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Natural Rubber Latex Allergy
a (rare, we think) cause of anaphylaxis

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Allergic to Latex? Learn more here.

As there are already many excellent websites on latex allergy, as you will see from the links below, this page makes no attempt to be complete. The idea is to give you some sort of introduction, a patchy one, and to let you explore the other sites.

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How dangerous is latex allergy? (26 Dec 2000)

Increasingly, it seems that latex allergy is not nearly so dangerous to life as people have thought in recent years. In the UK we are aware of only one well-documented death due to latex allergy, and other deaths with clear evidence are proving hard to find. IF YOU HAVE EVIDENCE OF FATAL CASES WE HAVE MISSED, PLEASE EMAIL US WITH DETAILS.

The one proven fatal case in the UK we are aware of did not involve a medical procedure. It occurred in a young woman who was having a hair extension attached to her scalp with latex adhesive. The bottle label stated that it should not be used by latex-hypersensitive people. She was not known to be hypersensitive to latex, but had nut allergy and possessed an epinephrine (adrenaline) injection pen for that. She gradually developed symptoms of anaphylaxis after the latex adhesive was applied but did not use the epinephrine, and died.

Of course it is possible that other deaths due to latex allergy have happened in the UK but have not been documented, or have been misdiagnosed, or have happened without enough evidence being collected to make it reasonably certain that the death was due to latex allergy. This could happen because sometimes there are several possible explanations for the death of a patient during an operation. On the other hand, deaths during operations which are in themselves unlikely to cause death would be investigated. The anaesthetist, the surgeon and the pathologist would all have strong motives for uncovering latex allergy as the cause. Once again, we would like to hear from anyone reading this who has evidence that deaths due to latex allergy in the UK have gone unreported, or unnoticed by us.

It seems to us that in the USA there have not been as many fatalities as some literature suggests. Review articles in medical journals generally stress the risk of death, but references to the sources of this information are often unsatisfactory or absent. A cluster of six cases of anaphylaxis attributed in 1991 to the use of latex balloon catheters for barium enema examinations is widely referred to. One of these patients died. The abstract of the relevant publication follows. I understand that other well-documented fatalities due to barium enema catheters were reported to the FDA (Food and Drug Administration) but have not obtained details of this, and there seem to have been other deaths in the USA on which I do not have further information.

Am J Roentgenol 1991;156:903-8
Anaphylaxis associated with latex allergy during barium enema examinations.
Ownby DR, Tomlanovich M, Sammons N, McCullough J
During the interval from January 1989 to March 1990, signs and symptoms of anaphylaxis developed in six patients during barium enema examinations in our institution. In all six cases the symptoms of anaphylaxis began during the procedure, usually within 10 min of starting the examination. The principal manifestation of anaphylaxis was severe hypotension, usually accompanied by edema and urticaria. The symptoms were considered potentially life threatening in all patients, and one patient died despite prompt recognition of the anaphylactic nature of the reaction and resuscitative efforts. Serum samples were obtained within a few hours of the reaction in two patients and at autopsy in the fatal case: all three samples showed elevated concentrations of mast cell tryptase, demonstrating the systemic release of anaphylactic mediators. In vitro tests demonstrated the presence of immunoglobulin E antibodies specific for latex allergens in five of the six cases. Further in vitro inhibition tests confirmed the specificity of the antibodies for latex allergens and demonstrated that similar allergens were found in both raw latex, latex gloves, and catheter balloons. Only one patient was willing to undergo a skin test, and her skin test was positive for extracts of latex products. After considering multiple possibilities, we conclude that the reactions associated with barium enemas observed in these six patients are most probably the result of latex allergy.

So there is clear evidence of serious anaphylaxis attacks in six patients. However, only one of the patients died, and this series has been misreported in that respect. The lack of similar reports since then or from other centres gives rise to the possibility that there may have been a freak problem with catheters from a particular source at a particular time, when manufacturers were not so aware of latex allergy as they are now.

Our conclusion for now? Continue to take latex allergy very seriously. It is a preventable, important, and still potentially fatal condition. However, the danger to life appears to have been exaggerated greatly. The effect of this has been to make the lives of sufferers more miserable than they need to be. A balanced view seems to require energetic re-examination of the evidence. Balance is in everyone's interest, especially that of sufferers.

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Latex Allergy Support Group - if you live in the UK.

If you have an unusual condition like latex allergy, you will benefit from joining a self-help group. For groups in the USA, see below.

In the UK there is a national self-help group, the Latex Allergy Support Group.

 

Latex allergy: the problem

Latex allergy has become a common problem of nurses, and to a lesser extent other health care professionals. It has also become a problem of children with spina bifida, and no doubt other groups are being discovered.

A typical story in a nurse (based on accounts from real nurses with this problem) might be that she has noticed an itchy rash of her hands on wearing latex gloves, and that she has had severe swelling in and around the mouth after eating bananas or food which contained banana. The hand rash is itchy and comes on within minutes or hours, and if sufficiently marked will show the features of urticaria (hives, nettlerash). Nurses have often regarded the hand rash as trivial and have not realised that it has any connection with the fact that when they eat bananas or some other foods they get swellings or even anaphylactic collapse.

In fact, one of the strange things about latex allergy is that it can cause you to have allergic reactions to some foods.

If you are allergic to latex, even though wearing latex gloves may cause only minor problems, you may have anaphylaxis if you yourself have surgery, or during medical, dental and gynaecological or other procedures using latex gloves or catheters or other products made from natural rubber latex. Blowing up balloons and contact with contraceptive devices will often cause urticaria or itching. One problem indeed seems to be that nurses, fearing the loss of their jobs, tend not to report the mild urticaria which results from wearing latex gloves, and just put up with it. Clearly this is hazardous in several ways. Failure to recognise the problem may lead to failure to prevent anaphylaxis if the nurse requires surgery or other procedures with latex, and continued exposure would cause the hypersensitivity to become worse.

Asthma occurs in operating theatre nurses with latex allergy. This is because glove powder becomes airborne during the working day in the operating theatre atmosphere. The powder consists of cornstarch, which itself does not produce asthma. The cornstarch is put on the gloves by dipping the newly manufacture gloves in a slurry of cornstarch in water. It seems that during this process protein dissolves out of the gloves into the slurry, which comes to contain more and more protein. The protein then sticks to the cornstarch particles. It is also possible that the cornstarch particles adsorb protein from the latex whilst in contact with the gloves . It is this protein, carried on cornstarch particles, which causes the occupational asthma in operating theatre nurses. It has been shown that the concentration of latex-coated starch particles increases during the working day in operating theatres when powdered gloves are used.

Airborne glove powder can evidently also be the cause of sensitisation. This is suggested by the story of the patient who worked in a pharmaceutical factory and developed typical latex allergy. She herself did not wear gloves at work, but others in the same room did, and changed them frequently during the day. Our patient would thus have been breathing glove powder for some years, and no other reason was apparent to explain why she became allergic to latex.

You may become confused unless you are quite clear about the distinction between the following types of glove.

 

TABLE: types of glove material. N.B.: This table, created 14 Dec 1999, is provisional and may not be entirely correct.

Material

Lubricant

Consequences

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.
Expensive.
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.

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Latex allergy. Foods may also cause reactions

People who are allergic to latex may also react to banana, avocado, kiwi fruit, chestnut, plum, peach, cherry, apricot, fig, papaya, tomato, potato and some other plant foods. The list is still growing. The reason is that these plants contain proteins which are similar enough to latex proteins to react with our allergy-producing antibodies to latex.

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.

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Anaphylaxis

Anaphylaxis is the word used for allergic reactions to latex, foods, medicines, insect stings or other agents of the type which, if severe enough, can be life-threatening.

To find out more about anaphylaxis, click here.


Effects of latex allergy which you or the patient may notice

Latex allergy can produce:
  • An itchy nettlerash (urticaria, hives), either where the latex or banana etc. touch you, or elsewhere
  • Swelling (angioedema), either where the latex or banana etc. touch you, or elsewhere
  • Asthma symptoms
  • Swelling in the throat, causing difficulty in swallowing or breathing
  • Vomiting
  • Cramping tummy pains
  • Diarrhoea
  • Faintness and unconsciousness
  • Death due to obstruction to breathing or extreme low blood pressure (anaphylactic shock). However, it does seem that death from anaphylaxis due to latex allergy is a great rarity.

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.

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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:

  • Occupational physicians have specialist knowledge of occupational illness such as latex allergy.
  • They have access to a great deal more expertise through their professional network.
  • They work on a confidential basis; no information about you will be revealed to anyone else without your permission. They will however normally liaise fully with your General Practitioner.
  • The information you provide helps them to be aware of hazards to you and others at work, so that they can advise management on improvement of working conditions to minimise risk to you and to prevent latex allergy in others. Your Occupational Physician is in an especially good position to influence your safety at work.
  • The information is also more likely to be communicated at national level to promote national action.
  • You will often find the Occupational Health Service at your place of work more convenient to use than your General Practitioner.
So by going to the Occupational Health Service you can help both yourself and others like you.

 

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Frequently asked questions:

 

Why do people who are allergic to latex react to bananas and other fruits?

Plants which are not very similar may have proteins which are similar. This is mainly because, though the plants look different, the chemical processes necessary for the life of the plants are very similar, and depend on similar proteins. If you become allergic to these proteins you will react to all the plants which contain them. Probably the reason why people become allergic by contact with latex rather than by eating bananas alone is that proteins kept on the skin for long periods cause a different immune reaction in the body to proteins which we eat.

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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.

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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.

  • Food hanlers too will be sensitised in some cases and will join the ranks of those affected.
  • Alternatives are available, e.g. polythene.
  • In most cases good traditional food hygiene with handwashing makes gloves unnecessary.
  • Latex gloves with sloppy hygiene practices can still cause food poisoning.
  • Even if such latex exposure only causes mild reactions, or no reaction at all, eating such food could still help to maintain or increase your latex allergy. Conceivably it might even cause it in others.

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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.

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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 so.

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:

  • Prevent reactions to latex
  • Prevent worsening of the allergy by latex contact
To prevent reactions to latex we must avoid latex balloons, the use of latex gloves (including the use of latex gloves to handle food), and obvious contact with natural rubber latex as in erasers. Keeping contact with rubber bands to a minimum is sensible.

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.

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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.

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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 - Dental

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What about medical and gynaecological examinations?

Non-latex gloves must be used.

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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:

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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.

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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.

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Is my asthma caused by latex? Or is it just ordinary asthma?

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 of checking.

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.

  • It's no good using inhalers religiously and meanwhile continuing to breathe in something which may make you more allergic still.
  • It doesn't make any sense to use regular medication when you can remove the cause. In fact in occupational asthma your outlook is much better if the cause is removed early.
  • The fact you got sensitised means others could. Recognising your problem for what it is can help your employer plan action to stop others becoming allergic.
  • In fact there may already be others who have the same problem, and diagnosing your allergy should lead to a search for other latex allergic staff.

On the other hand if all that is happening is that you are allergic to house dust mites or the cat, removing the cause means taking quite a different line. In that case your job may not be a problem at all and you may be able to stop worrying on that score at least.

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

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Am I imagining things? 'Latex phobia' or the real thing?

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.

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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 an error.

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.

Delaware Valley Latex Allergy Support Network. Excellent.

Canadian Latex Allergy Association. Superb.

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.

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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
(203) 482-6869
FAX: (203) 482-7640
Email: (76500.1452@compuserve.com)

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:

ELASTIC Inc.
USA National contact for membership

Lise C. Borel DMD
National Director
196 Pheasant Run Rd.
West Chester, PA 19380

Tel: 610-436-4801
Fax: 610-436-1198

ecbdmd@ix.netcom.com
http://www.netcom.com/~ecbdmd/elastic.html

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Latex Allergies: When Rubber Rubs the Wrong Way. Highly recommended.

Latex allergies - Mercy Hospital, Des Moines, Iowa. Excellent.

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.

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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.
Email: alert@execpc.com.

Contraception:

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A BOOK ON LATEX ALLERGY


"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.
Hardback.

An issue of the series "Immunology and Allergy Clinics of North America". Excellent.

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DISCLAIMER:

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.

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This page is maintained by Dr. Martin Stern
Original version completed: 25 May 1997. Amended: 18 August 1998, 14 Dec 1999, 9 Mar 2000 (Occupational Health Service, 5 Apr 2000 (deaths rare), 5 & 26 Dec 2000 (LASG, rarity of deaths, page layout, mended link). 13 Feb 2001 ed section on real vs exaggerated or imaginary reactions, info on epinephrine now mainly on anaphylaxis page. 11 Apr 2001 minor edits on deaths, schools.

Copyright © 1997, 1998, 1999, 2000, 2001 Martin Stern