Latex Exposures and Types of Symptoms/Response
Routes of latex exposure
Latex exposures can occur through direct contact with the skin, mucous membranes, or bloodstream, and through inhalation of airborne latex particles. The protein responsible for latex allergies has been shown to fasten to powder that is used on some latex gloves. When powdered gloves are removed, latex protein/powder particles get into the air, where they can be inhaled and come in contact with mucous membranes in the eyes, nose, and mouth.
Parenteral exposures are those in which latex may enter the bloodstream directly. These exposures have the potential for the most serious reactions. Parenteral exposure can occur during surgery when latex devices are used on open tissue. It can also occur following injections with needles that have punctured a latex rubber stopper on a medication vial.
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Inhalation of airborne latex particles can occur when latex proteins combine with the powder or cornstarch from the gloves and form aerosolized particles that become airborne. These particles get into eyes, nose, mouth, or lungs, where protein may be absorbed through these moist mucous membranes.
Studies have shown that airborne latex particles are significantly higher in areas and departments in healthcare settings where powdered latex gloves are used. These particles are particularly high in personal breathing zones of the person wearing latex gloves. These aerosolized particles can also attach to lint, dust, equipment, and even clothing, and become re-suspended into the air. There have been reports of family members with latex allergies having reactions after handling clothes worn by individuals who work in healthcare settings and were exposed to powdered latex gloves.
To ensure safety, in February 2011, the FDA recommended adding a warning label to exam gloves containing powder on their potential health effects.* FDA’s suggested warning for surgical and exam gloves states the following:
Powdered gloves may lead to foreign body reactions and the formation of granulomas in patients. In addition, the powder used on gloves may contribute to the development of irritant dermatitis and Type IV allergy, and on latex gloves may serve as a carrier for airborne natural latex leading to sensitization of glove users.
On December 19, 2016, the FDA published a final rule opens in a new tab banning powdered gloves based on the unreasonable and substantial risk of illness or injury to individuals exposed to the powdered gloves.
Latex allergy immune response
A latex allergy, also called latex sensitivity or Type I latex hypersensitivity, is an immune response following exposure of genetically predisposed individuals to the proteins in natural rubber latex. These latex proteins are the specific substances or allergens that can simulate the allergic response. More than 200 latex proteins exist, and more than 50 may have the potential to cause allergic reactions.
A person with a potential for developing a latex allergy will have an immune response when first exposed (or sensitized) to latex, although no external or physical response may be noted (asymptomatic). The immune response initiates production of latex-specific antibodies or immunoglobulins (IgE) that take part in the development of symptoms when a person is re-exposed to latex These antibodies are also helpful in diagnosing a latex allergy.
An individual with an allergy to latex becomes increasingly “sensitized” with each subsequent exposure, increasing the potential for the development of a reaction (physical symptoms) following exposure These symptoms can range from itching (pruritis) to the most severe and potentially fatal reaction (anaphylactic shock), a collapse of the cardiac and respiratory system. The amount of latex exposure needed to produce sensitization or an allergic reaction is unknown However, reductions in exposure to latex proteins have been reported to be associated with decreased sensitization and symptoms.
Signs and symptoms of latex allergy
Irritation
The most common reported reaction to contact with latex is an irritation known as irritant contact dermatitis. This is not an allergy to latex but rather a non-allergic inflammation that occurs when the skin surface becomes dry and irritated from other sources. This reaction is common among healthcare workers that wear gloves with irritation of the hands that may be related to sweating under the gloves, frequent hand washing, drying with rough paper towels, use of certain hand soaps
or detergents, exposure to ultraviolet light, or extremes in climate (e.g., cold, hot, dry, or windy). The skin is then exposed to glove powder. The combined effect of dry, irritated hands and exposure to latex gloves causes a reaction. Within minutes of donning latex gloves, the wearer experiences pain, stinging, and burning, and the skin becomes reddened. With repeated exposures, the skin becomes crusty and thickened, with dry bumps and scabs that may peel or form fissures or cracks.
Allergic contact dermatitis
This is a reaction to the chemical additives used during the manufacturing process. The chemicals added to latex can cause a skin rash 24 to 48 hours after contact. The rash usually starts on the parts of the skin that has come in contact with latex, and then may spread to other areas. It may also be accompanied by oozing blisters.
For healthcare workers wearing gloves, this type of reaction is an allergic response to the chemical additives in the latex gloves and NOT to the latex glove itself. Almost five percent of the final weight of latex gloves is added chemicals used as accelerators and antioxidants, emulsifiers, stabilizers, colorants, softeners, biocides, ultraviolet light absorbers, or fragrances This allergic reaction is similar to what happens to the skin after exposure to poison ivy and may have redness, itching, scaling, peeling, hard bumps, or fluid-filled blisters and oozing sores. The height of the reaction occurs one to three days after contact and may spread beyond the glove line and up the arm. With continued latex exposure, the skin can develop a crusted and thickened appearance.
Once an individual has an allergic reaction to a specific chemical additive and is sensitized, a similar reaction may occur after use of any product with the same chemical. Generally, allergic dermatitis conditions do not progress to latex allergies. However, it may be difficult to differentiate irritant reactions from allergic contact dermatitis reactions. Itching, dryness, erythema, bleeding, or scaling of the hands are manifestations of both types. Neither of the types of local reactions are good predictors of latex allergy.
Hypersensitivity immune system response
This response is an actual latex allergy. It occurs when the immune system reacts to proteins found in natural rubber latex.
The symptoms of true latex allergy or hypersensitivity usually occur immediately or within one hour following cutaneous, mucous membrane, parenteral, or airborne exposure to latex in sensitized individuals. Reactions can also occur as long as eight hours after exposure. The symptoms vary widely and mild episodes may involve skin flushing, itching, or tingling with hives that have blanched or white centers. Skin at the site of contact with latex appears swollen and tight. Other reactions might include symptoms similar to hay fever, such as sneezing, runny nose, itchy eyes, and more severe asthma-like symptoms (wheezing, difficulty breathing, shortness of breath).
Individuals genetically capable of developing a latex allergy may not have symptoms when they first come in contact with latex. The body must reach a certain level of sensitivity before symptoms appear. The length of time until that level is achieved depends upon the individual’s genetic make-up, the amount of allergen released from the product, the tissue in contact with the allergen (i.e., mucous membrane versus intact skin), and the frequency and total number of exposures.
Once the reactions occur, they will continue to erupt with each subsequent latex exposure, providing that the level of allergen is sufficiently high. The symptoms may vary, depending on the type of exposure. For example, entering an area of the hospital where powder latex gloves are used could cause sneezing, itchy eyes, or wheezing from exposure to airborne latex particles. Having a dental procedure when latex is used and directly touches the mucous membranes in the mouth could cause a more serious reaction Sensitized healthcare workers may continue to have symptoms despite using non-latex gloves and other equipment if they work in areas where latex is being used, particularly powder latex gloves. These areas include the operating room or labor and delivery suites. Conversely, allergic individuals may be able to work without incident if they wear synthetic gloves themselves and work in environments sufficiently low in allergen. Colleagues of these individuals may wear powder-free latex gloves.
Anaphylactic shock
The most severe and potentially life-threatening reaction is anaphylactic shock, which can cause respiratory and cardiac failure, and in rare instances, death. This reaction is a systemic (or total body) reaction to latex. Systemic symptoms that may indicate a serious latex allergy include nausea, abdominal pain, rapid heart rate, generalized hives, shortness of breath, drop in blood pressure, and fainting. If any of these symptoms develop following an exposure to latex, medical treatment must be initiated immediately.
Symptoms to differentiate types of reactions
| Symptoms | Irritation | Allergic dermatitis | Latex hypersensitivity |
| Medical terminology | Irritant contact dermatitis | Type IV delayed hypersensitivity; allergic contact dermatitis | Type I immediate hypersensitivity; IgE-medicated hypersensitivity |
| Timing of onset | Minutes to hours | 1 to 3 days | Minutes to 1 hour |
| Description of sensation | Pain, burning, stinging | Itching first, then pain as skin breaks down | Flush, itching, tingling |
| Skin appearance | Redness, hard crusting, thickened skin, scabs, dry bumps, peeling; skin appears glazed or scalded | Redness, itching, scaling, peeling, swelling, fluid-filled blisters and oozing sores; skin appears dry, crusted, thickened | Hives with blanched (white) centers; swollen; skin appears tight due to swelling |
| Fissures (cracks) | Fissures | More sores than fissures | No fissures |
| Rate of healing (uncovered) | Within 2 weeks after removal of source of irritation | May or may not diminish after latex avoidance | Symptoms reduced within hours after latex avoidance |
| Margin of reaction | Sharp and well-defined (e.g., up to edge of glove) | Undefined margin; may be at point of contact (e.g., under glove) or move up the arm | Undefined margin, may be at point of contact (e.g., under glove) or entire body |
| Tendency to spread | No spread | Yes; may spread beyond contact area | Yes; may spread beyond contact area |
| Respiratory involvement | None | None | May have wheezing, runny nose, shortness of breath, chest tightness |
| Facial involvement | Possibly, if face touched by irritant | Possibly, if face touched by the chemicals in the glove to which the individual is allergic | Swelling of eyelids, lips, face; tears, itchy eyes |
| Systemic (total body) involvement | None | None | Nausea, abdominal cramps, diarrhea, rapid heart beat, hives, shortness of breath, blood pressure drop, shock |
| Type of contact | Skin contact | Skin contact | Skin, mucous membrane, open wound, injection, inhalation of aerosol |
| History of allergies | Not relevant; irritation can be present without allergic history | Yes | Yes |
Symptoms to differentiate types of reactions
Irritation | |
|---|---|
| Medical terminology | Irritant contact dermatitis |
| Timing of onset | Minutes to hours |
| Description of sensation | Pain, burning, stinging |
| Skin appearance | Redness, hard crusting, thickened skin, scabs, dry bumps, peeling; skin appears glazed or scalded |
| Fissures (cracks) | Fissures |
| Rate of healing (uncovered) | Within 2 weeks after removal of source of irritation |
| Margin of reaction | Sharp and well-defined (e.g., up to edge of glove) |
| Tendency to spread | No spread |
| Respiratory involvement | None |
| Facial involvement | Possibly, if face touched by irritant |
| Systemic (total body) involvement | None |
| Type of contact | Skin contact |
| History of allergies | Not relevant; irritation can be present without allergic history |
Allergic Dermatitis | |
|---|---|
| Medical terminology | Type IV delayed hypersensitivity; allergic contact dermatitis |
| Timing of onset | 1 to 3 days |
| Description of sensation | Itching first, then pain as skin breaks down |
| Skin appearance | Redness, itching, scaling, peeling, swelling, fluid-filled blisters and oozing sores; skin appears dry, crusted, thickened |
| Fissures (cracks) | More sores than fissures |
| Rate of healing (uncovered) | May or may not diminish after latex avoidance |
| Margin of reaction | Undefined margin; may be at point of contact (e.g., under glove) or move up the arm |
| Tendency to spread | Yes; may spread beyond contact area |
| Respiratory involvement | None |
| Facial involvement | Possibly, if face touched by the chemicals in the glove to which the individual is allergic |
| Systemic (total body) involvement | None |
| Type of contact | Skin contact |
| History of allergies | Yes |
Latex Hypersensitivity | |
|---|---|
| Medical terminology | Type I immediate hypersensitivity; IgE-medicated hypersensitivity |
| Timing of onset | Minutes to 1 hour |
| Description of sensation | Flush, itching, tingling |
| Skin appearance | Hives with blanched (white) centers; swollen; skin appears tight due to swelling |
| Fissures (cracks) | No fissures |
| Rate of healing (uncovered) | Symptoms reduced within hours after latex avoidance |
| Margin of reaction | Undefined margin, may be at point of contact (e.g., under glove) or entire body |
| Tendency to spread | Yes; may spread beyond contact area |
| Respiratory involvement | May have wheezing, runny nose, shortness of breath, chest tightness |
| Facial involvement | Swelling of eyelids, lips, face; tears, itchy eyes |
| Systemic (total body) involvement | Nausea, abdominal cramps, diarrhea, rapid heart beat, hives, shortness of breath, blood pressure drop, shock |
| Type of contact | Skin, mucous membrane, open wound, injection, inhalation of aerosol |
| History of allergies | Yes |
Diagnosing a latex allergy
Latex allergy should be suspected in anyone who develops certain symptoms after latex exposure. The symptoms include nasal, eye, or sinus irritation, hives, shortness of breath, coughing, wheezing, or unexplained shock. A physician should evaluate any individual who is exposed to latex and experiences these symptoms, since further exposure could result in a serious allergic reaction.
Suspect possible latex allergy in anyone who reports:
- History of food allergy (e.g., hives or tingling in mouth) after eating avocados, kiwi fruit, chestnuts, potatoes, tomatoes, bananas, or any other food.
- History of allergic symptoms such as itching, hives, swelling of hands or eyes, watery eyes/nose, sneezing, wheezing, and shortness of breath in association with use of gloves, condoms, diaphragms, balloons, or any other natural rubber latex-containing device. History of allergic symptoms during medical or surgical procedures or exams such as dental, vaginal, rectal, or barium enema x-ray procedures.
- Any unexplained allergic or anaphylactic reaction during a medical or surgical procedure.
- History of severe or worsening latex glove-induced hand irritation or eczema, hives, watery eyes or nose, or asthma-like symptoms such as wheezing or shortness of breath, especially among healthcare workers.
- History of multiple surgeries as an infant (especially in children with congenital anomalies such as spina bifida).