Latex allergy is a set of pathological conditions that combine intolerance to products made of natural or (less often) synthetic rubber with the development of local or systemic reactions. Symptoms of pathology range from signs of dermatitis (redness, itching, burning) to lacrimation, nasal congestion, difficulty breathing, angioedema. Diagnostics includes the study of the patient’s anamnesis and complaints, skin immunological tests, determination of specific antibodies in the blood. Treatment is carried out by limiting contact with provoking material, the use of antihistamines and anti-inflammatory drugs.
L23.8 Allergic contact dermatitis caused by other substances
Latex allergy is considered a fairly common pathological condition, largely due to the widespread use of this material in various spheres of human life. Especially many patients are registered among medical staff and workers in the production of rubber products, which is explained by their more frequent and close contact with latex (gloves, plasters, some tools). According to statistics, from 5 to 10% of all medical workers experienced unpleasant symptoms when using rubber materials. In everyday life, genital forms of allergies caused by the use of condoms are more common – they are made almost from pure latex, in addition, the skin and mucous membranes of the genitals are more permeable to allergens.
The main component of latex or rubber is polymers that have a complex structure, but are unable to provoke allergic reactions in their pure form. The problem is that the cleaning of the material before its use in production is imperfect, impurities of various nature remain in it, which act as allergens. In latex of natural origin, these are a variety of plant proteins, in synthetic – impurities that fall due to the technological process of production. They often lead to negative reactions when using latex objects. The following conditions are considered predisposing factors for the development of allergies:
- The presence of allergic diseases. Food allergy to foods such as kiwi, avocado, apples, tomatoes, nuts acts as a provoking factor of intolerance to latex, especially of natural origin. This is due to the phenomenon of cross-allergic reaction – allergens of the listed products are similar in structure to the antigens of rubber proteins, so the body reacts to them in approximately the same way. Due to the altered reactivity of the body, an increased frequency of latex allergies is noted in people with bronchial asthma or eczema.
- Some medical manipulations. Diagnostic and therapeutic procedures that are performed with the introduction of latex into the internal environment of the body increase the risk of pathology. These include prolonged catheterization of the bladder, some surgical interventions.
- Frequent contact with latex. Prolonged use of latex products in the home and at work significantly increases the risk of allergies. This situation occurs with doctors (gloves and consumables), people working in the manufacture of rubber products and in other industries.
- Immunodeficiency. Certain types of decreased immunity (when taking cytotoxic drugs, congenital immunodeficiency) increase the likelihood of allergic diseases in general, including intolerance to latex materials.
The pathogenesis of most types of latex allergy is similar to other variants of the intolerance reaction of the first type or anaphylaxis. At the first contact of the body with an allergen (proteins or other compounds in the composition of rubber), a sensitization process occurs with the formation of memory cells “remembering” this antigen. An important condition is the penetration of some part of the provoking substance into the blood, which is not always possible through the skin. It is for this reason that this condition is often registered in persons who have suffered the ingress of latex materials into the internal cavities of the body – this greatly facilitates sensitization. Repeated contact with latex results in an immunological reaction mediated by IgE and leading to degranulation of tissue basophils with the release of histamine and other active compounds.
In other cases, the development of delayed reactions is observed, due not to humoral, but cellular immune reactions. When the antigen repeatedly hits the skin surface, T-lymphocytes (helpers) are activated, which, in turn, lead to the development of T-effectors. The latter secrete biologically active substances, directly attack the tissues in the area of allergen ingress, which leads to the appearance of a clinical picture of chronic contact dermatitis. Such a process takes longer than anaphylaxis, and is practically unable to provoke systemic reactions – to cause pathological manifestations in parts of the body that have not come into contact with latex.
There are several clinical varieties of latex allergy, differing in their pathogenesis, symptoms and methods of therapy. The classification of this condition also includes pathologies that, strictly speaking, are not allergies, but are caused by irritation of tissues with accompanying chemicals that are part of latex products. These can be powders on gloves, lubricant components on condoms, paint on clothing elements. Taking into account this circumstance , the following clinical forms of the disease are distinguished:
- Simple contact dermatitis. A non-allergic variant of pathology caused by irritation of the skin or mucous membranes with chemical compounds. Contact dermatitis occurs quite easily, manifestations affect only the areas of direct contact with the product. To improve the patient’s condition, it is enough to use products based on pure rubber or rubber without auxiliary substances – this proves that there is no allergy to latex itself.
- Allergic contact dermatitis. It is an allergic condition that develops according to the principle of delayed hypersensitivity reaction (HSR). It can be provoked both by rubber itself and by auxiliary components of gloves, condoms or other products. Allergic dermatitis is characterized by damage to the mucous membranes or skin in the area of contact with latex materials, sometimes involving neighboring areas.
- An immediate type of reaction. It is caused by the sensitization of the body and the subsequent reacting (through IgE) nature of the immunological reaction. The spectrum of manifestations is very wide, it depends on the reactivity and state of the immune system. There may be redness and itching of the skin at the point of contact, as well as systemic reactions.
When diagnosing a condition, it is extremely important to determine its type, since this significantly affects the nature of therapeutic measures. Drugs designed to eliminate the immediate type of reaction will be ineffective in HRT or simple dermatitis. If in some cases it is enough to simply change the type of latex products used (from another manufacturer or with a minimum of auxiliary additives), then in others it is necessary to completely exclude contact with this material.
Symptoms of latex allergy
Latex intolerance does not manifest itself with any specific symptoms, therefore, according to external data alone, a dermatologist or an allergist-immunologist often cannot accurately determine the pathology. Non-allergic contact dermatitis is characterized by redness and dryness of the skin, itching, peeling in the area of contact with rubber materials. This is preceded by prolonged use of latex gloves, caps, clothing items – according to statistics, most patients have similar symptoms after several months or even years of regular and almost daily use of latex. This form of the disease is registered mainly with doctors.
The allergic variant of contact dermatitis develops faster (from several weeks to 3-4 months of using latex products) and is also characterized by skin manifestations at the point of contact with the provoking substance. The symptoms are more pronounced, itching can turn into burning, redness of the skin is accompanied by swelling. With continued contact with rubber gloves or other objects, skin manifestations may spread to adjacent skin areas that have not been in contact with latex. The use of condoms leads to itching and redness of the genitals. As a rule, there are no general symptoms, in severe cases, a slight increase in temperature, weakness, headaches are possible.
The reagin form of latex allergy often occurs in persons with a history of getting rubber or latex products inside during medical or diagnostic manipulations. Possible reasons are the prolonged use of urethral catheters, the installation of various drains and tubes using rubber components. As a result, sensitization of the body occurs, manifested by allergic reactions in case of subsequent skin contact with latex. A feature of this form of the disease is the high risks of developing systemic reactions in addition to redness and itching of the skin in the area of contact with the allergen. These include lacrimation, nasal congestion, headaches, cough and difficulty breathing.
The occurrence of angioedema or anaphylactic shock is extremely rare. Anaphylactic shock is manifested by laryngospasm, a sharp drop in blood pressure, a violation of pulmonary ventilation. Such consequences occur with reagin variants of intolerance against the background of high sensitization of the body or immune disorders. Other, less pronounced forms of allergy violate the immunological properties of the skin at the site of the lesion, which, in combination with itching and combing, facilitates secondary infection. Some variants of pathology can lead to changes in the mucous membranes (for example, genitals), provoke leukoplakia, erosion and other disorders.
Unlike other types of allergies, the diagnosis of latex intolerance is somewhat complicated by the non-specificity of manifestations and a long chronic course. It is very important to correctly compare the data of the examination and collection of the patient’s anamnesis with the results of laboratory and instrumental research methods. With a competent approach to determine the condition, it is often enough to establish the fact of frequent contact with latex products, in such cases other diagnostic manipulations are used only to confirm the pathology. Determination of latex allergy includes the following techniques:
- Survey and anamnesis collection. If intolerance is suspected, they try to identify the possibility and frequency of contact with the material. The patient is asked whether he uses rubber products at home or in the workplace (gloves, hats, overalls), whether he uses condoms, whether there have been surgical interventions in the past. Comparing the data obtained with the clinical picture, the specialist determines the probability of pathology.
- Allergological studies. These include the method of skin allergy tests (application or prick test), during which small amounts of the main antigens of natural and artificial latex are introduced. An indirect sign may be an allergy to certain foods – avocados, nuts, tomatoes.
- Laboratory tests. In general and biochemical blood tests, there are usually no noticeable changes, with a severe course, leukocytosis and eosinophilia are possible. Special studies (to determine the level of latex-specific IgE) reveal the presence of immunoglobulins only in reagin types of pathology.
Differential diagnosis is performed with other forms of skin lesions, manifested by redness and itching – urticaria, some forms of dermatitis (for example, atopic). The main difference is the presence of a persistent relationship with the use of latex products, as well as the results of specific allergological and laboratory studies.
Latex allergy treatment
As with many other conditions in allergology, the main component of the therapy of this disease is the restriction of the use of latex and rubber products. Sometimes, when additional additives provoke a reaction, it is enough to change the type of gloves, condoms, caps or other products used. If latex itself causes an allergy, then if it is impossible to completely abandon products made of elastic materials, alternative compounds (for example, polyurethane) are chosen. Symptomatic treatment of allergies includes the following groups of drugs:
- Antihistamines. They are most effective in reagin forms, they suppress the main link in the pathogenesis of the disease – the activation of histamine receptors. They are often prescribed for other types of pathology, in which case their effectiveness is somewhat reduced. Antihistamines are usually used in the form of tablets that quickly eliminate symptoms – especially itching and redness.
- Corticosteroids. Corticosteroids are more often used topically in the form of ointments and creams. They quickly reduce the activity of inflammation, affecting cellular reactions, therefore effectively eliminate contact dermatitis.
- Auxiliary means. With a prolonged course of skin forms of latex allergy, it is possible to develop dystrophic skin manifestations that lead to cosmetic disorders. Their severity is reduced by local and general administration of vitamin preparations, biogenic stimulants and other drugs.
Prognosis and prevention
The prognosis of latex allergy is almost always favorable, this condition very rarely threatens the patient’s life or leads to serious complications. However, it is capable of creating many minor inconveniences, given the wide distribution of the material in all areas of life. In a particularly difficult situation are people who come into contact with latex at their place of work – medical staff, workers in the production of latex products. To prevent exacerbations of allergies, latex items should be replaced with other materials (for example, polyurethane), before using rubber gloves, wear others made of thin cotton fabric under them. Before performing surgical operations, it is extremely important to inform doctors about the presence of such intolerance.