Latex Complex: Latex Allergies on the Rise
In 1987 the AIDS epidemic prompted the CDC to establish universal precautions for prevention of viral transmission in the health-care setting -- involving, among other things, the wearing of latex gloves during almost all medical and dental procedures.Within a year, the FDA began to receive reports of allergic reactions in people who used those gloves. By 1989, cases of patients suffering anaphylactic shock and death in the operating room -- associated with contact with latex medical devices -- also began to occur with alarming frequency. Scientists realized that what they were witnessing was the emergence of a new and very real danger to both health-care workers and their patients -- latex allergy.This allergy is a reaction to a component of natural rubber latex -- the milky sap of a tree that grows in Africa and Southeast Asia. The harvested fluid contains both a polymerized fat -- the essential ingredient of rubber -- and over 200 different proteins. The natural rubber latex is chemically processed to produce the commercial latex products used today. Although chemicals used in the processing can cause skin irritation, the true allergy is caused by the nonessential proteins also found in the latex fluid.The rapid development of this problem can be illuminated by a single statistic: in 1987, one billion pairs of latex gloves were imported into the U.S.; in 1988, that figure was eight billion.In the mid-80s, about 3 percent of health-care workers were shown to have developed an allergy to latex. In a 1994 Annals of Allergy article, M.S. Yassin reported that up to 17 percent of hospital workers and up to 38 percent of dental workers experienced symptoms of allergy to latex. And although G.L. Sussman, in a 1995 issue of the Annals of Internal Medicine, estimated that less than one percent of the general population is currently sensitized to latex, the numbers will almost certainly rise due to increased use of latex gloves among policemen, fire fighters, ambulance and funeral-home workers, painters, gardeners, food-service workers, and members of other occupations.And gloves aren't the only threat. Latex is used to make a wide variety of medical devices and household objects. Catheters, intubation tubes, masks, stethoscopes, blood-pressure cuffs, tourniquets, and some dressings and bandages also contain latex.Outside the hospital, one may encounter latex in automobile tires, balloons, condoms and diaphragms, household gloves, rubber bands, pacifiers, baby-bottle nipples, motorcycle handgrips, and some sports equipment. Harmless enough objects unless you're one of the million-plus Americans who have developed a latex allergy since 1990, according to K.J. Kelly in a 1995 issue of the Source to Surgery newsletter. As with any allergy, sensitization to latex is a two-stage process. Preliminary contact generally causes no visible symptoms, but the immune system responds in such a way that certain cells retain a memory of the exposure. With subsequent contact those memory-cells produce a specific kind of antibody called IgE, which causes allergic symptoms.Latex allergy is generally first noticed as an irritation of the hands following the wearing of latex gloves; skin may be dry, cracked, or blistered. (Nonallergic forms of skin irritation can be caused by other factors -- friction from the gloves themselves, sweating inside the gloves, chemicals used in the latex-manufacturing process, or the repeated hand washing that often accompanies glove use.) System-wide symptoms like runny nose, itchy eyes, or asthma-like conditions may develop. Ultimately, latex allergy can cause life-threatening anaphylaxis, or even death.Even people who don't encounter latex on a routine basis may be sensitized. Anyone who has had multiple surgeries has been latex-exposed and is considered at high risk for serious allergic responses; in a study published in a 1994 issue of the Journal of Allergy and Clinical Immunology, A.J. Kelly determined that 67 percent of a group of spina bifida patients (who must undergo multiple urethral catheterizations) were sensitized to latex. And in a 1990 issue of the Lancet, U. Beuers reported the case of a woman with no known latex allergy who passed out after playing a squash match. Emergency personnel could find no pulse, but she was rushed to the hospital and eventually recovered. She had earlier had five minor operations; doctors determined that the latex handle on her squash racquet precipitated this episode of anaphylactic shock.Those who suffer chronic symptoms of allergy are also predisposed to latex allergy. In a study published in a 1992 issue of the Annals of Allergy, J.E. Slater found that people who complain of runny noses, asthmalike symptoms, or food allergies are seven times more likely to be latex-sensitized than the general population. And R. Arellano, in a 1992 issue of Anesthesiology, demonstrated that almost 25 percent of health-care workers with chronic allergy symptoms were allergic to latex.Interestingly, there appears to be an allergy-causing protein similar to a latex protein in some fruits and vegetables. Some people are sensitized to latex by the food, some are sensitized to the food by latex, according to A.J. Weido in a 1995 issue of Postgraduate Medicine. Fruits which may induce this cross-sensitization include avocados, bananas, kiwi, chestnuts, apricots, papaya, passion fruit, pineapple, peaches, nectarines, plums, cherries, melons, figs, grapes, and tomatoes. Potatoes and celery may also cause such a reaction.Latex allergy is now considered one of the most important occupational problems, and health-care providers are really just now realizing the danger that latex allergy can pose to their patients. Most of the people affected currently suffer no more than an irritation of the skin on their hands from wearing latex gloves. The response of allergic individuals often increases through repeated contact, however; over 1,000 people in the last few years have suffered anaphylactic shock and at least 15 people have died, according to Sussman.Cases of anaphylaxis and death have occurred in people who did not know that they had been latex sensitized, so it is important that everyone understand the potential danger and take what steps they can to protect themselves. Those who use latex gloves regularly on the job or in connection with a hobby, should use gloves only if and when necessary. If gloves are required, use vinyl or other non-latex kinds if possible. If only latex gloves will do, find and purchase one of the low-protein brands now being produced. They are less likely to cause sensitization than those with high protein concentrations.If you fall into any of the high-risk categories -- you are experiencing any type of skin irritation when you use latex gloves, have had several previous surgeries, have chronic unexplained allergy symptoms, or experience irritation around the mouth or other allergy symptoms when eating any of the fruits or vegetables listed above -- consider getting yourself tested. Latex allergy can be easily diagnosed through a skin-prick test. If you are sensitized, complete avoidance of latex is the only way to ensure your safety. There is no cure.Although most serious reactions occur when latex comes in contact with internal surfaces during surgeries, life-threatening situations can develop in seemingly harmless situations, too. (The woman with the squash racquet, for example, and the nurse who went into anaphylaxis after removing the rubber top from a medicine vial.) So take every precaution.Make sure all your health-care providers are aware of your allergy and the potential consequences of inadvertent exposure. Do not allow use of latex gloves around you, as the cornstarch powder used in the gloves carries the latex proteins into the air when the gloves are removed or put on, and serious allergic reactions have occurred in latex-sensitive individuals from inhaling latex-laden air in operating rooms or dental suites.You may want to consider wearing a medic-alert bracelet notifying possible caregivers that you are latex-sensitized, since latex exposure can happen unexpectedly. H.J.Schwartz, in a 1995 issue of the Journal of Allergy and Clinical Immunology, reported on the cases of two individuals who suffered allergic responses after eating at fast-food restaurants where employees wore latex gloves.If you are involved in any way in patient care, or are responsible for employees who are regularly exposed to latex, make it a habit to question those for whom you are responsible about possible sensitization. Educate your colleagues and employees with regard to the potential dangers. And be alert to the possibility of a serious latex reaction -- make sure your workplace has set up emergency procedures. Familiarize yourself with the symptoms, and know what to do.Latex allergy is a growing problem in the U.S. and around the world, and since we have only just begun to diagnose affected people, the problem will no doubt continue to worsen for a while. Better manufacturing techniques and greater public awareness will help, but the bottom line for now is caution.