Latex Allergy - Precautions and Care in Healthcare Settings

What Are the Sources of Latex?

The sap of the rubber tree (Hevea Brasiliensis) is from where the natural rubber latex substance is isolated. It can be used for various products ranging from balloons, examination gloves, condoms, etc.

Foods such as banana, avocado, kiwi, grapefruit, papaya, pineapple, tomatoes, chestnut, almonds also contain some amount of latex. It has been reported that 21.2 % to 86 % of patients who have been documented allergies to latex also had a food allergy.

What Are The Features of Latex Allergy?

The clinical features of a latex allergy would range from rash or hives to serious onset sequelae like chronic skin irritation, anaphylaxis, rhinitis, and difficulty in maintaining the airway. Due to the unavoidable fact that there is no known cure for latex allergy completely; one should hence consciously avoid the use of latex products and use the alternative substitutes for them as anaphylactic reaction or sensitivity to latex would prove fatal in these people.

The recent onset of latex and powder-free gloves can also help healthcare practitioners and dental surgeons who may have latex allergies because of the prolonged and repeated contact with surgical latex gloves. Whereas, if the latex allergies are connected to food products or fruits, it is called latex food syndrome.

Hypersensitivity Reactions - The two main kinds of reactions in latex allergy that can be observed are:

• IgE hypersensitivity, which can indeed be life-threatening as the host immune system produces antibodies against latex as a foreign body reaction.

• Cell-mediated hypersensitivity or type 4 hypersensitivity reaction can cause moderate to severe skin irritation and inflammation, and is referred to as contact dermatitis. However, it is not life-threatening but rather a source of severe discomfort and even swelling or pain.

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What Is the Pathophysiology of Latex Allergy?

Sensitisation mechanisms associated with latex allergy are due to the immunologically mediated reaction by the content present in these materials. However, it is important to note that the use of surgical gloves plays the main role in the prevention of infectious diseases such as HIV (human immunodeficiency virus), hepatitis B, and C as well. Sensitization depends on factors such as the route of exposure, dosage, frequency of exposure, and the person’s susceptibility. Exposure may occur as a result of direct contact with the skin or the mucosal membranes and maybe even through ingestion, which should be investigated thoroughly by the physician in an unknown case of allergy.

The absorption of latex from the surgeon’s glove are usually slow, and hence the reaction may occur about 30 minutes post-contact with the skin surface or the mucous membranes. However, the actual start of the reaction may range anywhere in or approximately from 10 minutes to as long as 4.5 hours. This interval will depend on the sensitivity as well as the amount of allergen (latex) absorbed in relation to the patient's skin or mucous membrane surface. In the contact surfaces, the absorption is faster through the peritoneum or vaginal mucosa than through the skin comparatively.

What Are the Risk Factors of Latex Allergy?

The following factors increase an individual’s risk for latex allergy:

• Spina bifida.

• Reconstructive urological surgery.

• Multiple surgical procedures.

• Intolerance to latex products (balloons, gloves preservatives, dental rubber dams).

• Allergy to fruits.

• History of intraoperative anaphylaxis (of unknown cause).

• Health personnel with prolonged exposure.

• Genetic tendency to develop a heightened immune response to allergens or atopy.

It is estimated that in around 30 % of affected cases by anaphylaxis, there is a suggestive history of previous reactions. Individuals with allergies to specific foods are also at an increased risk of developing allergic reactions to latex (latex food syndrome).

How Is Latex Allergy Diagnosed?

The diagnostic criterion for detecting a latex allergy are:

• Serum Tryptase - Mast cell activation is prominent that is detected in this test. It rises in mediated and non-IgE mediated hypersensitivity reactions.

• Serum-Specific IgE - The recommendation is to perform this test after four to six weeks and before six months of the allergic event. Immediate measurement after an allergy could give a false negative.

• Skin Tests - The skin test can be done up to one year after the allergic event, but not immediately (to avoid a false negative). The recommendation is to wait again four to six weeks after the allergic reaction.

• Prick Test - Evaluates the sensitization to the latex with high accuracy rates.

How to Prevent and Manage Latex Allergy?

The latex allergy might be prevented by:

• Minimizing the absorption of the product or agent containing latex (considering the variety of possible routes of exposure).

• Removing all products containing latex and changing over to latex-free gloves.

• Placing an allergy alert to the latex in a visible place at the entry, interiors, and exit points of the surgical arena.

• Detailed study and case history of the patient who is susceptible to a latex allergy.

What Are the Advantages of Latex Gloves?

A 100 % latex-free environment may not be advisable given that this allergy occurs in less than 1 % of the patients. To prevent the risk of cross-infection in a health setting, is to generate a safe environment for patients with prior allergy or history to latex. Rather than avoiding latex altogether in a health setting, it needs to be used with precaution, as surgical latex gloves are always beneficial in terms of wear and tear, protection and providing superior dexterity to the surgeon. In addition, the general measures should only include caution in individuals with a history of allergy to latex, that is the adequate identification of allergic patients and health personnel.

Conclusion:

In individuals suffering from latex allergy, be it either patients or health personnel and surgeons, a detailed clinical history helps elicit an appropriate preventive strategy for these individuals. Moreover, proper labeling of products formulated with latex and the use of latex-free gloves is also beneficial. Among the general recommendations for health, establishments are important to educate the staff in the healthcare setting and establish protocols for the management of these patients and personnel.