A large range of household and medical products are made from natural rubber latex:¹

• Household gloves
• Surgical gloves
• Examination gloves
• Condoms
• Teats
• Comforters
• Catheters
• Rectal Dams

During the past nine or ten years, latex allergy or sensitivity has become recognized as a significant problem for some routine users and, more seriously, medical patients and healthcare workers. While this can be a significant problem for those individuals who are allergic to latex, the incidence of this allergy is very small, estimated at less than 1% of the general population. The American College of Allergy and Immunology has developed guidelines for identifying patients/providers who are at risk and precautions for them to follow. However, before getting into the solution, let’s spend some time on the problem.

Latex sensitivity is a relatively new issue and believe it or not, is a result of the heightened concern for and risk of the transmission of blood born pathogens.

In the late 1980’s, the Centers for Disease Control Initiated Universal Precautions which changed the way healthcare workers protected themselves and others from patient’s blood and body fluids. Prior to Universal Precautions, patients were placed in various forms of isolation (such as Respiratory Isolation, Blood Precautions, Complete Isolation, Wound and Skin Precautions) when they were suspected of having or were known to have an infectious disease or an infection that would be readily transmitted from patient to patient or patient to staff. Generally, it was only when caring for patients in these situations that staff members took special precautions, such as wearing gloves when handling the patient’s blood and/or body fluids.

However, in the late 1980’s it became clear that more precautions were needed because diseases such as Hepatitis B and AIDS² could be transmitted by people who were without any symptoms of the disease. The practice of taking precautions only with patients who were suspected of disease based on symptoms or who had already been diagnosed, meant that there was great potential for transmission of these and other infections transmitted by blood and body fluids from patients who might never be suspected. Universal Precautions were developed to provide the needed protection.

Universal Precautions require healthcare workers to assume that the blood and body fluids of all patients are potential sources of infection, rather than only taking precautions with known or symptomatic patients. Those precautions included the wearing of gloves and other protective clothing, whenever hospital staff were likely to be in contact with specified body fluids. The end result of all of this was that the demand for latex gloves skyrocketed. To meet the demand, many new, inexperienced and poorly controlled manufacturing operations sprang up. Some of these manufacturers (many of them centered in Taiwan and Malaysia) produced poor quality latex gloves which contained high levels of protein. It is believed that these proteins, in such high levels, generated an allergic (antigen-antibody) response in some susceptible people who had contact with these gloves. For these allergic people, future exposure to these proteins can result in an allergic reaction ranging from a rash to anaphylaxis.³ Because of the allergic response that has been associated with the use of latex, healthcare practitioners may now take additional precautions with certain groups of people. Four groups of individuals appear to be at particular risk:

1. Patients, particularly pediatric age patients, with myelomeningocele⁴ and/or a history of
   
   chronic or recurrent instrumentation of the genitourinary tract.
2. Patients receiving barium enema procedures with a latex balloon tip.
3. Patients with occupational exposure, such as individuals who manufacture latex products.
4. Healthcare personnel and others who wear latex gloves.

The majority of patients who develop latex hypersensitivity have a history of some prior allergic condition. As a result, the American College of Allergy and Immunology has issued the following as preliminary recommendations until this situation is more clearly understood:

1. A careful history of the patient should be obtained concerning prior exposure to and reaction to latex or latex products.
   
   Any patient who has a history of rash, itching, hives, rhinitis, swelling or eye irritation or asthmatic symptoms after
   
   touching a balloon, rubber glove or any latex containing object is at risk of anaphylactic reaction.
2. Healthcare providers or others who give a history of only mild latex-glove eczema rarely have anaphylactic events.
   
   However, a history of severe or worsening latex glove induced eczema, urticaria (itching) or work-related conjunctivitis,
   
   rhinitis or asthma may indicate allergic sensitization and increased risk for more severe reactions in the future.

1. Latex sensitive patients should be protected from unintended exposures in the same manner as are drug-sensitive
   
   patients.
2. Patients with myelomeningocele should be referred for elective surgical procedures to centers which have latex-free
   
   surgical suites available.
3. Healthcare personnel who show signs of latex contact dermatitis or latex hypersensitivity should be encouraged to avoid
   
   exposure to natural latex.

Much research is underway to more clearly understand all of the issues involved with latex sensitivity. However, it is

generally accepted that latex products that are carefully manufactured from high quality, properly aged latex, carry a

minimal risk, because the protein level in the finished products is extremely low. Latex products manufactured under less than ideal conditions and using latex that has not been aged, carry significantly higher levels of these

proteins and are therefore much more likely to trigger allergic reactions in susceptible people.

If a clinician believes the patient to be latex allergic, the American College of Allergy and Immunology would recommend

that no latex product be used on such a latex sensitive individual. Even though the number of latex allergic individuals is

very low, once the clinician is knowledgeable about the allergy, he/she will treat this patient like any other patient with a

known allergy: Avoid the allergen and find substitute products. For example, patients who are allergic to drugs such as

penicillin are given other antibiotics when indicated that are non-penicillin derivatives. Put yourself in the clinician’s

place. If you or someone you are responsible for is known to be allergic to bee stings, you would not recommend that they

harvest honey from a bee hive. The risk of a bee sting and a possible fatal reaction would be too great for you to make such

a recommendation. The clinician is in a similar situation. The risk is too great to take a chance with any latex product if

the patient has a known sensitivity to latex.