Latex allergy: Management
- Robert G Hamilton, PhD, DABMLI, FAAAAI
Robert G Hamilton, PhD, DABMLI, FAAAAI
- Professor of Medicine and Pathology
- Johns Hopkins University School of Medicine
Natural rubber latex (NRL) allergy is caused by sensitization to proteins in the sap-like fluid (latex) from the commercial rubber tree, Hevea brasiliensis (Hev b). Most patients are sensitized through exposure to latex gloves or other latex products (eg, dental dams, condoms, and balloons) in a medical or occupational setting.
The mainstay of management of latex allergy is avoidance of latex products. Several other therapeutic approaches have been under investigation, including immunotherapy (IT) and anti-immunoglobulin E (IgE) therapy, but these have not shown promise.
The management of latex allergy, including avoidance measures and experimental therapies that have been attempted, will be reviewed here. An overview of latex processing and latex allergens and review of the epidemiology, clinical manifestations, and diagnosis of latex allergy are discussed separately. (See "Latex allergy: Epidemiology, clinical manifestations, and diagnosis".)
GENERAL MANAGEMENT STRATEGIES
Latex allergy can involve delayed or immediate-type reactions. Individuals with delayed hypersensitivity, manifested as a contact dermatitis, are at increased risk for developing immunoglobulin E (IgE)-mediated reactions. Thus, all individuals with latex sensitivity, as documented by a positive Hevea latex-specific IgE antibody response, should be managed similarly.
There are four possible strategies for preventing or managing allergic symptoms once an individual is diagnosed with latex allergy:
- Bernstein DI. Management of natural rubber latex allergy. J Allergy Clin Immunol 2002; 110:S111.
- Sutherland MF, Suphioglu C, Rolland JM, O'Hehir RE. Latex allergy: towards immunotherapy for health care workers. Clin Exp Allergy 2002; 32:667.
- Kelly KJ, Wang ML, Klancnik M, Petsonk EL. Prevention of IgE Sensitization to Latex in Health Care Workers After Reduction of Antigen Exposures. J Occup Environ Med 2011; 53:934.
- Blumchen K, Bayer P, Buck D, et al. Effects of latex avoidance on latex sensitization, atopy and allergic diseases in patients with spina bifida. Allergy 2010; 65:1585.
- Rolland JM, O'Hehir RE. Latex allergy: a model for therapy. Clin Exp Allergy 2008; 38:898.
- Nucera E, Schiavino D, Sabato V, et al. Sublingual immunotherapy for latex allergy: tolerability and safety profile of rush build-up phase. Curr Med Res Opin 2008; 24:1147.
- Chang TW, Wu PC, Hsu CL, Hung AF. Anti-IgE antibodies for the treatment of IgE-mediated allergic diseases. Adv Immunol 2007; 93:63.
- Leynadier F, Doudou O, Gaouar H, et al. Effect of omalizumab in health care workers with occupational latex allergy. J Allergy Clin Immunol 2004; 113:360.
- Cusick C. A latex-safe environment is in everyone's best interest. Mater Manag Health Care 2007; 16:24.
- SGNA Practice Committee. Guideline for preventing sensitivity and allergic reactions to natural rubber latex in the workplace. Gastroenterol Nurs 2008; 31:239.
- Accetta D, Kelly KJ. Recognition and management of the latex-allergic patient in the ambulatory plastic surgical suite. Aesthet Surg J 2011; 31:560.
- Bernstein DI, Karnani R, Biagini RE, et al. Clinical and occupational outcomes in health care workers with natural rubber latex allergy. Ann Allergy Asthma Immunol 2003; 90:209.
- Cremer R, Kleine-Diepenbruck U, Hering F, Holschneider AM. Reduction of latex sensitisation in spina bifida patients by a primary prophylaxis programme (five years experience). Eur J Pediatr Surg 2002; 12 Suppl 1:S19.
- Yunginger JW, Jones RT, Fransway AF, et al. Extractable latex allergens and proteins in disposable medical gloves and other rubber products. J Allergy Clin Immunol 1994; 93:836.
- Kujala V, Alenius H, Palosuo T, et al. Extractable latex allergens in airborne glove powder and in cut glove pieces. Clin Exp Allergy 2002; 32:1077.
- Brown RH, Hamilton RG, McAllister MA, Johns Hopkins Latex Task Force. How health care organizations can establish and conduct a program for a latex-safe environment. Jt Comm J Qual Saf 2003; 29:113.
- Hamilton RG, Brown RH. Impact of personal avoidance practices on health care workers sensitized to natural rubber latex. J Allergy Clin Immunol 2000; 105:839.
- Bernstein DI, Biagini RE, Karnani R, et al. In vivo sensitization to purified Hevea brasiliensis proteins in health care workers sensitized to natural rubber latex. J Allergy Clin Immunol 2003; 111:610.
- Smith AM, Amin HS, Biagini RE, et al. Percutaneous reactivity to natural rubber latex proteins persists in health-care workers following avoidance of natural rubber latex. Clin Exp Allergy 2007; 37:1349.
- Madan I, Cullinan P, Ahmed SM. Occupational management of type I latex allergy. Occup Med (Lond) 2013; 63:395.
- Sussman, G, Gold, M. Guidelines for the management of latex allergies and safe latex use in health care facilities. Am College of Allergy Asthma and Immunology 1996. www.acaai.org/public/physicians/latex.htm (Accessed on January 16, 2009).
- Kostyal D, Horton K, Beezhold D, et al. Latex as a significant source of Hevea brasiliensis allergen exposure. Ann Allergy Asthma Immunol 2009; 103:354.
- Nienhaus A, Kromark K, Raulf-Heimsoth M, et al. Outcome of occupational latex allergy--work ability and quality of life. PLoS One 2008; 3:e3459.
- Lee MF, Wang NM, Han JL, et al. Estimating allergenicity of latex gloves using Hev b 1 and hevamine. J Investig Allergol Clin Immunol 2010; 20:499.
- Baur X. I are we closer to developing threshold limit values for allergens in the workplace? Ann Allergy Asthma Immunol 2003; 90:11.
- Beezhold DH, Kostyal DA, Tomazic-Jezic VJ. Measurement of latex proteins and assessment of latex protein exposure. Methods 2002; 27:46.
- ASTM D5712-05E1: Standard test method for analysis of aqueous extractable protein in natural rubber and its products using the modified Lowry method. American Society for Testing Materials, International, West Conshohocken, PA, 19428.
- ASTM D6499: Standard test method for the immunological measurement of antigenic protein in natural rubber and its products. American Society for Testing Materials, International, West Conshohocken, PA, 19428.
- Yeang HY, Arif SA, Yusof F, Sunderasan E. Allergenic proteins of natural rubber latex. Methods 2002; 27:32.
- Sussman GL, Beezhold DH, Kurup VP. Allergens and natural rubber proteins. J Allergy Clin Immunol 2002; 110:S33.
- Palosuo T, Alenius H, Turjanmaa K. Quantitation of latex allergens. Methods 2002; 27:52.
- ASTM D7427-08. Standard test method for immunological measurement of four principal allergenic proteins (Hev b 1, 3, 5, 6.02) in natural rubber and its products derived from latex. American Society for Testing Materials, International, West Conshohocken, PA, 19428.
- Palosuo T, Reinikka-Railo H, Kautiainen H, et al. Latex allergy: the sum quantity of four major allergens shows the allergenic potential of medical gloves. Allergy 2007; 62:781.
- Renaud MY. Composition of synthetic latexes used for manufacturing gloves by dipping processes. Clin Rev Allergy 1993; 11:363.
- Siler DJ, Cornish K, Hamilton RG. Absence of cross-reactivity of IgE antibodies from subjects allergic to Hevea brasiliensis latex with a new source of natural rubber latex from guayule (Parthenium argentatum). J Allergy Clin Immunol 1996; 98:895.
- Carey AB, Cornish K, Schrank P, et al. Cross-reactivity of alternate plant sources of latex in subjects with systemic IgE-mediated sensitivity to Hevea brasiliensis latex. Ann Allergy Asthma Immunol 1995; 74:317.
- Gentili A, Lima M, Ricci G, et al. Secondary prevention of latex allergy in children: analysis of results. Pediatr Med Chir 2006; 28:83.
- American Latex Allergy Association www.latexallergyresources.org (Accessed on February 09, 2009).
- Hamilton RG, Scheer DI, Gruchalla R, et al. Casein-related anaphylaxis after use of an Everlast kickboxing glove. J Allergy Clin Immunol 2015; 135:269.
- Leynadier F, Herman D, Vervloet D, Andre C. Specific immunotherapy with a standardized latex extract versus placebo in allergic healthcare workers. J Allergy Clin Immunol 2000; 106:585.
- Turjanmaa K, Palosuo T, Alenius H, et al. Latex allergy diagnosis: in vivo and in vitro standardization of a natural rubber latex extract. Allergy 1997; 52:41.
- Sastre J, Fernández-Nieto M, Rico P, et al. Specific immunotherapy with a standardized latex extract in allergic workers: a double-blind, placebo-controlled study. J Allergy Clin Immunol 2003; 111:985.
- Patriarca G, Nucera E, Pollastrini E, et al. Sublingual desensitization: a new approach to latex allergy problem. Anesth Analg 2002; 95:956.
- Nettis E, Colanardi MC, Soccio AL, et al. Double-blind, placebo-controlled study of sublingual immunotherapy in patients with latex-induced urticaria: a 12-month study. Br J Dermatol 2007; 156:674.
- Bernardini R, Campodonico P, Burastero S, et al. Sublingual immunotherapy with a latex extract in paediatric patients: a double-blind, placebo-controlled study. Curr Med Res Opin 2006; 22:1515.
- Nucera E, Schiavino D, Pollastrini E, et al. Sublingual desensitization in children with congenital malformations and latex allergy. Pediatr Allergy Immunol 2006; 17:606.
- Lasa Luaces EM, Tabar Purroy AI, García Figueroa BE, et al. Component-resolved immunologic modifications, efficacy, and tolerance of latex sublingual immunotherapy in children. Ann Allergy Asthma Immunol 2012; 108:367.
- Cisteró Bahima A, Sastre J, Enrique E, et al. Tolerance and effects on skin reactivity to latex of sublingual rush immunotherapy with a latex extract. J Investig Allergol Clin Immunol 2004; 14:17.
- Antico A, Pagani M, Crema A. Anaphylaxis by latex sublingual immunotherapy. Allergy 2006; 61:1236.
- Buyukozturk S, Gelincik A, Ozşeker F, et al. Latex sublingual immunotherapy: can its safety be predicted? Ann Allergy Asthma Immunol 2010; 104:339.
- Nettis E, Delle Donne P, Di Leo E, et al. Latex immunotherapy: state of the art. Ann Allergy Asthma Immunol 2012; 109:160.
- Rolland JM, Drew AC, O'Hehir RE. Advances in development of hypoallergenic latex immunotherapy. Curr Opin Allergy Clin Immunol 2005; 5:544.