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Latex allergy: Epidemiology, clinical manifestations, and diagnosis

Author
Robert G Hamilton, PhD, DABMLI, FAAAAI
Section Editor
Bruce S Bochner, MD
Deputy Editor
Elizabeth TePas, MD, MS

INTRODUCTION

Rubber (polyisoprene) is a vital natural resource that is used in the manufacturing of a wide variety of commercial products ranging from airplane tires to protective medical gloves. Ninety-nine percent of natural rubber comes from one source: the sap-like fluid (latex) from the commercial rubber tree, Hevea brasiliensis (Hev b), grown in Africa and Southeast Asia (Thailand, Indochina, Malaysia, and India) [1].

A tube-like network of laticifer cells beneath the H. brasiliensis tree bark contains natural rubber (polymeric hydrocarbon 1,4 cis-polyisoprene), water, and cytoplasmic organelles. In addition, the cytoplasm contains a variety of enzymes and structural proteins that are involved in biosynthesis of polyisoprene, coagulation of latex, and plant defense against microbes. A number of these proteins are known to be potent allergens that elicit human immunoglobulin E (IgE) antibody, leading to sensitization in exposed individuals and a spectrum of allergic reactions upon subsequent exposure [2-4].

This topic gives an overview of latex processing and latex allergens and discusses the epidemiology, clinical manifestations, and diagnosis of latex allergy. The management of latex allergy is discussed separately. (See "Latex allergy: Management".)

HEVEA LATEX ALLERGENS

Approximately 250 different natural rubber latex polypeptides have been identified, of which 60 are able to bind human immunoglobulin E (IgE) antibody. Only 15 of the principal allergens have been given official numbers (H. brasiliensis [Hev b] 1 through Hev b 15) by the International Nomenclature Committee of Allergens in the International Union of Immunological Societies (IUIS). These allergenic proteins are described in the table (table 1), including their molecular weight, plant family, and any known crossreactivity to structurally similar food, pollen, and mold allergens. The 15 allergenic Hevea proteins are involved in a broad range of activities in the rubber tree, including rubber biosynthesis, disease resistance, structure, and housekeeping. Nine additional Hevea proteins that can induce IgE antibody have been described (table 1).

Hev b 1, 2, 3, 4, 5, 6.02, 7.01, and 13 have been identified as the most highly sensitizing of the Hevea allergens [5-9]. There is disagreement as to the relative clinical importance of certain Hevea allergens, such as Hev b 2 and Hev b 13. However, this discussion is largely academic because management of an individual with latex allergy involves avoidance of exposure to all Hev b allergens.

                        

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Literature review current through: Nov 2016. | This topic last updated: Fri Nov 13 00:00:00 GMT+00:00 2015.
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