Do you have a latex allergy?

Your symptoms could start with swollen lips after your child’s birthday party. Or some welts on your hands after washing dishes. Or an itchy mouth after a visit to the dentist. What could be causing such reactions? Increasingly, the surprising answer you’ll hear from experts is latex, or natural rubber. And it’s everywhere – party balloons, dish-washing gloves, dental gloves and countless other items. Sometimes it’s even in the air.

Unlikely as it may seem, latex allergies do exist. How could you be allergic to latex? Just like ragweed, latex comes from a living thing, a rubber tree, and contains proteins that trigger allergic reactions in some susceptible people.

The incidence of latex allergy, though still low, is growing rapidly. It was virtually unheard of as recently as 1988. But today, perhaps 8 percent of the general population has latex-allergic antibodies (although only about a quarter of these individuals go on to develop clinical signs of latex allergy). Two groups in particular stand a greater chance of actually developing the allergy: (1) those with high latex exposure at work, especially health-care workers and (2) people who’ve undergone multiple surgeries, especially children when operations begin in infancy.

Should you be worried? “No,” says B. Lauren Charous, M.D., chairman of the latexallergy committee of the American College of Allergy, Asthma and Immunology. “But you should be aware,” he says.

Here’s what you need to know to detect or prevent a latex allergy and, if you are allergic, to cope with it.

SOURCES OF TROUBLE

Latex has been in common use for over 50 years. It’s in our underwear, clothing, socks and shoes, underneath the carpet we walk on and in the rubber plant in the corner. It’s in the rain slickers that keep big people dry, and the pacifiers baby-bottle nipples and toys that keep little people content. Contact may come from unexpected sources, as when restaurant sandwiches are prepared by someone wearing latex gloves. The list of examples is nearly endless.

What’s more, latex also forms “a significant proportion of air pollution, in the form of particulates from tires,” says P. Brock Williams, Ph.D., of the Allergy Respiratory Institute of Colorado, in Denver. The direct-contact sources mentioned above may be more problematic – indeed, relatively few people seem affected by airborne latex particulates. But experts suspect that these few may be more significant than previously realized. In fact Dr. Williams believes airborne latex particulates may partially explain the continuing rise in asthma cases despite a decrease in auto emissions. The scientific jury, however, is still out.

For health-care workers, airborne latex takes a somewhat different form: The powder in medical gloves can become airborne, carrying latex allergens, which are then inhaled, sensitizing susceptible people or triggering reactions in allergic individuals. This form of airborne latex is considered a significant problem.

SUSCEPTIBILITY FACTORS

No one is free of the risk for developing a latex allergy, says Dr. Charous. However, some factors have been associated with increased likelihood:

High exposure to latex The factor linked most strongly with latex allergy is total exposure. Though the overall risk of developing a latex allergy is low, greater exposure increases this risk.

Allergic history If you’re a health-care worker and you’re an allergic person to begin with, you’re more likely to develop an allergy to latex, says Jay E. Slater, M.D., of Children’s National Medical Center in Washington, D.C. So far, this link between previously having allergies and then developing a latex allergy has been observed only in health-care workers. But experts suspect the link exists in other groups.

Multiple surgeries Young children who’ve had multiple surgeries since infancy – including children with spina bifida – may have a 30 to 60 percent risk of developing latex allergy. (Many surgeons now routinely take precautions with such children, assuming they may be latex allergic.) Older children, teens and adults undergoing multiple surgeries may face a slightly increased risk. Doctors suspect multiple direct contacts between latex and internal tissues may account for the increased susceptibility.

Food allergies One shocking aspect of latex allergy is that people who have certain food allergies appear to be more likely to react to latex. Why would this be? Some vegetables and fruits contain proteins that are similar to the proteins found in latex. In essence, what can happen is that our bodies can generalize an allergic reaction from one protein to another similar one. This is called cross-reactivity.

Over the past two to three years, the list of foods shown to cross-react with latex has grown longer and longer. And although food allergy is relatively rare, affecting less than 1 percent of the population , the following foods have been reported to cross-react with latex: bananas, water chestnuts, kiwis, raw potatoes, tomatoes, celery, carrots, hazelnuts and stone fruits (e.g., peaches and cherries), figs, avocados, papayas and passion fruit.

For some, having a known allergy to one or more of these foods may even serve as an early-warning sign of possible latex allergy. But while having allergies, especially these food allergies, is a risk factor for developing latex allergy, it is not a guarantee that you will. And the reverse is also true: Just because you don’t have other allergies doesn’t mean you can’t develop a latex allergy.

Occupational exposure People who work in the rubber industry or related industries (e.g., tire manufacturing) face the highest level of exposure. But by far, health-care workers comprise the largest group affected. They come in contact with latex through a broad range of medical equipment, from blood-pressure cuffs to surgical tubing, but especially through powdered latex exam gloves. One recent study found some gloves to be extremely high in latex allergens, containing upwards of 16,000 arbitrary allergy units as opposed to, say, less than 5 units in many baby-bottle nipples (Journal of Allergy and Clinical Immunology, May 1994). From their occupational exposure to latex allergens, as many as 10 to 17 percent of health-care workers may be predisposed to latex allergy.

CONFIRMING THE PROBLEM

For any person who may be at risk for developing a latex allergy, early detection is the key to possibly keeping nuisance reactions from becoming more dangerous ones. Be aware of any symptoms you might have that correspond with latex contact. And if you do notice a trend, see your doctor. Since no single test can diagnose a latex allergy, you and your doctor will need to look at multiple clues.

Medical history In taking a medical history, your doctor will also look for links between symptoms and possible contacts with latex. The two most sensitive indicators are hives (urticaria) and, much less frequently, anaphylactic shock. Other symptoms can include sneezing and nasal congestion, along with watery and itchy eyes.

To obtain a full medical history, the physician must leave no stone unturned. Your doctor will need to find out, for example, if you have had any kind of reaction to household goods like balloons, rubber bands or rubber handles, or reactions during a dental or pelvic examination or prior surgery. Women may report that they’ve had cramps or itching and swelling following intercourse using a diaphragm or condom. These symptoms should be taken as possible indications of latex allergy.

Not all reactions to latex are allergic ones: Some are considered reactions to chemicals used to make gloves or other products, not latex per se. However, if you’re having some reaction, you can’t assume it’s not an allergy. This is especially important if you are facing surgery.

Allergy tests Only after your doctor has taken a careful medical history and evaluated risk factors will he give you an allergy test. “Allergy tests can be used only to confirm suspicions of a latex allergy,” says Dr. Charous. That’s because the chance is too great that the test will fail to spot the allergy, or conversely, raise a false alarm where noallergy exists.

Your physician has either of two standard allergy tests available to help determine if you have latex allergy: a skin prick test, where a small amount of latex is scratched into the skin and the patient’s reaction is monitored, or a radioallergosorbent test (RAST), where blood is drawn and examined for levels of antibodies to latex, an indication the patient is at least predisposed to the allergy.

PREVENTION TACTICS

If you’re at some risk for latex allergy, you may be able to keep an allergy from ever developing by modifying your exposure to latex. (If you’re not at any notable risk, modification is probably not necessary.) Generally a latex allergy takes time to develop. With repeated exposures to the allergenic proteins in latex, the immune system of a potentially allergic person is switched on, producing antibodies to the allergens. But these antibodies must reach a critical level before an allergic reaction is triggered. By limiting exposure, you may be able to keep antibodies from reaching that level.

One symptom may be especially important to be on the lookout for: “The appearance of a latex-glove-associated contact rash may precede the development of latex allergy, particularly in people with other allergies,” says Dr. Charous.

If you’re at risk, here are some steps you can take to try to keep from developing a latex allergy and avoid a medical emergency:

Minimize exposure. If you’re a healthcare worker with an allergy – particularly an allergy to one of the previously mentioned foods – try switching to nonlatex gloves. They may not be quite as comfortable, but there’s nothing comfortable about a latex allergy. (“Hypoallergenic” latex gloves do not necessarily offer protection.) You should also request that those around you wear nonpowdered latex gloves to reduce your exposure to airborne latex allergens.

Your own doctors, including your dentist, should be prepared to examine you with nonlatex gloves if necessary. If you’re concerned about whether or not they can accommodate your request, call in advance. If worst comes to worst, you can always bring your own latex alternatives.

At home as well, highly susceptible people should minimize contact with latex items, including the most-innocent-appearing rubber bands and balloons, which turn out to be extremely high in latex allergen.

Women at high risk for a latex allergy might want to be especially careful about the use of diaphragms and condoms made with latex. (Allergic reaction from condoms and diaphragms are a concern for women more so than for men because they come in direct contact with women’s mucous membranes.) Discuss options with your gynecologist or physician.

Get evaluated before surgery. Many experts suggest that people in high-risk groups have a full medical evaluation for latex allergy before undergoing surgery. Though rare, individuals without any previous history of latex allergy can have their first reactions during surgery, and the risk would seem to be greater for those who are allergic to the foods mentioned previously. This reaction is potentially dangerous because it could lead to anaphylactic shock, which can interfere with breathing and disturb heart rhythms. Remember, though, the possible risks from surgery to a small minority of allergic persons shouldn’t cause you to avoid – or delay – a needed operation. Steps can be taken to provide a latex-allergic person with a safe surgical environment.

Wear a medical-alert bracelet. Emergency medical technicians are trained to look for a medical-alert bracelet. This can provide important information since many pieces of first-aid equipment may contain latex. Include the warning “possible latex allergy” and other appropriate information (e.g., “allergic to bananas”).

MANAGING LATEX ALLERGY

If you are latex allergic, follow all the precautions we gave you under “Prevention Tactics,” plus a couple more.

Carry some adrenaline. Symptoms of an allergic reaction, including difficulty breathing (wheezing, chest tightness, shortness of breath), generalized hives, rapid heartbeat and faintness, all may indicate that a systemic (whole-body) reaction is occurring, and that’s never a minor reaction. So if you’ve ever had a severe reaction to latex or one of the listed foods, you should carry a personal adrenaline syringe, available by prescription. Some are available with an automatic release. This allows you to easily inject yourself with a dose of epinephrine, to slow an anaphylactic reaction. But be advised: You still need to call 911, or have someone transport you immediately to an emergency room.

Find a latex-free operating room. Today most hospitals can create a latex-safe operating room. Some medical equipment parts need to be replaced with nonlatex pieces and alternative gloves substituted for latex, among other precautions. But when proper care is taken, the risk from surgery is absolutely minimized.

Be the first patient of the day. The day’s first surgery is when airborne latex allergen levels, which tend to build through the course of the day, are at their lowest. Being first to see your dentist might also be beneficial.