Latex


Natural latex is extracted from the Hevea brasiliensis tree and is used to produce rubber (latex + low molecular weight chemical additives). Main products: household and surgical cloves, balloons, cofferdams used in dentistry, caps, face masks, condoms.The first manifestation described in 1927 was the case of a chronic urticaria due to a dental prosthesis made with latex. Cases of anaphylactic shock due to glove wearing were reported from 1987.
 
Incidence
20% of the anaphylactic shocks occurring during general anesthesia.
Contact dermatitis or urticaria due to glove wearing is observed in 6% of the medical and paramedical operating room staff.
 
Latex sensitization (majority without clinical manifestations) is found in 1-6 % of the general population.
 
Risk factors
Atopy (70% of cases).
 
Occupational contact.
 
Fruit allergy.
 
In children: spina-bifida and multiple surgical procedures.
 
Clinical manifestations
General: perioperative anaphylactic shock usually occurs more than 15 minutes after induction of anesthesia. The first symptom is rash or urticaria followed 2 or 3 minutes later by severe collapse with or without bronchospasm requiring blood volume expansion and adrenaline.
 
Anaphylactic shock may occur while putting latex gloves on.
Anaphylactic shock has been reported during gynecological examinations or after dental work (latex cofferdams).
Cutaneous: flush, contact dermatitis or urticaria, angioedema.
 
E.N.T: rhinitis.
 
Respiratory: asthma.
 
Ophthalmologic: conjunctivitis.
 
Diagnostic methods
Cutaneous testing.
 
Prick, intradermal, patch, and scratch skin tests with the supernatant of the preparation used to make latex gloves, latex or extracts from Hevea brasiliensis leaves. At present, prick-tests can be performed with commercial standardized natural latex extract.
 
Prick and intradermal skin-tests are positive in case of anaphylactic shock due to surgical gloves.
 
In patients who develop contact dermatitis after wearing gloves, rule out sensitivity to rubber additives (patch-tests with rubber mix, naphtyl mix, PPD mix, carba mix, metal salts).
 
Specific latex IgE antibodies (UniCAPâ/Pharmacia CAP Systemä and other methods).
 
Often detected in patients with anaphylactic shock
 
Nasal or bronchial provocation tests.
 
Mechanisms
IgE-mediated hypersensitivity (immediate positive skin-tests, specific IgE, specific histamine release).
 
The role of several identified proteins (Hev1-7) was shown and may explain some cross-reactivity with fruits (banana, avocado, kiwi, chestnut, tomato).
 
Delayed-type allergy in contact dermatitis.
 
Management
  • Avoiding thr use of powdered latex gloves reduces the risk of latex sensitization and clinical symptoms.
     
  • Avoid mentioning "hypoallergenic gloves".
     
  • Use of non latex gloves and "latex-free" operating room for allergic patients under surgery.
     
  • Careful medical questionnaire before any surgical procedure.
     
  • Avoid any systematic preoperative testing in a non at-risk po pulation.

References

  1. Posch A, Chen Z, Raulf-Heimsoth M, Baur X, "Latex allergens: a review", Clin. Exp. Allergy, 1998; 28: 134-40
  2. Levy D.A, Leynadier F, "Latex and food allergy", Rev. fr. Allergol., 1997; 37: 1188-94
  3. Porri F, Pradal M, Lemiere C, Birnbaum J, Mege J.L, Lanteaume A, Charpin D, Vervloet D, Camboulives J, "Association between latex sensitization and repeated latex exposure in children", Anesthesiology, 1997; 86 (3): 597-602
  4. Porri F, Lemiere C, Birnbaum J, Guilloux L, Lantaume A, Didelot R, Vervloet D, Charpin D, "Prevalence of latex sensitization in subjects attending health screening: implications for a perioperative screening", Clin. Exp. Allergy., 1997; 27: 413-17
  5. Turjanmaa K, Alenius H, Mäkinen-Kiljunen S, Reunala T, Palomo T, "Natural rubber latex allergy", Allergy, 1996; 51: 593-602
  6. Laxenaire M.C et le groupe d’étude des réactions anaphylactoïdes peranesthesiques, "Substances responsables des chocs anaphylactiques peranesthesiques. Troisième enquête multicentrique française (1992-1994)", Ann. Fr. Anesth. Reanim., 1996; 15: 1211-8
  7. Levy D.A, Charpin D, Pecquet C, Leynadier F, Vervloet D, "Allergy to latex", Allergy, 1992; 47: 579-87
     
     
     
     

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.