Latex

Latex is a milky sap from plants like the tropical rubber tree. It contains a mixture of water, sugar, and proteins. The sap is collected by drilling into the tree and making rubber items such as household gloves and medical gloves, shoes, tires, balloons, and condoms.

During the manufacturing process, chemicals such as accelerators are added to harden it, and the rubber item is heated then finally rinsed. The finished item, in addition to latex, may contain residual added (non-latex) proteins and chemicals, and these can also cause allergic reactions.

We are all exposed to natural rubber latex items in day to day life, and for most people, these cause no problems. A small number of people can become allergic to latex proteins, which can trigger allergic reactions.

This allergy happens because the immune system reacts to the latex proteins as if they were harmful. This overreaction is called ‘allergic hypersensitivity,’ and latex is the ‘allergen’ (a substance that causes the allergy). 

Latex proteins cause immediate allergic reactions that develop within minutes to an hour of contact with the rubber item. The specific symptoms depend on how allergic somebody is, how much latex protein they have been exposed to, and whether contact is with the skin or internally. 

The most typical problem is ‘contact urticaria,’ which means itch, redness, and swelling (hives) of the skin in contact with the rubber item. This reaction typically affects the hands when wearing rubber gloves or the lips after blowing up a balloon.

Sometimes a widespread reaction can develop at other body sites with swelling of the face, especially around the eyelids and lips.

Other symptoms include sneezing and irritating the nose and eyes like hay fever and wheezing or breathing difficulty. Rarely, a severe allergic reaction called anaphylaxis can occur, with dizziness, low blood pressure, feeling faint, breathing difficulty, swelling of the throat, and collapse.

People who wear rubber latex gloves frequently and for long periods, such as healthcare workers, hairdressers (when working with chemicals), and cleaners, are at increased risk, especially if they have a tendency to allergic conditions (hay fever, food allergy, and asthma) or have atopic eczema.

Hand eczema increases the risk of latex allergy as the proteins can get through the broken eczema skin more easily. (Cross-reference PIL on hand eczema) People with spina bifida and people who have had repeated operations on the bladder are at increased risk of latex allergy. It is thought that this is because they have a lot of exposure to latex in urinary catheters. 

Firstly, the doctor will take a history of the symptoms. Antibodies (also called Immunoglobulin type E or IgE) against latex are found in the blood of people with latex allergy. These can be measured in a blood sample by a test called a specific IgE. The doctor organizes this test. Skin prick testing is another way to confirm the diagnosis of latex allergy. A dermatologist or an allergy specialist does this test.

It involves puncturing the skin with a small needle (the ‘skin prick’) through a drop of latex solution. If an itchy swelling or ‘wheal’ develops, this usually indicates an allergy. The test takes 15-20 minutes. There is a tiny chance of triggering a severe allergic reaction with skin prick testing, so a fully trained practitioner should only do it with resuscitation equipment. 

The test is not reliable if antihistamines have been taken. If someone has symptoms that are very suggestive of latex allergy, but they have a negative skin prick test and antibody test, they may need further tests such as a latex challenge. Here a latex product is used (such as putting on a glove) and assessing the response. Because the initial tests are negative, the chance of a severe reaction here is meager.

If you have been diagnosed with a latex allergy, you must inform any medical practitioners (such as doctors, dentists, and healthcare workers) as well as other workers (carers, hairdressers, nail technicians, and beauticians) that you have a rubber latex allergy. It is best to avoid any rubbery items unless confirmed to be latex-free.

Household items: Many household items can contain natural rubber latex. Most allergies happen after contact with thin rubber items made from dipped rubber, especially household ‘Marigold’ washing up gloves, disposable rubber gloves, balloons, and condoms. There is a long list of other household items that may contain latex, for example, bath mats, bath toys, baby dummies, bicycles, elastic bands, envelope seals, footwear, and hot water bottles. 

Hospital items: Medical examination gloves can be made from natural rubber latex, but increasingly non- latex alternatives are being used, such as PVC or nitrile.  Other items that may contain latex include adhesive plasters and tape, blood pressure cuffs, dental dams (used in dental surgery), catheters, drainage tubes, face masks, intravenous injection equipment, and tourniquets. 

Office items: Computer mouse mats, computer mouse roller ball, envelope adhesive, elastic bands, and rubber pencil tops. 

Successful cases of latex desensitization have been reported recently, but this is an experimental process and not routinely available.

The most critical aspect of managing latex allergy is to avoid direct contact with latex items. Carry a latex allergy card (these are available in many languages) or wear a medical ID item such as MedicAlert jewellery (bracelet, necklace, watch). These give essential information to those caring for you in an emergency when you may not communicate. Inform all medical, nursing, and dental staff and your employer or your school that you have a latex allergy, which can be documented in your records.

If you are at risk of a severe allergic reaction and have been prescribed an adrenaline (epinephrine) auto-injector (adrenaline pen), it is vital to carry this at all times. Make sure you know how to use it. Tell others how to use it (friends, family, teachers, and work colleagues) and where to find it in an emergency Store correctly and check the expiry date.

If you have asthma, keep this under proper control by using inhalers as prescribed and carry your inhalers when you go out for use in an emergency. Keeping your asthma under control may lessen the impact of an allergic reaction.

Mild allergic reactions such as localized irritation of the skin under gloves should be managed by removing the glove/latex item, rinsing in cold water, and taking an antihistamine tablet.

In the event of a severe allergic reaction (throat swelling, difficulty breathing with a hoarse voice), use the adrenaline auto-injector, and call the emergency services. 

People with latex allergy can also be allergic to tropical fruit, especially banana. Likewise, people with banana allergy may be allergic to latex. This allergy is because the fruit contains very similar proteins to the tropical rubber tree. 

Other fruit and vegetables that can provoke the same reaction to latex include avocado, celery, fig, chestnut, papaya, and passion fruit. Fruit allergy usually causes itch and swelling of the lips, tongue, and throat within a few minutes of eating a fruit or drinking its juice. In people with a severe allergy, this can be followed by nausea, vomiting, widespread hives, wheezing, and anaphylaxis. 

What will happen if I need an operation, including dental surgery? It is imperative that you advise your nurse, doctor, dentist, or any other therapist who may examine or treat you when wearing gloves about your allergy so they can avoid using latex items. Surgical procedures must be done in a latex-free operating theatre.

Residual natural proteins in rubber latex cause immediate allergy symptoms, as described above. Chemicals added during rubber manufacture (e.g., carbamates, thiurams, and mercaptos) can also cause allergic reactions, but these happen more slowly over hours or days and cause an itchy, red rash called allergic contact dermatitis. It is essential to understand if you have an immediate allergy to latex or a delayed allergy to chemicals. Patch tests diagnose rubber chemical allergy.

People with hand eczema are at increased risk of getting immediate allergies to latex proteins and delayed allergy to the rubber chemicals. What gloves can be used? Synthetic rubber or vinyl (PVC) gloves are safe alternatives for people with natural rubber latex allergy. If you also have a rubber chemical allergy, your dermatologist will provide additional advice on suitable gloves.