Chapter 196

Hypersensitivity reactions to latex are a significant concern among patients and health care providers. The apparent increased prevalence of latex allergy over the last few decades is believed in part to be due to the widespread use of latex gloves to prevent transmission of blood-borne pathogens such as HIV. The frequent use of latex-containing materials within the health care system thus generates a great deal of concern and anxiety among individuals who have adverse reactions to latex, and true latex allergy can cause serious complications, including death.

Natural rubber is a highly processed plant product of the commercial rubber tree, Hevea brasiliensis. Most true allergic reactions to natural rubber latex occur with exposure to “dipped” products such as gloves or balloons. These products made from liquid latex rubber have a large number of soluble proteins capable of binding IgE.1

IgE-mediated allergic reactions to latex, while not common in the general population, are a leading cause of anaphylaxis in children, particularly for events that occur during hospitalization. Life-threatening allergic reactions may be the presenting factor of latex allergy in up to 30% of latex-sensitive children. The majority of latex-allergic individuals are highly atopic, with histories of allergic conditions such as rhinitis or asthma. The prevalence of clinical latex allergy in the general population has not been established. Studies have demonstrated that 3% to 9.5% of the general population is sensitized to latex as determined by skin or serum allergy testing; however, these numbers do not represent the prevalence of clinical reactions to latex exposure (ie, a positive allergy test does not mean a clinical allergy to latex). Studies have demonstrated a higher prevalence of latex sensitization in certain high-risk groups with frequent exposure to latex, including health care workers and children with spina bifida undergoing repeated urologic and neurologic surgical procedures. Children with spina bifida have the highest prevalence of latex sensitization, with reports ranging from 18% to 73%.2 Risk factors for sensitization in this population include more than 5 surgeries and a history of atopy. While these prevalence rates indicate the presence of latex-specific IgE by diagnostic testing rather than clinical allergic reactions, the high rate of sensitization and potential severity of reactions suggest that all spina bifida patients should be evaluated for their individual risk of latex allergy prior to surgical procedures to minimize complications as much as possible.

Interestingly, latex allergy has been associated with allergy to several fruits and vegetables, including avocado, kiwi, banana, potato, tomato, chestnut, and papaya. Termed the latex-fruit syndrome, this clinical observation has been traced to homology between major latex allergen proteins (Hev b 5, Hev b 6, Hev b 7) and various proteins found within these foods.3

True latex allergy is mediated by antigen-specific IgE, which triggers mast cell activation with latex exposure. Atopic individuals may potentially generate latex-specific IgE after an initial exposure to latex antigen. The sensitizing exposure is ...

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