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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.
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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
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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.
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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
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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 ...