THE LATEX ALLERGY THREAT: CAN WE KEEP CLINICIANS AND PATIENTS SAFER?

FCAAIA Notes: Latex allergy is usually diagnosed purely by clinical history. Unfortunately, there is no other good test for latex allergy. This article gives a nice review of latex allergy with some good points for allergic patient.

People with latex allergy should wear or carry a medic-alert identifier that specifies what type of reaction they had.

(Source: http://www.medscape.com/viewarticle/879081?src=WNL_infoc_170427_MSCPEDIT_TEMP2&uac=112079PK&impID=1336031&faf=1 April 27, 2017. For Medscape articles: User name: FCAAIA, Password: Allergies)

When Australian mother and physician Pooja Newman descended into anaphylactic shock after a massive Adele concert balloon release, latex allergy got a great deal of media attention around the globe. But Dr. Newman, who is also president of Anaphylaxis Australia, is not alone. The American Latex Allergy Association estimates that although a mere 1% of the general population is allergic to latex, some 8%-17% of healthcare workers have this allergy. (The Allergy & Asthma Network and Centers for Disease Control and Prevention report that up to 6% of the general population may be affected.) Other high-risk groups include restaurant workers, children with spina bifida, and anyone who has had several surgeries. In the United States alone, about 3 million people are allergic to latex. Repeated exposure to latex increases the likelihood of becoming allergic to it, which is why certain groups are at higher risk than others.

Latex is a by-product of milky sap from the rubber tree (Hevea brasiliensis), typically found in Vietnam, Indonesia, and Thailand. Before processing, it contains 60 polypeptides that are potentially allergenic, including 15 that have been conclusively identified as allergens.

The main allergenic polypeptides are as follows:

  • In spina bifida patients: Hev b 1 and 3;
  • In healthcare workers: Hev b 5 and 6, and secondarily, Hev b 2, 4, 7, and 13;
  • Associated with cross-reactivity with fruits*: Hev b 6.02 and 7; and
  • Panallergens, with unknown cross-reactivity: Hev b 8, 11, and 12.

Hevea latex is a widely used material throughout the world and in several industries because it is versatile, flexible, and durable; resistant to moisture and chemicals; and low in cost. It is commonly found in toys, rubber bands, condoms, erasers, sports balls, and elastic goods. In the healthcare setting, it can be found in gloves, adhesives, catheters, syringes, stethoscopes, compression stockings, blood pressure cuffs, vial stoppers, electrode pads, masks, bandages, and medical tape.

Most reactions are to the rubber proteins, but some people may also be sensitive to the added chemicals in final products, said allergist and immunologist, Dr Purvi Parikh. “Adverse effects come in three varieties: irritant contact dermatitis, allergic contact dermatitis, and immediate-type allergic reactions.”

Both types of dermatitis result in skin redness, lesions, or itching, and may take up to several days to manifest. The less severe of these two, irritant contact dermatitis, presents as a nonallergic, localized dermal inflammation, typically in reaction to the chemicals rather than to latex. Known as “type IV hypersensitivity,” allergic contact dermatitis is a T-cell–mediated reaction to chemicals. Neither type of dermatitis tends to extend beyond the skin, although inflammation can weaken the dermal barrier, providing allergens with access to the body’s internal tissues.

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