Latex allergy T78.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Allergy to latex; Latex allergy; Latex incompatibility; Latex sensitization

Definition
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Usually IgE-mediated type I reaction to latex-containing products (rarely type IV reactions). After contact with surgical gloves, examination gloves, household gloves, plasters, respiratory masks, urine bags, intestinal tubes, etc., but also by mere stay in rooms where latex gloves were used, the reaction occurs in the sense of contact urticaria with not uncommon generalisation up to anaphylaxis.

Besides skin reactions, mucous membrane reactions are also possible, e.g. indirect contact with latex-containing volatile particles (rhinitis, conjunctivitis, bronchial asthma; see below). rhinoconjunctivitis allergica).

Occurrence/Epidemiology
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It is more common in high-risk groups, especially health care workers (frequency up to 17%) and patients suffering from spina bifida.

Etiopathogenesis
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Type 1 reaction or type IV reaction against latex allergens. According to the IUIS allergen nomenclature, including the isoforms, 16 latex allergens are known, which are called Hevea brasiliensis allergens (Hev b 1 - Hev b 13). Causes of the increase in sensitization:
  • Widespread availability and increased consumption of disposable latex gloves in health care facilities for protection against HIV infection and other blood-borne infectious diseases.
  • Use of latex in bladder catheters, tubes, respiratory masks, plasters, etc.
  • Production-related high protein and allergen content in latex products.

Clinical features
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The clinical symptoms of latex contact urticaria syndrome after skin contact with latex are divided into 4 stages according to v. Krogh and Maibach:
  • Stage I: Localized contact urticaria
  • Stage II: Generalized urticaria including lid edema
  • Stage III: bronchial asthma allergy, rhinoconjunctivitis,
  • orolaryngeal and gastrointestinal symptoms
  • Stage IV: Anaphylactic shock.

Diagnosis
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  • Prick test with partially standardized, partially already standardized commercial natural latex test extracts from various suppliers, natural latex milk (if possible low ammoniacal or non-ammoniacal natural latex milk), extract from powdered medical gloves containing natural latex (glove extract)

Remember!

In case of a history of severe reactions, prepare dilution series of natural latex test solutions and perform threshold tests.
  • Standard series of aero- and food allergies (to detect associated sensitisations).
  • Testing for specific IgE antibodies against natural latex in serum (even in severe natural latex allergic reactions specific IgE antibodies are not always detectable).
  • Provocation tests: Wearing test with moistened fingertips containing natural latex allergens for 20 minutes; control test with synthetic material on the other hand.
    • If negative: closed epicutaneous test for 20 minutes with moistened glove material containing natural latex allergens on an area of 5 × 5 cm (preferably on the back of the hand), control test with synthetic glove on the other hand.
    • If negative: 20-minute wear test with glove containing natural latex allergens, control test with synthetic glove on the other hand; if necessary, conjunctival, nasal or bronchial provocation test with natural latex test solution; if necessary, imitation of a situation described as causing symptoms with natural latex contact.
If necessary, additionally:
  • Lung function diagnostics
  • Natural latex allergen detection in the suspected exposure area by dust analysis
  • Diagnostics to detect natural latex allergy-associated food allergy
  • Diagnosis of associated immediate type allergy to ficus benjamina.

Therapy
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Consequences in case of natural latex sensitization or allergy:
  • Issue of an allergy passport.
  • Carrying and use of an emergency medication if required (oral, fast-acting antihistamine and oral glucocorticoid, each as a dropping solution or tablet; adrenaline syringe for injection).
  • Notification of occupational diseases in the event of occupational sensitisation and/or complaints at the workplace, if necessary, a dermatologist's report in advance.
  • Rehabilitation of the workplace: Natural latex allergen-free working materials for the person concerned and elimination of powdered gloves containing natural latex allergens in the entire area. If necessary, use of gloves free of natural latex allergens may be necessary; if these measures are insufficient: abandonment of the workplace (rarely necessary in the case of consistent absence).
  • In the case of a confirmed associated food allergy, appropriate leave of absence measures.

Note(s)
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  • Latex is the milk of certain tropical plants, which escapes and is obtained after cutting the bark of the plant. 95% of the world harvest is provided by the rubber tree Hevea brasiliensis. Natural latex consists mainly of water (50-60%) and natural rubber (30-35%). To a lesser extent it also contains proteins, resins, carbohydrates, inorganic salts and fatty acids. It is not the natural rubber itself, but the proteins that can trigger allergic reactions of the immediate type in sensitised persons.
  • Latex can be found in all areas of the labour market where occupational substances containing natural latex are present, in weavers with contact to latex threads, in the production of textiles and rubber bands, in the automotive industry, in workers with powdered latex gloves, shoe salesmen, gardeners, workers in the glove and doll industry and especially in health care workers and patients suffering from spina bifida.
  • In order to reduce the risk of developing latex sensitization, an allergen content of 0.5 µg allergen/g for rubber products and an allergen limit of 0.5 ng/m3 for the ambient air in workplaces have been proposed.
  • Cross-reactions with plants, fruits or vegetables are relatively frequent:
    • Plants: Ficus benjamina (birch fig), buckthorn, gum tree, hemp, hops (beer), evergreen, coffee (also as a drink), cacti, coral spurge, cassava, mulberry tree, oleander, Rauwolfia (partly in herbal medicines), poinsettia.
    • Fruits: Pineapple, avocado, banana, dates, chestnut, figs, kiwi, mango, melon, orange, papaya, passion fruit (passion fruit),
    • Peach, tomato, grapes.
    • Vegetables/Salad: Chicory, endive, potato, lettuce, dandelion, radiccio, black salsify, asparagus.
  • Remember! Occupational dermatological evaluation: Assessment of reduction in earning capacity: Depending on the clinical picture of latex contact urticaria syndrome, the effects of the allergy on the occupational disease must be assessed from "minor" to "serious" according to No 5101 of the Annex to the Ordinance on Occupational Diseases. The clinically most frequently encountered stage I is usually assessed as "mild". Stages II and III, depending on their severity, are to be assessed as "moderate" to "severe", stage IV is to be assessed as "severe".

Literature
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  1. Allmers H et al (1996) Latex sensitization and latex allergen concentration in the air. Allergology 2: 68-70
  2. Bernstein DI et al (2002) Management of natural rubber latex allergy. J Allergy Clin Immunol 110: 111-116
  3. Diepgen TL, Dickel H, Becker D, Geier J, Mahler V, Schmidt A, Schwanitz HJ, Skudlik C, Wagner E, Wehrmann W, Weisshaar E, Werfel T, Blome O (2005) Evidence-based assessment of the effect of type IV allergies in the reduction of earning capacity - assessment of occupational skin diseases. Evidence-based evaluation of the occupational relevance of different delayed type sensitizations or allergens - Survey of occupational skin diseases]. dermatologist 56: 207-223
  4. Diepgen TL et al (2002) Assessment of the effect of allergies in the reduction of earning capacity in the context of BK 5101 Dermatol Occupation Environment 50: 139-154
  5. Ebo DG et al (2004) Sensitization to cross-reactive carbohydrate determinants and the ubiquitous protein profilin: mimickers of allergy. Clin Exp Allergy 34: 137-144
  6. Elliott BA (2002) Latex allergy: the perspective from the surgical suite. J Allergy Clin Immunol 110(2 Suppl): 117-120
  7. Recommendations of the interdisciplinary working group (1995) Natural latex allergy. Allergology 5: 248-251
  8. Pereira C et al (2003) Specific immunotherapy for severe latex allergy. Allerg Immunol (Paris) 35: 217-225
  9. Chowdhury MM et al (2003) Natural rubber latex allergy in a health-care population in Wales. Br J Dermatol 148: 737-740
  10. Hepner DL, Castells MC (2003) Latex allergy: an update. Anesth Analg 96: 1219-1929
  11. Roest MA et al (2003) Insulin injection site reactions associated with type I latex allergy. N Engl J Med 348: 265-266
  12. Schürer NY et al (1995) The latex allergy. dermatologist 46: 742-753

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020