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Shorts Notes LATEX ALLERGIES September 24, 1999 Michael Zacharisen M.D. Allergy/Asthma Center - Milwaukee, WI

I. Review of where rubber is obtained was done. It is much like the collection of sap for maple syrup; the substance is drained from the rubber tree in Malaysia. Various early uses of rubber were discussed leading up to the use of it for gloves in the medical industry. History of latex allergy was discussed - 1979 Nutter was the first to report rubber glove urticaria. There have been 23 deaths attributable to latex over the past several decades - one from latex gloves.

II. Types of reactions : delayed - allergic contact dermatitis . Can be allergic to thiuram, mercaptobenzothiazole, carbamates - these reactions aren't necessarily from rubber but rather from the preservatives or powder in the gloves. The immediate or anaphylactic reaction is the most concerning as it can lead to death and is usually from the latex.

III. Natural history of latex allergy in health care workers : asymptomatic initially, then contact dermatitis then possibly contact urticaria then possibly anaphylactic reaction. OR ....one can be asymptomatic and have anaphylaxis from an exposure without any preceding delayed hypersensitivity reactions.

IV. Prevalence of latex allergy is 7-10% among health care workers - mainly among those who wear gloves frequently during their work day. Patients with spina bifida are particularly at risk for latex allergy as are those who have had multiple surgeries. Airborne latex in hospitals is highest in urology clinics, general surgery clinics, dermatology clinics, and then drops as the use of latex gloves drops.

V. Causes of increasing latex allergy : increased demand of latex gloves, end products are high in residual allergen more so than in the past, some gloves may have more latex proteins, and there is increased and more efficient reporting occurring.

VI. Diagnosing latex allergy : RAST testing, ELISA testing can be done to diagnose.These can be diagnostic in 85% of those with latex allergy. Hence there can be false negative results. In the past, pieces of rubber have been applied to the patient but this runs the risk of anaphylaxis. A crude method was to snap a rubber glove in front of the potential victim's nose. What is needed is a safe, efficacious, specific, sensitive method. There presently is one product awaiting FDA approval for this purpose.

VII. History : does the patient have unexplained anaphylaxis, atopic dermatitis, food allergies, seasonal rhinitis - all increase the likelihood of latex allergy.

VIII. Hospital sources of latex exposure besides gloves : IV tubing and associated equipment.

IX. Food allergy in latex allergy patients : many fruits can also result in reactions such as banana and grapefruit.

X. Treatment :Avoid powdered latex gloves, elastic bands in clothing, may need to take antihistamines. Immunotherapy is presently being developed to address this presently - no products are presently commercially available that are safe or effective. . Patients are told to be sure to always include latex allergy in their allergy list - to be sure to inform doctors, dentists, nurses, etc. Perioperatively - patients with latex allergy should be the first case of the day if possible - less latex allergen in the air.

XI. Eliminating latex allergy : reduce allergen content, reducing exposure in the air. Good resource that addresses latex allergy is ALERT - phone number 1-888-97ALERT.

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