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Natural Rubber Latex Allergy

A Guideline for Allergic Patients
This Guideline has been produced by the Canadian Society of Allergy and Clinical Immunology(CSACI).  CSACI wishes to acknowledge the assistance of the Task Force on Latex Allergies of the Medical Devices Bureau of Health Canada.

Principal authors of this booklet are:
Dr. G. Sussman, MD (University of Toronto)
Dr. M.A. Drouin, MD (University of Ottawa)
Dr. F.E. Hargreave, MD (McMaster University)
Mr. A. Douglas (Health Canada)
Dr. K. Turjanmaa, MD (University of Tampere, Finland)

The authors wish to thank the many participants of the Task Force on Latex Allergies who have offered their suggestions in the preparation of this document.

1994

What is natural rubber latex?
Natural latex rubber is a particular kind of rubber that has been manufactured from the sap of the rubber tree.  Rubber tree sap, or natural rubber latex, is a cloudy white liquid (a chemical Latex) containing a large amount of natural rubber that can be used to manufacture various consumer products.  Table A gives a list of common natural rubber latex products.

Natural rubber latex products cannot be identified visually.  Any rubber-like object could be made of natural rubber latex, or it could be made of synthetic material (including synthetic rubber).  Even things which are not stretchy may have natural rubber latex on them as a paint-like coating.

Latex does not necessarily mean natural rubber latex.  Latex paints and latex caulking are synthetic materials that do not usually contain natural rubber latex.

What is latex allergy?
A latex allergy is an allergy to products made from natural rubber latex.  It is an allergy to proteins originating from the rubber tree and still present in products made from natural rubber latex.

Products made from natural rubber latex usually contain a number of chemicals.  Some people are not allergic to natural rubber latex itself, but chemicals found in manufactured natural latex rubber latex products.  Your allergist will identify which materials affect you.  If you react to chemicals, you may have a rubber allergy and may be referred to a dermatologist for further tests.

Who suffers from latex allergy?
In the last 5 years latex allergy has become more common and its consequences better recognized.  The major use and exposure to natural rubber latex is from gloves used in medical and dental practices.

People most at risk of having or developing a latex allergy are those who have other allergies (such as hay fever) and regularly use natural rubber latex products.  High risk persons who have been identified include people who used natural rubber latex gloves in their everyday occupation.  This includes physicians, nurses, dentists, dental hygenists and dental assistants.  Children with certain medical conditions (such as spina difida) that result in frequent exposure to natural rubber latex products are also commonly latex allergic.

What are the symptoms of latex allergy?
Latex allergy often begins with a rash on the hands when using natural rubber latex gloves.  Other allergic symptoms include hay fever type reactions such as itchy swollen eyes, runny nose, and sneezing.  Some patients may develop asthma symptoms such as chest tightness, wheezing, coughing and shortness of breath.

However, people that have skin problems on their hands from glove use are not necessarily latex allergic.

How are latex and rubber allergies identified?
Patients at risk or with symptoms of possible latex allergy should be tested by an allergy specialist.  The latex skin prick test is a very sensitive and safe mean of identification of potentially allergic patients.  Other skin tests can identify whether you are allergic to natural rubber latex or the chemicals added to rubber products.

Can my latex allergy get worse?
There is evidence that the more you are exposed to latex, the more allergic you may become.  If you have only a minor latex allergy, you should minimize your exposure to latex so that you do not risk becoming more sensitive.

If you suffer from hay fever symptoms when exposed to latex, continued exposure to latex can cause you to develop asthma.

Can a latex allergy be life-threatening?
While it is uncommon, some latex allergic individuals can suffer a potentially life-threatening allergic reaction when they come in contact with natural rubber latex.

This serious reaction is called anaphylactic shock.  It occurs within minutes of exposure, and is characterized by generalized hives, breathing difficulties and low blood pressure.  Anaphylactic shock may be fatal and must be promptly treated by adrenalin injection.

Anaphylactic shock is most likely to occur during direct tissue contact with natural rubber latex products.  Direct contact occurs when the skin barrier which protects you has been broken, or the contact is across a mucous membrane.  Mucous membrane contact can occur in the mouth (e.g. blowing up a balloon, dental surgery, anesthetic administration), vagina (condom use, vaginal examination), rectum and colon (examination or enema administration), or urethra (catheterization).  Direct tissue contact occurs during surgery because surgeons normally wear natural rubber latex gloves when operating on a patient.

Can latex allergy be treated?
No treatments are yet available to cure natural rubber latex allergy.  So far the best treatment is to avoid exposure to latex.  Medications are available to temporarily alleviate symptoms.

What precautions should allergic patients take?
Latex allergic patients take certain precautions to prevent future allergic reactions:

Patients who are only mildly sensitive to latex products should observe the following precautions:

  1. Avoid contact with natural rubber latex products such as those listed in Table A Non-latex substitutes are available for most commonly used natural products.
  2. Before visiting doctors or dentists for any examination or procedure, warn them of your allergy to latex.  Ask to be scheduled as the first patient in the day in order to minimize your exposure to airborne latex particles.  Allergy causing latex dust is put into the air when staff put on and take off powdered natural rubber latex gloves.  Dust from non-latex gloves will not cause an allergic reaction, since it is the latex (not the powder) which is allergenic.
  3. If you work in high latex exposure areas and have skin irritation, hay fever or asthma symptoms, you must advise the employee health department and consult a physician about your treatment.  You may only be able to work in that environment if your symptoms are minimal or if your co-workers change to non-latex or powderless natural rubber latex gloves.
  4. You should consult with your physician about medicine you can take to reduce allergy symptoms.
  5. You should be aware that some latex allergic people also have certain food allergies.  Foods so far associated with latex include bananas, avocados, and chestnuts.  If any of these foods give you symptoms such as itching around the mouth, local swelling, hives or shortness of breath, you should avoid them.

Patients who are very sensitive to latex - for example, react even when briefly in contact with a balloon or glove - should take the following additional precautions:

  1. Obtain and wear a Medic Alert bracelet printed with severe allergy to natural rubber latex.
  2. When traveling to areas where medical supplies are limited, carry with you a variety of sizes of non-latex sterile gloves, in case you should need emergency medical or dental work.  Non-latex sterile gloves are a specialty item that should be obtained in advance of traveling to these regions.  Consult your doctor or hospital.
  3. Be familiar with the proper use of the self-administration of epinephrine (adrenalin).  The indications and proper use of this should be explained by your physician.
  4. Prior to surgery you should consult your physician about the need for a latex-free operating environment.

What is being done to help people with latex allergy?
Health Canada is working with medical doctors and manufacturers to try to overcome problems caused by latex allergies.  For information about the federal program contact:

Medical Devices Bureau
Health Protection Branch
Health Canada
775 Brookfield Rd
Ottawa ON  K1A 1C1
Tel:  (613) 954-0738
Fax:  (613) 993-0281

Table A

Examples of types of products that often contain natural rubber latex, and their potential substitutes.╣

Natural Rubber Latex Products Substitutes
For Babies  
Pacifiers, feeding nipples Silicone products
For school and office  
Erasers, craft supplies, make-up and Halloween masks, adhesives Look for products labelled vinyl or silicone
Clothing  
Elastic fabric, diapers, underwear Many elastic fabrics are not rubber (for instance Spandex and Lycra) but elastic webbing often contains rubber
Housework  
Cleaning gloves Gloves are a major source of exposure because they are in direct contact with the skin for a long time and may give off an allergenic dust - use nitrile, neoprene, vinyl or copolymer gloves.
Toys and sporting goods  
Balloons, Koosh balls, rubber ducks, soccer balls, volleyballs, coated or taped racquet handles Mylar (foil type) balloons, leather balls
Furnishings  
Rubber mats, carpet backing, foam rubber Most foam rubber is polyurethane foam and will not cause problems
Medical Products  
Condoms, female condoms, diaphragms Synthetic rubber or natural membrane condoms▓
Medical gloves, dental dams As with household gloves above, use only gloves made with synthetic materials
First aid tape, bandages Some brands do not contain natural rubber latex
 
  1. It is nearly impossible to list every natural latex-containing consumer product.  The allergenicity of latex products can be reduced by washing a product thoroughly with soap and water.  The product should be soaked with large amounts of water for several minutes.  Just wiping the surface with a damp rag is not sufficient cleaning to remove allergens.  Clothing that might contain latex elastic should be laundered before use.
  2. Natural membrane condoms may provide protection against pregnancy and many common sexually transmitted diseases (STD's).  However, they may not provide as much protection against certain viral STD's including AIDS and hepatitis - as latex condoms.

(Note:  As of June 1994, synthetic condoms and synthetic female condoms were not yet commercially available in Canada.)

 
     
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