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Latex allergies

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. Latex allergies, including life threatening ones- are becoming more frequent. Patients with spina bifida particularly are at high risk since they may have repeated exposures to latex during procedures in the hospital and home (such as bladder catheterisation with latex catheters), but more importantly, because of the increased exposure in the operating room due to the number of surgeries that are required.

Latex allergies and Spina Bifida
A survey on latex allergies and Spina Bifida
List of products containing latex
Foods with a cross-reactivity to latex
Makers of Latex-Free Products

Fact sheet
Latex allergy

Latex allergies and Spina Bifida

Sensitivity to latex (natural rubber) can be a problem for people with spina bifida because of the frequency with which they come into contact with it.
Many healthcare products contain latex so people with spina bifida (and medical professionals) are exposed to it on a regular basis - either during surgery (through the use of latex gloves and anaesthetic equipment) or during bladder and bowel management (through the use of latex tubing, gloves and catheters). Latex allergy occurs when the body's natural defences against an allergen come into force. It involves the production of antibodies when there is contact with a specific antigen (in this case latex). Antibodies are produced by the initial reaction to latex which sensitise the cells in all tissues. The severity of subsequent reactions depends on the means of entry of the antigen.
Exposure to latex occurs when products containing rubber come in contact with a person's skin or mucous membranes such as the mouth, eyes, genitals, bladder or rectum. Serious reactions can also occur when latex enters the bloodstream. In addition, the powder from balloons or gloves can absorb particles and become airborne causing reactions when breathed by a latex sensitive person.
The most potent and life-threatening reaction is entry into the vascular system, which can lead to changes in blood pressure and circulation (anaphylactic shock). Skin contact produces a less severe reaction Ð this is usually raised, pinkish, itchy weals, which develop suddenly and last a few days, but leave no visible trace.
Research has shown in the United States that between 18% and 73% of children and adolescents with spina bifida are sensitive to latex as measured by history or blood test.
Although widely accepted in the United States, latex allergy is still not considered a problem by authorities over here. This is partly due to lack of research into the extent of latex allergy among patients and medical staff, and partly due to a belief that it is impurities in the latex which cause the allergic reaction, not the latex itself.
More is known about latex allergy in hospital staff and dentists than in patients. But things are changing. The Royal College of Nursing's Society of Occupational Health Nursing (SOHN) did a survey of health departments in 1996 to find out the number of staff with a latex allergy in UK hospitals. These figures will be used to lobby the government and to encourage hospitals to introduce allergy screening for new staff and patients, and to work out how to deal with patients and staff who have latex allergy. The Department of Health's Medical Devices Agency has suggested that health professionals ask patients about previous allergic reactions to latex. However, some believe nurses should go further and ask patients about any food allergies as the two are cross-related.
The mother of a case study says: ''George seems an isolated case at the moment. We're fighting for his problem to be recognised. People don't believe it. If he ever had to be admitted into hospital as an emergency, I'd have kittens. They would have to suck all the air out of the operating theatre because even latex in the air can affect him.''

A survey on latex allergies and Spina Bifida
ASBAH is conducting its own survey to find out the extent of the problem among service users. The Spina Bifida Association of America recommends that all individuals with spina bifida should be considered high risk for having an allergic reaction to rubber and should avoid contact with rubber products, particularly during medical or surgical procedures. In addition, it says people who have experienced allergic reactions during surgical or medical procedures should consider wearing a medic-alert bracelet or necklace. The Spina Bifida Association of California issues medical alert cards stating that spina bifida patients often have a severe allergic reaction to latex.

P L May, MBBS, FRCS, Consultant Paediatric Neurosurgeon and member of ASBAH's Medical Advisory Committee, writes: Severe reactions in patients exposed to the latex antigen was first described in 1984. Over the last few years, however, there has been an increasing recognition in the United States of the condition particularly with respect to patients with spina bifida and associated abnormalities. The Food and Drugs Administration (FDA) in the United States has undertaken several studies to examine the incidence of reaction in spina bifida patients to latex either in the form of skin rashes or more serious manifestations of sensitivity. In 1991 this incidence was reported to the FDA to be somewhere between 18-40%. It was noted by the American workers that children appeared to be particularly at risk of hypersensitivity with this allergen. The Medical Devices Agency in the United Kingdom has been monitoring the subject of latex allergy for several years because of concerns raised by American reports of increased incidents of latex allergy among healthcare workers and certain groups of patients. At the present time there are no authoritative statistics which indicate the extent of the problems in the UK healthcare setting or in the general population. From our own experience in the Royal Liverpool Children's Hospital over the last six months we have documented at least one episode of a major hypersensitivity reaction in a young female patient with spina bifida undergoing corrective spinal surgery. The condition was recognised and she has made a full recovery. The increased incidence of this sensitivity is thought to be related to the general increase in the use of latex products, particularly gloves, by healthcare workers and also to the incorporation of tube products with a higher latex content. Patients with neural tube defects and congenital urogenital abnormalities seem to be particularly at risk probably because of the increased number of surgical procedures they are exposed to involving equipment containing latex. Latex is present in many different types of material within the operating theatre set-up including surgical gloves, urinary catheters, surgical drains, disposable syringes and IV fluid giving sets. Latex itself is a cloudy white liquid which comes from a rubber tree, Hevae brasiliensis. Once the liquid has been tapped from the tree, chemicals are added to it which provide the strength, elasticity and dimensional stability characteristic of many rubber products. Natural rubber latex is therefore composed of proteins and added chemicals, some of which would be removed during the later stages of production. The reactions that can occur in an allergic response to latex can range from mild irritation of the skin to more serious general manifestations of anaphylaxis or major shock. In this country it is clear that more work needs to be done to identify the potential problem so that we can reassure our service users involved in repeated forms of surgery. This also involves increasing awareness among healthcare professionals as well as those service users susceptible to latex hypersensitivity. There are at present tests which are freely available to assess the sensitivity of the individual to latex, the commonest of which, I believe, is the RAST test which is a blood test. It is also possible to perform skin testing to latex allergy. It is clear that more work needs to be done before we are able, in this country, to give a clearer picture of the true incidence of this apparently relatively rare event in service users undergoing frequent surgical procedures in the UK.

List of products containing latex

Latex is the sap from the Hevea brasiliensis tree.

Common household and hospital products containing latex:

  • Household gloves
  • Hospital gloves
  • Condoms
  • Condom incontinence aids
  • Wheelchair tyres
  • Adhesive tapes (sticky plasters)
  • Some urinary catheters
  • Some enema tubing
  • Protective sheets
  • Colostomy/urostomy products
  • Balloons and rubber balls
  • Art supplies
  • Dental dams
  • Baby bottle nipples and pacifiers
  • Elastic on clothes
  • Beach toys
  • Chewing gum

There are alternative, non-latex products for all of these items. Usually, these alternatives are made of plastic, vinyl or silicone.

Foods with a cross-reactivity to latex

Research has shown that proteins found in certain foods show similar immune system reactivity to the proteins found in latex. So, if your mouth itches when you eat any of the foods listed below, you could be allergic to latex as well. Foods which have been identified as having cross reactivity include:

  • Bananas
  • Potatoes
  • Avocados
  • Tomatoes
  • Kiwi Fruit
  • Mangoes
  • Chestnuts

Makers of Latex-Free Products
  • Continence sheath - Clear Advantage from Depuy Healthcare. Freephone 0800-590916.
  • Condoms - Naturalamb from Lamberts (Dalston) Limited, Dalston House, Hastings Street, Luton, Beds, LU1 5BW. Tel: 01582-400711. Fax: 01582-400646. This is made of a non-latex natural membrane which will help prevent pregnancy but does not protect against HIV infection (AIDS) and other sexually transmitted diseases. Natural skin condoms can be worn under latex condoms (if male is sensitive to or at risk from latex) or over latex condoms (if female is sensitive or at risk).
  • Disposable gloves - N-dex Nitrile EMS gloves from Sentinel Laboratories Ltd,12-13 Lindfield Enterprise Park, Lewes Rd, Lindfield, West Sussex RH16 2NH. Tel: (01444) 484044. Contact: Brian Smith.

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