Use links to other websites for more details.
|Natural rubber latex||Cornstarch||Air and surfaces in working environment become
contaminated with natural rubber protein carried on the starch particles. |
Sensitisation and symptoms by the respiratory route and also by direct contact.
Possible symptoms include occupational asthma.
|Natural rubber latex||Non-powder lubricant||No airborne contamination. Surface contamination seems
possible but generally unimportant to latex-hypersensitive staff working in the
same environment. |
Must not be used by or in contact with latex-hypersensitive staff or patients as it can sensitise and cause symptoms by contact.
|Neoprene (synthetic rubber)||Cornstarch or non-powder||Safe in contact with
latex-hypersensitive patients and staff. |
Handling properties inferior to natural rubber latex.
|Vinyl||Cornstarch?||Inferior and in critical situations unacceptable barrier against infection but adequate for some tasks. Cheap. Not elastic.|
|Polyethylene||Generally none||Inferior and in critical situations unacceptable barrier against infection but adequate for some tasks. Cheap. Not elastic.|
|Polyurethane?||No data||I am not currently aware that polyurethane gloves are available. Since this material, much stronger than vinyl or polyethylene and has proved satisfactory for contraceptive devices, gloves made from it may be feasible and useful in some settings in the future. Not elastic.|
Nonpowdered gloves, still manufactured from rubber latex, do not produce the airborne powder, and hence do not produce asthma in sensitised staff. They do however cause contact urticaria and we do believe that they can sensitise via skin contact.
In contrast, synthetic powdered gloves which are not made from rubber latex cause no problem. However, polyethylene or vinyl gloves do not provide the same barrier against infection which is achievable with latex gloves. Synthetic rubber gloves made from neoprene can cause neither allergic sensitisation nor symptoms but protect against infection as thoroughly as natural latex. Since they are not made from rubber trees, they contain no protein. They don't quite match natural rubber for handling properties and 'feel', and are much more expensive. For this reason their use is generally confined to contact with staff or patients who are already hypersensitive (allergic) to natural rubber latex.
Since non-powdered natural rubber latex gloves are readily available, it is no longer acceptable to use powdered latex gloves in an area in which latex-hypersensitive staff have to work. The added expense of non-powdered gloves is not an acceptable argument against their use in these circumstances, since even taking the narrowest financial view, the cost of increasing the sensitisation of already sensitised staff is far higher. In my own hospital I have not seen occupational asthma from latex, though I have seen it in nurses exposed elsewhere. I believe this is due to an early decision made by others to use exclusively non-powdered gloves in the operating theatres.
Natural rubber latex gloves differ enormously in latex allergen content. The differences are thought to be due to different degrees of purification of the latex prior to glove manufacture, and to different degrees of washing of the gloves after they have been produced by dipping a former into latex liquid and stripping the latex rubber layer off the former. Thus latex examining gloves, which are manufactured by cheaper processes, contain much more protein than surgeons' gloves, for example. However, considerable differences in protein content have been found between apparently similar latex gloves from different sources.
This may help to explain why nurses develop latex allergy more commonly than surgeons, since they probably don examining gloves more often than surgeons.
We see a very few adults with latex allergy who are not health care workers. Nearly all have direct or indirect occupational contact with latex. Examples are: the wife of a doctor, the wife of a teacher of theatre studies who makes a lot of latex masks, and the worker in a pharmaceutical factory who does not wear latex gloves but shares a workspace with workers who do. Only a few adult patients I have seen with latex allergy did not have such a history or other risk factors as far as I could determine. Latex allergy seems to be a problem of people who are regularly exposed.
Severe reactions including anaphylaxis may also occur on contact with a range of fruits and possibly other foods. See below.
Latex allergy. Foods may also cause
Restaurant workers often wear rubber latex gloves to handle food. This can also cause otherwise mysterious reactions. Many authorities believe that the use of latex gloves in the catering industry in this way is inappropriate.
From the medical journals (the abstract has been edited by us) :
"Latex-fruit syndrome": frequency of cross-reacting IgE antibodies.
Brehler-R; Theissen-U; Mohr-C; Luger-T. Allergy. 1997 Apr; 52(4): 404-10
...Serum of 136 patients with immediate-type hypersensitivity against natural rubber latex had IgE antibodies to fruits in 69.1% of samples. IgE antibodies reacting with both latex and fruit allergens (papaya, avocado, banana, chestnut, passion fruit, fig, melon, mango, kiwi, pineapple, peach, and tomato) were found by RAST-inhibition tests. Of our patients, 42.5% reported allergic symptoms after consuming these fruits, in a total of 112 intolerance reactions. But fruit-specific IgE antibodies were found only in serum samples from 32.1% of the patients who noticed symptoms due to these fruits. Blood tests seem to be poor at predicting symptoms these foods in someone with latex allergy.
To find out more about anaphylaxis, click here.
Five deaths attributed to latex balloon catheters used for barium enemas are claimed to have been associated with one particular batch of catheters, and were reported by the Food and Drug Administration in the USA in 1992.
Latex Allergy is an Occupational Illness; your
Occupational Health Service is there to help you If you are an adult
with latex allergy, you almost certainly owe that fact to your job. Of course we
all take some risks in order to do our jobs. Builders can fall off scaffolding
and sea fishermen can fall overboard, for example. In health care we may have
some risk of getting infections through our work. Some level of risk is inherent
in almost anything we do, and some of us willingly accept higher than average
risks in order to do something worthwhile. So the mere fact that you became ill
because of your job does not necessarily mean that your employer deserves any
blame. In fact the National Health Service in the UK provides an excellent
Occupational Health service for its staff specifically to help you, and you
should definitely take advantage of it. The same is true for many other employers
and in many other countries.
Among the advantages for you are:
What should I do to prevent reactions? Carry
clear information stating that you are allergic to latex rubber. In Britain the
two most popular identifiers are the SOS Talisman, also available
from jewellers and pharmacies, and the MedicAlert bracelet, sold by MedicAlert. MedicAlert is also available
in many other countries.
Look up some of the other websites on latex allergy. This page is seriously incomplete for the simple reason that the other sites are excellent and we're not trying to duplicate other people's work.
Be prepared to find that your doctor or health care worker may not know about latex allergy, at least if outside the USA. There is a need for a leaflet you can carry, intended for health professionals. Meanwhile you could print out a copy of this web page. Latex allergy support groups could perhaps set up or sponsor a telephone helpline for health professionals. You can refer them to this website, which gives access to many other websites.
Seek to be treated by 'latex aware' doctors, hospitals, and health professionals including dentists. Or convert your health professional to latex awareness by supplying reliable information from a reputable source.
If you cannot find a 'latex aware' centre, you could carry your own latex-free gloves for some procedures. This is hardly practicable for serious surgery.
Know all the procedures which may involve dangerous exposure to latex. These include catheterisation with latex catheters: people have died having barium enema x-rays in which a latex balloon catheter was used to introduce the barium suspension.
Don't eat alone if you are eating unfamiliar food which could possibly contain any of the things to which latex-hypersensitive people react. Don't eat foods you are unsure about, e.g. fruit salad in a hotel could easily contain kiwi fruit or banana. Remember about things like chestnut in the stuffing of the Christmas turkey. For nut-allergic people, eating in restaurants is a problem and causes a high proportion of the serious reactions. The same will probably be true for people who are allergic to latex.
Join or set up a local support group. You will learn from the experiences and knowledge of fellow-sufferers, and they will learn from you. It will improve your ability to press for the health care changes which latex allergy sufferers need. If you are involved in the running of a self-help group, seek advice from others with substantial experience of running one. They are often not easy to run, since most or all the work can all too easily fall on one person or a tiny number; this is not viable in the long run. Interpersonal conflict will occur sooner or later and it is essential that common purpose should triumph over personal differences.
The Anaphylaxis Campaign is a national charity in the UK which has local branches and publishes a newsletter. It was founded because of the increasingly common problem of nut allergy, but covers other causes of anaphylaxis also.
There is a need for support groups for people who suffer from latex allergy. There is so much to learn and discuss on this subject alone that meetings covering other causes of anaphylaxis will only be satisfactory when subjects of common interest are being discussed. You may not have a local support group. Consider setting one up. A few brief tips on this. Such a group must be led by people who have the problem, not by professionals advising them. The professionals should have the role of providing expert advice, education and assistance. Don't do it alone unless there is no alternative; the strain of running such a group without sharing the burden will probably become too much, with the risk that the group will collapse. Get advice from a few people who have set up or run support groups which have been successful for a few years, and learn from any unsuccessful ones you come across. Make contact with other latex allergy support groups and learn from them. Politics and interpersonal differences can come to make well-intended activities difficult: this is more or less inevitable, so prepare yourself and the organisation you set up to be able to cope. I learned much of what didn't just learn from observation and bitter experience from Judy Wilson, and hope her book "Self-help Groups. Getting Started - keeping going" (Publisher Longman self-help guides, 1986, ISBN 0-582-89268-6, paperback) is still in print or available through libraries.
Which foods should I avoid? See above. The two main problems are knowing which fruits cause
problems and knowing the unexpected ways you may encounter them. For example
people have reacted to banana muffins, not expecting to find banana in a muffin.
Many food handlers in restaurants, canteens and packing facilities now wear latex gloves. Eating the food they have handled can cause reactions. In our opinion the use of latex gloves for food handling should be abandoned for this reason and some others.
When should I use adrenaline (epinephrine)?
Some specialists advise that adrenaline should be used for any reaction.
We don't agree.
In fact we almost never issue epinephrine (adrenaline) kits for latex allergy.
If your specialist does recommend that you carry an epinephrine (adrenaline) kit, you can find our views on its use on the Anaphylaxis page. Remember that these are our current views and they may not be right for you. Remember that life-threatening anaphylaxis seems to be rare (but not impossible) in latex allergy.
School and latex allergy
This section was added on 24-2-98 as an initial draft. Please e-mail us with your experiences and thoughts
on this subject to improve this section. Up to 11 April 2001 no-one has done
As in the case of nut allergy, children with latex allergy need special consideration at school. But there are far fewer children with latex allergy, so knowledge about this seems harder to come by.
To give the parents and the child a feeling of safety at school, we need to consider two objectives:
To prevent the allergic state from becoming worse we should avoid even small amounts of contact which might not be enough to cause symptoms at the time.
As always, keeping a sense of proportion is important. Nut allergy at school seems more dangerous. However, a child with latex allergy is entitled to feel that those in charge will protect him or her from unpleasant symptoms.
There is a need for an instruction leaflet for parents and for school staff to help with an appropriate level of care.
What if I need an operation? It is vital that
non-latex gloves are used. Non-powdered (powder-free) gloves are made of
natural rubber latex and must not be used on latex-hypersensitive patients.
The anaesthetist, nursing staff and surgeon must know that you are allergic to
latex. Some latex products (e.g. injection ports on drip sets, and rubber bungs
on injection ampoules) may be difficult to avoid but the USA websites have some
good ideas on these, e.g. tape over latex injection ports and inject via plastic
3-way tap. Treatments for anaphylaxis must be at hand, and the anaesthetist may
decide to give you a 'premed' of drugs to guard against allergic reactions.
During the operation, injectable adrenaline (epinephrine) should be immediately
to hand on the anaesthetist's trolley (ready drawn up in my view, but most
clearly labelled to avoid injecting it in error), and the anaesthetist should be
clear about the route of injection and the dose to be used if the need for it
arises, especially in the case of a child, for whom the dose will be related to
body weight. If the operation is not an emergency procedure, you should be
operated on as the first patient of the day in the operating theatre if powdered
gloves are used. There will then be less glove powder in the air.
There are websites which provide helpful information on surgery for people who are allergic to latex. An example is the site on LATEX ALLERGY - Perioperative Management. You can find other sites via the links fruther down this page.
What about dentistry? Non-latex gloves must be
used. Latex gloves might not only cause a reaction, but would perpetuate your
hypersensitivity to latex. There is a website page with links on dentistry: Latex Allergy Links
What about medical and gynaecological examinations?
Non-latex gloves must be used.
What about contraception? Latex contraceptives
do cause reactions, but usually to a surprisingly small extent. This is probably
because the products are washed well during manufacture. "Low allergen" or
"hypoallergenic" contraceptives are made from natural rubber latex. If you have a
latex allergy you should not use any kind of latex contraceptive, because even if
the reactions are not too bad or there is no obvious reaction at all, they may
increase or maintain your hypersensitivity.
Polyurethane contraceptives are safe and available. Examples are the Femidom, and 'Avanti' condoms, made by London Rubber Industries. The latter are certainly available in the USA. But have a look at HealthNews: New Plastic Condoms Slip, Break. This site mentions practical problems experienced with polyurethane condoms.
Other sites to look at:
What about latex rubber in clothing? Natural
rubber latex may occur in elastic. If so it is likely to cause a rash in the
contact area, and may perpetuate your hypersensitivity.
What about rubber in cars? Door seals are not
made from natural rubber latex. Don't worry about touching them. The rubber
backing of car carpets is also not natural rubber latex.
Is my asthma caused by latex? Or is it just ordinary
If your asthma is caused by glove powder in the operating theatre air, that may
be quite obvious, and it may be that your doctor has no difficulty in confirming
it. But it appears that there are some people who are not so sure. There are ways
Asthma is so common that some people working in operating theatres are bound to have it, even if they are not allergic to latex. But if it is caused by latex it is vitally important to find that out.
Of course the two possibilities are not mutually exclusive. It would be amazing if we didn't sometimes find people with asthma from latex and something else. It may take some real expertise to get the whole truth.
Enough reasons for checking it out thoroughly? Enough said.
There is a web page on Occupational Asthma
Am I imagining things? 'Latex phobia' or the real
Revised 13 Feb 2001
Some people with latex allergy have objected to a previous version of this section. Apart from emotive comments, there was clearly a concern that a substantial section on this topic on a page which is otherwise light on information (because there are so many good sites on latex already) might encourage others to wonder whether latex allergy is important. It should be obvious that the reality and importance of latex allergy are not in doubt. The point here is whether someone who wonders whether they are imaginig reactions might be having real ones, and whether someone who thinks they have real latex reactions might be wrong about that or about the severity. If this subject is of interest to you, I hope you will see this section as an attempt to discuss some of the issues around it.
Some reactions to latex will be slight, usually because exposure is slight. You may not be sure if you are having a real reaction or are imagining it. More distressingly, others may not believe you. Either way it is useful to settle the issue.
If your reactions are slight, then in themselves they are of course not life-threatening. But exactly such slight exposure may keep your allergy going or make it worse. If you have only ever had slight reactions to slight sources of latex you could still have an extremely serious reaction to more serious contact. Just because a reaction is slight, that does not mean you and others should not take it seriously.
If you have obvious signs such as rash or swelling, the only thing you might be mistaken about is the cause. Other common conditions can produce symptoms like those of latex allergy. In fact latex allergy picks on people who are prone to develop other allergies of this general type. Strenuous avoidance of latex won't help asthma from cats, or nut allergy, or aspirin hypersensitvity, for example. Usually this kind of doubt can be settled fairly easily.
Some people mistakenly believe that they have allergies of various kinds, and this can be true for latex allergy. It may just be like any other mistaken conclusion any of us might reach through not knowing enough, and we might be relieved to find that we had been wrong, or at least prefer to know the correct answer. At the other extreme it might be just one symptom of a complicated illness involving terrible anxiety, and no amount of reason might convince us that it was not so. Treating such people only with adrenaline and other measures against latex allergy simply harms them. People who turn out to be mistaken must be treated with the same sympathy, professionalism and respect as people with latex allergy. It is self-evidently ludicrous to suggest that people struck down by anxiety with another cause should be treated badly.
If you really were imagining latex allergic reactions, it would be better to know. Getting the diagnosis right for all your reactions is important to help you do the right things about them. Getting it right convincingly is important when others don't believe you.
Usually a qualified allergy specialist will be able to resolve doubts. His or her experience and knowledge will be very helpful, not only because of experience in seeing people with latex allergy, but from experience in other forms of allergy such as food allergy and bee or wasp venom hypersensitivity. Similar events and issues sometimes arise in these other conditions, so your allergy specialist will be able to use wider experience to help you. Such a person will not be influenced by natural anxiety and personal involvement. An expert learns from your fellow sufferers and gets a feel for what is likely and is also likely to be better at dealing with untypical situations. This can save you a lot of time and trouble.
An expert should be a help in dealing with officials and others who doubt your diagnosis. With time the educational efforts now going on should ease the problems of getting others to understand the needs of latex allergic people.
There are various objective tests. They are not perfect. For example, Ownby showed that positive blood test results for latex allergy were surprisingly common in blood donors who were not thought to be allergic to latex. But tests certainly help to build up a picture. Skin tests have improved with the arrival of commercially available standardised latex extracts. They are very helpful. As a last resort, tests involving actual exposure to a latex product may be useful. Their validity and safety depends quite a lot on the skill of the person carrying out the tests.
In almost every patient who has come to our clinic with latex allergy there has been no serious problem in establishing the diagnosis and understanding the events. However, a few people strongly believe that they suffer from allergies and turn out to be wrong. It would be extremely surprising if this did not occur with latex allergy, and indeed we know that it can. There are also people who report severe reactions to latex which never seem to be confirmable by doctors. Some of these people may be suffering abnormal anxiety about minor genuine reactions and some may well be reporting completely imaginary reactions. Of course their fear itself is very real and a cause of true suffering, even if the cause is not allergy as such. In no sense are these people trying to fake things, and a doctor's job is to help them understand and conquer their problem, usually much to their relief.
Sadly, it is inherently likely that among people reporting latex allergy there will be a few malingerers, an entirely different group. Quite unlike the others, they knowingly try to fake illness in order to get compensation and sympathy. These people are not ill with latex allergy, nor do they primarily suffer from abnormal anxiety. They are essentially frauds, exploiting the problems of people with real latex allergy. It is important that these people should be found out and should not discredit people who have the real thing.
We human beings are complicated things, and in reality things may not be so black and white as I have painted them for simplicity. Your interest is that if you do have latex allergy your doctor should recognise it and lead you to the best way of dealing with it. If you do not have it as badly as you thought or do not have it at all, then your doctor should help you to know this too. A good honest working relationship between patient and doctor is a joy for both.
For the real problems of latex allergy to receive the recognition they need, it is all the more important to be able to distinguish between problems which are due to latex allergy and problems which are not.
Other websites on latex allergy There are a
great number of excellent sites on this subject, so much so that we have avoided
duplicating information so well presented in the sites which follow. Favourable
comments by us don't imply the others are less good. Of course we take no
responsibility for advice offered in other websites, even if only for the simple
reason that an excellent site might inadvertently be edited so that it contains
The sites are in no particular order. We know of many others but have not finished working on the following list.
Latex Allergy Links - Main Menu. Key to huge list of latex links, organised by subject.
Nurse Week Latex tutorial. From Clinical Nurse Specialist Marianne Gritter, MS, RN, the administrative officer for the spinal cord injury service at the Palo Alto VA Healthcare System. She has worked in critical care nursing and has been an assistant professor of nursing. Nurses in the US can get CME credits for this tutorial.
Latex- Table Of Contents to the site for doctors by Dr. GS Kantor, MD, Dept of Anesthesiology, Case Western Reserve University.
How to Manage a Latex-Allergic Patient, by Dr. GS Kantor, MD, Dept of Anesthesiology, Case Western Reserve University.
The Latex Allergy Information Resource Page of the Anesthesia Department, Case Western Reserve University. Also marvellous.
Latex Allergy Help - A MedAware Resource Site. MedAware is the Internet domain name of Medical Educational Services, Inc. a medical educational and information service run by Dr. Philip B. Kellett, M.D. The Database section on latex has extensive text pages on Dental Info, EMT Info, Physician Info, Nursing Info, Parental Info, Patient & Family Info, Kid Info, Legal Issues. Other topics include Latex Safe Medical Products, Latex Safe Home Products, Latex Allergy News, and educational Videos
On the first page there is a section marked "Home 1-800# Comments Meeting noti......" Click on 'Comments' to get to the discussion group; you will be able to ask or reply to questions. It is best if you do not leave your name or e-mail address.
Latex Allergy News , accessible via the same Latex Allergy Help website, is an independent newsletter-information sharing vehicle for E.L.A.S.T.I.C.- (Education for Latex Allergy / Support-Team and Information-Coalition). To subscribe to Latex Allergy News, and become informed of current developments, contact:
Debra Adkins, Editor
176 Roosevelt Ave.
Torrington CT 06790
FAX: (203) 482-7640
E.L.A.S.T.I.C.Inc. A non-profit, national volunteer organization - (Education for Latex Allergy / Support-Team and Information-Coalition). Information, and within the USA state chapters and support, for individuals with latex allergies, education, health information. research, survival skills and ELASTIC proceedings. To join or for further information please contact:
USA National contact for membership
Lise C. Borel DMD
196 Pheasant Run Rd.
West Chester, PA 19380
Latex Allergies: When Rubber Rubs the Wrong Way. Highly recommended.
The Rubber Room - For Discussion of Rubber and Latex Allergies. This group runs an e-mail discussion group from which you can learn about what some of your fellow-sufferers are experiencing, and what they think. Many are not experts, so don't expect them to be right necessarily.
A Brief Natural History of Latex and the Rubber Tree. Fascinating. Part of the same website (The Rubber Room).
Foundation for Latex Allergy Research and Education. Aims too educate health care providers and the general public about latex allergy.
A.L.E.R.T., Inc. Home Page.
ALERT, Inc. is a non-profit, USA, educational support organization with
membership and a newsletter. The name represents their mission: Allergy to Latex
Education & Resource Team. Within the USA they provide educational materials to
individuals, facilities, government, doctors, dentists, restaurants, schools, and
manufacturers to assist them in risk reduction programs, and provide emotional
support to individuals and their families, education on policies, and promote
research on the allergy.
A BOOK ON LATEX ALLERGY
Editor: Jordan N. Fink, MD
Publisher: W B Saunders.
Year of publication: Feb 1995
ISSN: 0889-8561 This is a 'serial', technically not a book.
An issue of the series "Immunology and Allergy Clinics of North America". Excellent.
This page contains some important information which we hope you will find useful. It has not been checked by other doctors and may very well contain mistakes. It does not and cannot constitute medical advice to you or anyone else personally and if you feel any of the information may be relevant to you, then you should discuss it with your own doctor. Please see the disclaimer on the Home Page. We welcome e-mail with questions and tips to help us make the page more useful for people with allergy to latex.