introduce heat into an acupuncture point and alleviate symptoms. There is limited evidence suggesting that moxibustion may help treat hives. Additional research is needed to evaluate the safety and efficacy of moxibustion for this use.
Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," heart disease, convulsions, cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, or inflammatory conditions. Avoid use over allergic skin conditions, ulcerated sores, skin adhesions, or inflamed areas or organs. Do not use on contraindicated acupuncture points, the face, genitals, head, or nipples. Use cautiously in patients who have just finished exercising or taking a hot bath or shower. Use cautiously in elderly people with large vessels. Not advisable to bathe or shower for up to 24 hours after a moxibustion treatment. Avoid if pregnant or breastfeeding.
Peppermint oil: Peppermint is a flowering plant that grows throughout Europe and North America. Peppermint is usually grown for its fragrant oil. Historically, peppermint has been used to treat hives. Further research is needed to determine whether peppermint is safe and effective for this use.
Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with G6PD deficiency or gallbladder disease. Menthol, which makes up part of peppermint oil, is generally considered safe in non-allergic adults. However, doses of menthol greater than 1 gram per kilogram of body weight may be deadly in humans. Avoid if pregnant or breastfeeding.
Probiotics: Probiotics are beneficial bacteria that are sometimes called friendly germs. They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Although probiotics have been suggested as a possible treatment for hives, there is insufficient scientific evidence on its safety and efficacy for this use.
Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.

Prevention

Individuals with a history of anaphylaxis should carry a prescription epinephrine auto-injector (known as an EpiPen?) with them at all times. A trained family member or friend may help the patient administer the epinephrine, if necessary.
Allergic individuals should tell their healthcare providers, including their dentists orthodontists, nurses, and personal care assistants, if they are allergic to latex.
Wearing an identification bracelet that describes the allergy is also recommended.
Patients should consider carrying non-latex gloves with them for emergency personnel if urgent medical care is ever needed.
Many products that are made with latex clearly state that they contain latex or natural rubber. However, if there is ever any doubt, allergic individuals should call the manufacturer to determine whether or not the product contains latex.
Hypoallergenic products may contain latex. Hypoallergenic simply means fewer chemicals were used to make the product. It does not necessarily mean that latex was not used.
Allergic individuals should use non-latex condoms. Consider using polyurethane or lambskin condoms. However, condoms made of alternative products do not protect against sexually transmitted diseases (such as HIV, gonorrhea and syphilis) as well as latex condoms.
Healthcare professionals with latex allergies should wear non-latex gloves when a protective barrier is necessary. They should also use equipment, such as stethoscopes and surgical masks, that are latex-free.
Individuals should also tell their friends, loved ones, and coworkers they are allergic to latex, to help avoid exposure to many types of equipment and products that contain latex.

Common triggers

Condoms: Patients who are allergic to latex should not use latex condoms. Instead, they should consider using polyurethane or lambskin condoms. However, condoms made of alternative products do not protect against sexually transmitted diseases (such as HIV, gonorrhea, or syphilis) as well as latex condoms.
Medical equipment and supplies: Most healthcare facilities in the United States are required to have latex-free products available to patients and employees who are allergic to latex. Certain medical equipment, including blood pressure cuffs, intravenous (IV) tubing, stethoscopes, syringes, respirators, electrode pads, and surgical masks may contain latex. Therefore, patients should always tell their healthcare providers, including dentists, orthodontists, nurses, and personal care assistants, if they are allergic to latex. They should also wear a medical alert bracelet at all times.
Orthodontic rubber bands: Orthodontic rubber bands, which are used to help straighten the alignment of the teeth, can trigger an allergic reaction in sensitive individuals. Patients who are allergic to latex should tell their orthodontists so non-latex bands or alternative methods are used instead.
Rubber gloves: Many rubber gloves are made from latex. Some latex gloves are coated with cornstarch powder, which the latex particles may stick to. When the gloves are snapped on or removed, cornstarch powder and latex allergens become airborne. An allergic reaction may develop if a patient inhales the allergen.
Rubber gloves are used as a protective barrier in healthcare settings to prevent the spread of diseases, such as HIV, hepatitis, and other infections. However, most healthcare facilities in the United States are required to have non-latex rubber gloves available for allergic individuals, and many facilities use non-latex rubber gloves as their standard preventative barrier. Non-latex gloves are equally effective at preventing the spread of disease as latex gloves.
Other: Other products that may contain latex allergens include swim caps, dishwashing gloves, carpeting, balloons, waistbands, hot water bottles, rubber toys, disposable diapers, baby bottle nipples, sanitary pads, rubber bands, erasers, diaphragms, swim goggles, racket handles, pacifiers, band aids, and motorcycle and bicycle handgrips.

Risk factors

General: For unknown reasons, certain individuals may have an increased risk of developing latex allergies.
Children with spina bifida: Patients with spina bifida have an increased risk of developing latex allergies. Spina bifida is a birth defect that causes the protective membranes of the spinal cord to not form properly, which leaves parts of the spinal cord exposed. Children with spina bifida are frequently in the hospital and exposed to latex products during early childhood, which may contribute to the increased risk of latex allergies. It is estimated that about half of all children with spina bifida are allergic to latex.
Food allergies: Latex allergy also is related to certain foods. Foods, such as avocados, bananas, chestnuts, kiwis, and passion fruits, contain some of the same allergens found in latex. This is because these plants are biologically related to the rubber tree. Patients who are allergic to one or more of these foods should consider being tested for latex allergies. Patients who are allergic to latex should consider being tested for possible food allergies.
Healthcare workers: Healthcare workers, including medical doctors, nurses, personal care assistants, dentists, and orthodontists, have an increased risk of developing latex allergies because they are repeatedly exposed to latex products. Researchers estimate that about two percent of hospital employees in the United States are allergic to latex.
History of allergies: Patients have an increased risk of developing latex allergies if other people in their family have allergies, such as hives or hay fever.