Latex is a milk-like fluid which is derived from the rubber tree known as Hevea brasiliensis. Latex is composed of nucleic acids, sugars, lipids, and allergenic proteins. Allergies associated with latex are most commonly found among adults and children. Latex is an organic polymer which is elastic in nature. Protein content present in latex varies according to the location of its harvest and process of its manufacturing.
In its manufacturing process, latex is treated with several accelerators and antioxidants to shape it into the required object. Impurities and proteins present in latex are rinsed and dried, after which it is dry-lubricated with talc powder or cornstarch.
In modern society, the use of latex is inevitable, specifically in the field of health care. Millions of latex gloves are utilized in the medical field solely in the US annually.
Incidence of latex allergy:
· In the US, one to five percent of the population is suffering from latex allergy.
· The population, which is chronically exposed to latex products, is more prone to developing latex allergy.
· The highest incidence of latex-related allergies has been found in patients with urogenital abnormalities and spina bifida. Children suffering from spinal cord injuries are also seen with latex allergies. Spina bifida patients have DQB1, DRB, and HLA (human leukocyte antigen) alleles, which are more likely to react with an antigen of latex.
· Occupations involving interaction with harvesting and processing of latex or having latex trees are more likely to develop latex allergies.
· Patients suffering from type-1 hypersensitivity have more rates of morbidity and mortality.
· The male and female ratio is equal regarding latex allergy.
Three clinical syndromes are associated with latex exposure.
1. Irritant dermatitis – results from skin disruption due to mechanical force as rubbing the gloves and inducing skin rashes.
2. Delayed (type-IV) hypersensitivity reactions – symptoms of the allergy start to appear within one to two days after exposure of mucous or cutaneous membrane of skin to the latex. Multiple sources can be a reason for sensitization, but most commonly found culprits are soles of children’s shoes and gloves.
3. Type-1 hypersensitivity reaction (immediate) – as the proteins present in latex are highly allergenic, therefore, IgE molecules cross-linking on basophil cell membranes, and mast cells by allergens of protein latex can trigger the release of several mediators as histamine in individuals who are already sensitized.
The most immediate sign and symptoms of latex allergy include:
· Skin edema, mucous, and subcutaneous tissue edema.
· Tearing of skin
· Pruritis in exposed mucous membranes and skin
· Syncope and lightheadedness
· Vomiting and nausea
· Abdominal cramps
· Rash –edema, erythema, and papules in cases of the direct contact area.
· Rash – thickening, pigment changes, and erythema in patients with chronic exposure to latex
· Wheezing or stridor
· Shock and hypotension.
Causes of latex allergy:
Individuals can be exposed to latex allergies through their mucous membranes, skin, or even through the airway (as endotracheal, nasal, and oral tissues). Exposure through inhalation can be caused either within the hospital settings or outside it, where powder-lubricated latex products are used.
The most common sources of latex in our daily life are:
· Medical instruments and devices as a stethoscope
· Gloves and tourniquets used for examination and intervention.
· Electrodes or pads of the modalities
· Syringe plungers and several intravenous tubing and devices.
· Goggles and masks
· Tubes and wound drainers
· Tires and handgrips
· Nipples of baby bottles and pacifiers (most commonly used product)
· Rubber bands, computer-related accessories
· Garments and shoe soles.
How to deal with latex allergy?
Latex allergy management comes in three necessary steps:
1. Pre-hospital care –
· Patients and providers should be well aware of their allergy. Make sure to note all the allergies of patients in pre-examination history.
· Use products that are powder-free to minimize the risk of an allergic reaction.
· In allergic patients, don’t give medications via rubber topped devices or latex IV ports.
2. Care in an emergency –
· In emergency departments, latex-free resuscitation equipment should be available. It is usually accomplished via latex-free cart or mobile cart without any latex intubation, IV tubing, electrode pads, masks, gloves, medication holders, syringes, and other required equipment.
· Healthcare providers must keep the patient in a latex-free environment.
· Manufacturers of medical devices have already prepared several products, which are the latex-free alternative for invasive procedures and even routine care.
3. Consultations –
· During the consultation, a physician must be aware of avoiding the exposure of the patient to the latex during their procedures and examinations
Latex allergies are one of the most common allergies worldwide. In this age, it is almost inevitable to live without latex products but, if a person is suffering from this type of allergy, then he/she must take some preventive steps to avoid its exposure and stay safe from its allergic reactions. In health care facilities, there should be a facility of latex-free environment for patients having this type of allergy.