Latex allergy comes from an over-exuberant reaction to a rubber component from the body’e defenses, and can can produce a range of reactions. Latex is common in gloves and balloons but is present in many other things. It is estimated1 that in the general population, 0.8% to 8.2 % have some allergic component to latex proteins, however; many show no symptoms (yet).
It is known to produce two of the four types of allergic reaction pathways called hypersensitivity reactions.
Types of reaction to latex
Type 1 hypersensitivity reaction is immediate and life threatening. IgG antibodies are made in response to each exposure to the material. The IgG attaches to mast cells. When exposed again to the latex protein, the IgG immediately stimulates the mast cells on which they are attached to release histamine, cytokines and other allergic mediation compounds. When the number of mast cells that are modified by the IgG reaches a critical number and re-exposure to the rubber protein occurs, the sudden mast cell release can be life threatening. This is the same reaction seen in bee sting and peanut allergies that cause anaphylaxis (severe life threatening response.)
The protein in latex that causes most type one hypersensitivity reactions is from the Hevea brasiliensis tree, a common rubber tree used in these products. When an individual’s immune system is “primed” the simple exposure from minute protein particles present in a room where a balloon had been previously inflated can stimulate a life threatening response.
Type IV hypersensitivity is also called a delayed hypersensitivity reaction. This form of allergy is not caused by antibody production. It is a “cell-mediated” response, ie the cells and not antibodies lead the way. It generally develops after 2-3 days of exposure. Poison Ivy (Rhus dermatitis) is another type IV reaction.
Chemical irritant dermatitis is a condition that some wearers of latex gloves develop but is unrelated to the rubber and is not allergic in nature.
Symptoms of Latex allergy
Type 1 reactions may not display any symptoms as initial exposures begin to create IgG. When enough IgG attaches to enough mast cells, early symptoms may be a few hives and itching. Depending on individual genetics and exposure, the results can slowly worsen with each subsequent exposure or develop very quickly from a few hives to respiratory arrest.
Symptoms associated with type I reactions include:
- Urticaria (hives) Itch welts that can occur anywhere on the body.
- Pruritus (itching) usually associated with the hives but may occur without.
- Angioedema (swelling) of the hands, feet, tongue, eyelids or lips.
- Wheezing or shortness of breath. Occasionally a dry cough is the only respiratory complaint.
- Tachycardia (rapid heart rate) or irregular rapid heartbeats.
- Feeling of impending doom when a severe reaction occurs.
Type IV reactions occur at the skin site of contact. A range from itchy red area to weeping blisters and bullae (large blisters) on an erythematous base with severe burning itch may present. Crusting can occur when the fluid dehydrates at body temperature.
Secondary infection can occur from open areas when inoculated by environmental bacteria and from scratching.
It is important to mention that the reaction cannot be spread through contact with the weeping fluid. Only contact with the allergen can create more rashes.
Type I reactions are treated based on the severity of symptoms. Initially treatment will consist of antihistamines and avoiding the allergen.
For rapidly advancing symptoms or more severe reactions emergency treatment may include adrenalin (epinephrine), antihistamine (Benadryl and an H2 blocker like cimetidine) and a steroid. Patients will go home on continued antihistamines and decreasing steroids.
Steroids provide two functions in progressive allergic reactions. They stabilize the immediate cascade of events that can lead to organ failure and death. They also prevent large amounts of additional antibody to be produced modulating the next reaction.
People with progressive latex allergic reactions should carry “Epi-pens”. An Epi pen allows the self-injection of an adult dose of adrenalin to buy time to get to emergency care in the event of a reaction. An Epi-pen is not a substitute for treatment; it is a preventive emergency measure.
Desensitization can be achieved for patients with severe or rapidly progressing symptoms. A series of progressive inoculations alter the immune response and can eventually remove the risks of subsequent exposures.
Type IV allergic treatment again depends on the severity. Topical antihistamine cream or a steroid cream can be locally applied. In general a drying agent like calamine lotion is recommended. For excessive weeping an over the counter product called Domeboro’s solution may be used. It is an aluminum sulfate tetradecahydrate and calcium acetate monohydrate solutionsolution from which astringent soaks are made and applied to the blisters and bullae 20- 30 minutes four times daily. This will help dry up the rash and provide comfort. Steroids will be used for severe reactions. Oral antihistamines may provide some relief from itching and sedation.
Avoidance of further contact will be necessary. Note that some gloves are chemically manmade with a molecule identical to the allergen found in the plant. This will also precipitate a reaction in susceptible people. The ingredient is not specially required to be noted on gloves that are marketed as “Rubber” or “latex” free.
There are risk factors associated with Type 1 reactions. 68% of children born with spina bifida have this allergy. 10% of latex workers will develop an allergic reaction with continued exposure. Also at risk are health care workers from constant exposure and those with multiple surgeries, especially if in childhood.
Having a type IV allergy does not increase the risks of developing a type I reaction.
If allergic to latex, avoidance and knowing what to expect and what to do when exposed is the key. With type I severe or rapidly progressive reactions the individual should consider wearing or carrying identification advising of the allergy. It could be lifesaving if ever the response results in anaphylaxis.
1: Grzybowski M, Ownby DR, Rivers EP, Ander D, Nowak RM (October 2002). “The prevalence of latex-specific IgE in patients presenting to an urban emergency department”. Ann Emerg Med 40 (4): 411–9.doi:10.1016/S0196-0644(02)00063-X.PMID 12239498.