An immediate allergy to natural latex is becoming increasingly important, especially as an occupational skin disease in medical staff. According to recent screening investigations, up to 17% of those working in the medical professions and 2.3% of the general population are affected. Apart from the high prevalence of latex allergy, the increase in severe generalised reactions which can extend to anaphylactic shock with a fatal outcome is also a cause for concern.
Form of Latex Allergy
Contact urticaria (Maibach stage II). It is manifested as erythema and hives.
Clinically, latex allergy manifests itself in various ways, depending on the route of allergen absorption.
Contact urticaria (Maibach stage II). It is manifested as erythema and hives. The contact urticarial syndrome arises as a result of dermal allergen absorption through direct skin contact with latex-containing objects (e.g. wearing latex gloves) and by mucosal contact (e.g. during operations). Contact urticaria is classified into four stages (see table). Contact urticaria after wearing latex gloves is apparent about 10 to 30 minutes after contact with the allergen as erythema with hives, affecting mainly the knuckles and wrists. Inhalational latex allergy is produced by inhaling latex proteins which are, for instance, bound to glove powder particles and are released into the air in the room. The latex allergens thus reach the mucous membranes of eye, nose and bronchus by the air-borne route, without being preceded by immediate skin contact with latex-containing objects. The occurrence of mucosal symptoms ("runny nose", "itchy eyes") in medical staff during working hours is characteristic, since the air in hospitals usually contains high concentrations of latex proteins. Apart from rhinoconjunctivitis, the symptoms of inhalational latex allergy range from urticaria (especially in the face and on the neck), angioneurotic oedema and asthma to anaphylactic shock. A further possible way of allergen absorption is the parenteral route if latex-containing infusion systems are used, where the allergen gets into the bloodstream of the affected patient directly and can lead to general reactions.
Diagnosis
Apart from the patient's medical history, skin testing, serological investigations and provocation tests are performed to diagnose latex allergy. Predisposing factors (atopy, profession, previous medical operations etc.) should be enquired about when recording the history, and indications of a latex allergy (for instance, itching and hives when wearing rubber gloves, using condoms or blowing up balloons; unclarified events during invasive investigations or operations) should be noted.
Therapeutic Methods
Peha-taft syntex is a latex- free glove, which can be used universally in all areas.
The only causal treatment of latex allergy is avoidance of the allergen. Patients with contact urticaria should avoid direct contact with latex-containing products. If medical staff have a latex allergy, they can wear latex-free instead of latex-containing gloves. Several latex-free products are available, for instance HARTMANN's surgical glove Peha-taft syntex which is made synthetically without using natural latex.
Peha-taft syntex is a latex-free glove, which can be used universally in all areas. The raw material is a 100% synthetic copolymer offering comparable characteristics to natural latex. However, patients with inhalational latex allergy can avoid the allergens dispersed in the air only in a latex-free environment. In many cases, an internal change of workplace or retraining will be necessary. In order to reduce the rate of new sensitisation, persons who belong to the risk groups (e.g. doctors and nursing staff with atopy) should use skin protective measures consistently.
It is also important to identify patients with a disposition to latex allergy by taking a deliberate history, especially before latex contact from medical procedures, in order to avoid unexpected anaphylactic reactions.
English translation of an article by Dr. Elisabeth Rimmele-Schick Department of Dermatology of Ulm University Hospital Oberer Eselsberg, 89081 Ulm
