Latex allergy

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Latex allergy
Classification and external resources

Latex medical glove
ICD-9 V15.07
MeSH D020315

Latex allergy is a medical term encompassing a range of allergic reactions to natural rubber latex.

Contents

[edit] Types

Latex is known to cause 2 of the 4 (or 5) types of hypersensitivity.

[edit] Type I

The most serious and rare form, type I is an immediate and potentially life-threatening reaction, not unlike the severe reaction some people have to bee stings. Such reactions account for a significant proportion of perioperative anaphylactic reaction, especially in children with myelomeningocele.[citation needed]

Testing for type I natural rubber latex allergy is through blood testing, such as RAST (radioallergosorbent test) identifies what types of IgE proteins trigger allergic reactions. While the standard for allergen testing is the skin prick test, there is no approved skin testing reagent for latex in the United States,[citation needed] though some[specify] other countries do have approved skin testing reagents. Type I natural rubber latex allergy is caused from IgE (immune) mediated reactions to proteins found in the Hevea brasiliensis tree, a type of rubber tree.

Some people who are allergic to latex are also allergic to clothes, shoes, and other things that contain natural rubber latex—for example elastic bands, rubber gloves, condoms, pacifiers and baby-bottle nipples, balloons, cars, and clothing containing natural rubber based elastic. A Type I reaction can be triggered by exposure to airborne particles resulting from the inflation of balloons even if the person is not present while the balloons are being inflated.

[edit] Type IV (allergic contact dermatitis)

Also known as allergic contact dermatitis. This involves a delayed skin rash that is similar to poison ivy with blistering and oozing of the skin (see urushiol-induced contact dermatitis). This type is caused by a naturally occurring latex protein.[citation needed]

Type IV reactions are caused by the chemicals used to process the rubber.[citation needed] Patch testing needs to be done to verify which type of chemical triggers the reaction. Once the chemical is identified, then the person can choose products that are not processed with that chemical.

[edit] Irritant contact dermatitis

It can also cause irritant contact dermatitis:[1] The most common type of reaction.[citation needed] This causes dry, itchy, irritated areas on the skin, most often on the hands. It can be caused by the irritation of using gloves, or it can also be caused by exposure to other workplace products. Frequent washing of the hands, incomplete drying, exposure to hand sanitizers, and the talc-like powder coatings (zinc oxide, etc.) used with gloves can aggravate symptoms.[citation needed] Irritant contact dermatitis is not a true allergy.[citation needed]

[edit] Those at greatest risk

  • Children with Spina bifida. About 68% will have a reaction.[2]
  • Industrial rubber workers, exposed for long periods to high amounts of latex. About 10% have an allergic reaction.[citation needed]
  • Health care providers. Given the ubiquitous use of latex products in health care settings, management of latex allergy presents significant health organizational problems. Healthcare workers who frequently use latex gloves and other latex-containing medical supplies such as physicians, nurses, aides, dentists, dental hygienists, operating room employees, laboratory technicians, and hospital housekeeping personnel are at risk for developing latex allergy.[3] Between about 4% to 17% of healthcare workers have a reaction, this usually presents as Irritant Contact Dermatitis, and can develop through allergic sensitivity to a status of full anaphylaxis shock; with health workers losing their vocation.[4] In the surgical setting, however, the risk of a potentially life-threatening allergic reaction by a patient has been deemed by Johns Hopkins Hospital to be sufficiently high to replace all latex surgical gloves with synthetic alternatives.[5]
  • People who have had multiple surgical procedures, especially in childhood.[1]

Estimates of latex sensitivity in the general population range from 0.8% to 8.2%,[6] although not all will ever develop a noticeable allergic reaction.[citation needed]

[edit] Latex and foods

Some people who have latex allergy may also have an allergic response to any of a number of plant products, usually fruits. This is known as the latex-fruit syndrome.[7] Fruits (and seeds) involved in this syndrome include banana, pineapple, avocado, chestnut, kiwi fruit, mango, passionfruit, strawberry and soy. Some but not all of these fruits contain a form of latex. The Asthma and Allergy Foundation of America estimates that nearly 6 percent of the United States population have some type of food allergy and up to 4 percent have an allergy to latex.[8] It can also cause reactions from foods touched by latex products in the most severe cases.

Some individuals who are highly allergic to latex have had allergic reactions to foods that were handled or prepared by people wearing latex gloves.[citation needed]

[edit] Alternatives

  • Synthetic elastic such as elastane or neoprene do not contain the proteins from the Hevea brasiliensis tree that trigger type I reactions.
  • Products made from guayule natural rubber emulsions also do not contain the proteins from the Hevea rubber tree,[2] and have only trace amounts of other proteins, indicating a very low potential for causing sensitization to this material.
  • Chemical treatment to reduce the amount of antigenic proteins in Hevea latex has yielded alternative materials, such as Vytex, which reduce exposure to latex allergens while otherwise retaining the properties of natural rubber.
  • Some patients' sensitivity is so extreme that replacement of Latex products with non-latex products may still result in a reaction if the products are manufactured in the same facility as the Latex-containing products.

[edit] Latex allergens

Hevein-like protein domains[9] are a possible cause for allergen cross-reactivity between latex and banana[10] or fruits in general (latex-fruit syndrome).[11]

Natural rubber latex contains several conformational epitopes located on several enzymes like Hev b 1[12], Hev b 2[13], Hev b 4[14], Hev b 5[15] and Hev b 6.02.[16][17]

FITkit is a latex allergen testing method for quantification of the major natural rubber latex (NRL) specific allergens: Hev b 1, Hev b 3, Hev b 5 and Hev b 6.02.[18]

[edit] See also

[edit] References

  1. ^ a b "Latex Allergy". http://www.aafp.org/afp/980101ap/reddy.html. Retrieved 2009-08-08. 
  2. ^ a b "Plant Biologists And Immunochemists Develop Hypoallergenic Alternative To Latex". ScienceDaily. December 1, 2008. http://www.sciencedaily.com/videos/2008/1206-protect_yourself_from_latex_allergies.htm. Retrieved 2010-02-13. 
  3. ^ "NIOSH Alert:Preventing Allergic Reactions to Natural Rubber Latex in the Workplace". United States National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/latexalt.html. Retrieved 2008-01-20. 
  4. ^ Latex Allergy
  5. ^ WJZ 13 (CBS) (2008-01-15). "Hopkins ceases use of latex gloves during surgery". Baltimore. http://wjz.com/local/johns.hopkins.hospital.2.629922.html. Retrieved 2009-07-30. 
  6. ^ Grzybowski M, Ownby DR, Rivers EP, Ander D, Nowak RM (October 2002). "The prevalence of latex-specific IgE in patients presenting to an urban emergency department". Ann Emerg Med 40 (4): 411–9. doi:10.1016/S0196-0644(02)00063-X. PMID 12239498. 
  7. ^ Brehler R, Theissen U, Mohr C, Luger T (April 1997). ""Latex-fruit syndrome": frequency of cross-reacting IgE antibodies". Allergy 52 (4): 404–10. doi:10.1111/j.1398-9995.1997.tb01019.x. PMID 9188921. 
  8. ^ “Allergy Facts and Figures,” Asthma and Allergy Foundation of America http://www.aafa.org/display.cfm?id=9&sub=30
  9. ^ What is the role of the hevein-like domain of fruit class I chitinases in their allergenic capacity? Dìaz-Perales A, Sánchez-Monge R, Blanco C, Lombardero M, Carillo T and Salcedo G, Clin Exp Allergy. 2002 Mar;32(3), pages 448-454, PubMed
  10. ^ Hevein-like protein domains as a possible cause for allergen cross-reactivity between latex and banana. Mikkola JH, Alenius H, Kalkkinen N, Turjanmaa K, Palosuo T and Reunala T.J, Allergy Clin Immunol. 1998 Dec, 102(6 Pt 1), pages 1005-1012, PubMed, doi:10.1046/j.1365-2222.2002.01306.x
  11. ^ The latex-fruit syndrome. Wagner S and Breiteneder H, Biochem Soc Trans. 2002 Nov, 30(Pt 6), pages 935-940, PubMed
  12. ^ On the allergenicity of Hev b 1 among health care workers and patients with spina bifida allergic to natural rubber latex. Zhiping Chen, Reinhold Cremer, Anton Posch, Monika Raulf-Heimsoth, Hans-Peter Rihs and Xaver Baur, Journal of Allergy and Clinical Immunology, Volume 100, Issue 5, November 1997, pages 684-693, doi:10.1016/S0091-6749(97)70174-X
  13. ^ Mapping of IgE-binding epitopes on the major latex allergen Hev b 2 and the cross-reacting 1,3beta-glucanase fruit allergens as a molecular basis for the latex-fruit syndrome. Barre A, Culerrier R, Granier C, Selman L, Peumans WJ, Van Damme EJ, Bienvenu F, Bienvenu J and Rougé P, Mol Immunol. 2009 May, 46(8-9), pages 1595-604, {{PMID|19185347}, doi:10.1016/j.molimm.2008.12.007
  14. ^ Structural analysis of the glycoprotein allergen Hev b 4 from natural rubber latex by mass spectrometry. Daniel Kolarich, Friedrich Altmann and Elumalai Sunderasan, Biochimica et Biophysica Acta (BBA) - General Subjects, Volume 1760, Issue 4, April 2006, Pages 715-720, doi:10.1016/j.bbagen.2005.11.012
  15. ^ Human IgE-binding epitopes of the latex allergen Hev b 5. Donald H. Beezhold, Vicky L. Hickey, Jay E. Slater, Gordon L. Sussman, Journal of Allergy and Clinical Immunology, Volume 103, Issue 6, June 1999, pages 1166-1172, doi:10.1016/S0091-6749(99)70194-6
  16. ^ Insights into a conformational epitope of Hev b 6.02 (hevein). Reyes-López CA, Hernández-Santoyo A, Pedraza-Escalona M, Mendoza G, Hernández-Arana A and Rodríguez-Romero A, Biochem Biophys Res Commun. 2004 Jan 30, 314(1), pages 123-130, PubMed
  17. ^ Analysis of B-cell epitopes from the allergen Hev b 6.02 revealed by using blocking antibodies. Martha Pedraza-Escalona, Baltazar Becerril-Luján, Concepción Agundis, Lenin Domínguez-Ramírez, Ali Pereyra, Lidia Riaño-Umbarila and Adela Rodríguez-Romero, Molecular Immunology, Volume 46, Issue 4, February 2009, Pages 668-676, doi:10.1016/j.molimm.2008.08.282
  18. ^ Koh D, Ng V, Leow YH, Goh CL. (2005). "A study of natural rubber latex allergens in gloves used by healthcare workers in Singapore.". Br. J. Dermatol. 153 (5): 954–59. doi:10.1111/j.1365-2133.2005.06820.x. PMID 16225605. 

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