Latex allergy (LA) is an IgE-mediated, immediate (type I)
hypersensitivity reaction caused by proteins in latex. In recent years,
LA has been encountered with an increasing frequency among health
care workers using latex gloves and rubber industry workers as well as
in children with spina bifida.
A wide spectrum of reactions ranging from contact urticaria,
rhinoconjunctivitis and asthma to severe anaphylactic reactions
including death have been associated with latex hypersensitivity.
Mucosal and parenteral exposure may lead to life threatening reactions
whereas cutaneous exposure usually causes localized reactions.
The diagnosis of LA should be based on the clinical history of
symptoms caused by latex materials. Atopy and high total serum IgE
seem to be risk factors for LA.
The patients with a past or present history of reactions to latex
materials can be examined by the following methods:
Skin tests including skin prick and epicutaneous tests have been
widely used among exposed individuals. There is, however, a risk of
adverse and anaphylactic reactions at the time of testing especially
when intradermal tests or non-standardized test reagents are used.
In earlier studies the measurements of specific IgE to latex (RAST,
ELISA, etc.) have been less sensitive in detecting latex hypersensitive
patients than have been skin tests. A negative result in latex IgE
measurements does not rule out the possibility of LA or a risk for
anaphylaxis. Test reagents are currently commercially available for
antibody measurements to latex. There is, however, an urgent need to
develop countable and reliable methods for in vitro testing of latex
allergy and purify and characterize test reagents because of the risks
associated with skin tests.
A histamine release test has been used in the detection of LA patients
but is available in only a few research centers at the moment.
Skin provocation tests ("use tests") have been performed by using a
piece of a glove (finger tip) which is held by the patient for 10-15
minutes. A piece of a glove rather than a whole glove is preferred in
this test to avoid anaphylaxis.
Inhalation or nasal provocations have not been widely used because
the typical history of allergic symptoms, skin tests and/or specific IgE
to latex are safe ways to confirm the LA diagnosis. If the inhalation
or nasal provocations are considered necessary they should be
performed with utmost care and by using well defined test reagents.
