Latex allergy continues to be a major concern in the healthcare field worldwide. Medical personnel are questioning who is at risk and how should these individuals be identified. Studies to clarify this have concentrated on high risk groups or sequential testing of low
risk populations without a medical history linked to serological or skin test results. The results of these studies have produced wide variations in opinions as to the size of the populations truly at risk. The lack of control data and wide variation in the sensitivity and
specificity to commercially available antibody tests have further contributed to the ambivalence in this data.
General Population
Historically it has been reported that in the general population sensitivity to natural rubber latex (NRL) is approximately 1%1. However, Ownby et al reported a 6.5% prevalence in 1,000 volunteer blood donors evaluated by latex specific IgE antibodies2. In this study males were twice as likely as females to have latex specific IgE but it was not associated with age or race. The same group of investigators also measured latex specific IgE antibodies in sera submitted for total IgE determinant 3. Of the 200 sera tested, 12% were positive for latex specific IgE. Upon review of the medical records of
these individuals only one of the twenty-four positive serum donors had previously identified risk factors for latex allergy. Screening populations where there is a low prevalence of disease by serum analysis alone may lead to false positive results when using a test with a high sensitivity.
Healthcare workers
According to a summary report by Yunginger et al4, healthcare workers, particularly those who are atopic and who use rubber gloves regularly, are at increased risk of sensitization to NRL. In questionnaire surveys, 14% of responding U.S. Army dentists5 and 53% of responding medical laboratory technologists 6 self-reported some type of reaction to rubber gloves. By questionnaire and latex skin testing, 5.6% 7 to 11%8 of operating room nurses, 7.4% of surgeons7, 8% of hospital housekeeping personnel
9, 10% of hospital-based physicians10, and 17% of a cross-section of hospital employees11 were documented as latex-sensitive.
Spina Bifida
Sensitization to latex by skin or serologic testing ranges from 18% to 68% in patients with spina bifida12,13,14,15. Many of these patients are asymptomatic but first manifest their latex allergy in the operating room when severe anaphylaxis, urticaria or bronchospasm occurs16. Most children with spina bifida require surgical intervention on the first day of life to close the spinal defect. This also creates significant exposure to latex medical products in neonatal intensive care units and operating rooms. The role of early intense exposure to latex products during the first weeks of life in the development of latex allergy is unknown.
The value of screening patients with spina bifida for latex allergy is controversial. Presently the recommendation is to consider all spina bifida patients to be at risk for latex allergy and enact latex precautions in their treatment and environment.
Other High Risk Groups
Rubber workers, chronically instrumented patients, atopic patients and patients with multiple operations may be at higher risk of latex sensitization17,8,18,19,16. Rubber industry workers have been identified to be at risk of occupational asthma related to latex allergy20,21. Manufacturers of latex products have not considered this as a serious or common problem in the workers. Since the majority of latex is harvested in Southeast Asia one may expect a high prevalence of problems in the workers. However, the daily exposure and genetic make-up of the workers in this part of the world is likely to be different than European, Canadian and Canada workers where most of the reactions have been reported. Studies of the immunologic characterization of the different workers will be necessary. If this observation by the manufacturers is true, this implies development of tolerance from frequent contact which is encouraging for
the future of immunotherapy in the disease.
Summary
The recently published OSHA Hazard Information Bulletin22 has summarized the OSHA position to be 8-17% of healthcare workers, 9-13% of dental workers and 1% of the general public represent the at risk population for sensitization of NRL. Coupled with the data of 18 - 68% of the spina bifida population, these numbers represent the anticipated populations at risk for latex sensitization.
REFERENCES
- Nightingale SL: New regulations to improve quality control of medical gloves. JAMA 265:1229, 1991.
- Ownby DR, Ownby HE, McCullough JA, et al: The prevalence of anti-latex IgE antibodies in 1000 volunteer blood donors. J Allergy Clin Immunol 93:282, 1994 (abst).
- Reinheimer GA, Ownby DR: Frequency of latex specific IgE in patients being evaluated for allergy. J Allergy Clin Immunol 93:281, 1994 (abst).
- Yunginger John W, Allergy to Natural Rubber Latex. Allergy Principles and Practice, Update 18, 4th edition, 1994
- Berky ZT, Luciano WJ, James WD: Latex glove allergy: a survey of the US Army Dental Corps. JAMA 268:2695, 1992
- Salkie ML: The prevalence of atopy and hypersensitivity to latex in medical laboratory technologists. Arch pathol Lab Med 117:897, 1993
- Turjanmaa K: Incidence of immediate allergy to latex gloves in hospital personnel. Contact Dermatitis: 17:270, 1987.
- Lagier F, Vervloet D, Lhermet I, et al: Prevalence of latex allergy in operating room nurses. J Allergy Clin Immunol 90:319, 1992
- Lem DE, Sussman GL, Douglas A: Latex allergy with housekeeping personnel. J Allergy Clin Immunol 93:299, 1994 (abst).
- Arellano R, Bradley J, Sussman G: Prevalence of latex sensitization among hospital physicians occupationally exposed to latex gloves. Anesthesiology 77:905, 1992
- Yassin MS, Lierl MB, Fischer TJ et al: Latex allergy in hospital employees. Ann Allergy 72:245, 1994
- Banta JV, Bonanni C, Prebluda J: Latex anaphylaxis during spinal surgery in children with myelomeningocele. Developmental Medicine & Child Neurology 1993; 35(6): 543-8.
- Ellsworth PI, Merguerian PA, Klein RB, et al. Evaluation and risk factors of latex allergy in spina bifida patients: is it preventable? J of Urology 1993; 150 (2 pt 2): 691-3.
- Kelly KJ, Pearson ML, Kurup VP et al: Anaphylactic reactions in patients with spina bifida during general anesthesia: epidemiologic features, risk factors, and latex hypersensitivity. J Allergy Clin Immumol (In Press).
- Moneret-Vautrin DA, Laxenaire MC, Bavoux F: Allergic shock to latex ethylene oxide during surgery for spina bifida. Anesthesiology 1990, 73: 556-8.
- Slater JE. Rubber anaphylaxis. N Engl J Med 1989; 320: 1126-30.
- Buback ME, Reed CE, Fransway AF, et al. Allergic reactions to latex among health care workers. Mayo Clin Proc 1992; 67: 1075-9.
- Moneret-Vautrin DA, Beaudouin E, Widmer S, et al. Prospective study of risk factors in natural rubber latex hypersensitivity. J Allergy Clin Immumol 1993; 92: 668-77.
- Shield S, Blais M: Prevalence of latex sensitivity in children evaluated for inhalant allergy. Allergy Proc 1992; 13: 129-130.
- Bascom R, Baser M, Thomas R, et al: Elevated serum IgE, eosinophilia, & lung function in rubber workers. Arch of Environ Health 1990; 45: 15-19.
- Tarlo SM, Wong L, Roos J, et al. Occupational asthma caused by latex in a surgical glove manufacturing plant. J Allergy Clin Immunol 1994;93: 733
- OSHA, Hazard Information Bulletin: Potential for Sensitization/Allergy and Life Threatening Reactions to NRL Gloves and Other Products (Draft), Latex-97-41.1, 1997
