Today, we encounter new chemical substances that are increasing day by day due to industrial developments. Latex, which is produced from natural rubber tree, which is used in many areas, is one of the most important industrial raw materials. Allergy to latex comes up with various complaints every day. Allergic diseases that develop due to latex can be seen in the form of itching and redness in the body, as well as sometimes with a fatal picture such as shortness of breath, low blood pressure and then allergic shock (anaphylactic shock). Symptoms of latex allergy range from contact urticaria, which is seen in the form of itching, redness, and swelling, where it comes into contact with the body, and anaphylaxis.
It is obtained from the sap of natural latex rubber tree (Hevea brasiliensis). Demand increased tremendously as it began to be used in a variety of industries, starting with Macintosh’s production of waterproof raincoats by covering the fabric with rubber in 1823. Currently, over 10 million tons of natural rubber are produced annually. In our daily life, millions of consumers use products such as gloves, rubber, condoms, balloons, rubber boots, mattresses, bonnets, catheters and vial stoppers, and different commercial products are used in many industries.
Compared to data published at the beginning of the 21st century, the current prevalence of latex allergy is 9.7% in healthcare workers, 7.2% in susceptible patients and 4.3% in the general population, and its prevalence in the general population seems to be increasing.
Latex allergy is now recognized as an international health problem as it has been shown to cause an increasing number of health problems in recent years. In high-risk groups with high latex exposure in the community, especially healthcare workers, rubber industry workers, children with spina bifida and urogenital anomalies, atopic people and patients with certain fruit allergies (especially kiwi, avocado, chestnut and banana), patients with many surgical history this rate can go up to 10-12%.
WHAT ARE THE SYMPTOMS OF LATEX ALLERGY IN ADULTS?
Latex allergy is now recognized as an international health problem as it has been shown to cause an increasing number of health problems in recent years. Latex exposure can be by direct skin/mucosal surface contact or by inhalation. After skin contact with latex-containing products, complaints such as itching and redness on the skin occur, while respiratory contact may cause nasal discharge, sneezing, itching or shortness of breath, wheezing. Apart from these, the most serious allergic reactions, which are shortness of breath, dizziness, confusion, and then allergic shock (anaphylactic shock) can be seen.
The most common reaction in healthcare workers or people who come into contact with latex products is irritant dermatitis on the hands due to prolonged contact. Irritant contact dermatitis, which is the most common clinical reaction with the use of gloves, is a skin response that develops due to dry, itchy, non-allergic irritation at the point of contact of the glove. This reaction may develop in non-allergic ways, ie frequent hand washing, use of detergents, insufficient drying of the hands, other irritants such as soap, sweating under the glove surface or may develop due to irritation caused by corn starch gloves. Since irritant dermatitis develops in non-allergic ways, no allergy is detected in allergy tests.
The most common allergic reaction due to skin exposure to latex is contact dermatitis, which occurs with a type IV (delayed) hypersensitivity reaction to latex and additives. Allergic contact dermatitis most commonly occurs on skin areas that come into contact with gloves, shoes, sports equipment, and medical devices. We may encounter products containing latex differently in different periods of our lives, for example, starting with a pacifier or bottle from infancy, latex can be encountered in many different ways, including balloons and chewing gum. Therefore, if there is a dermatitis in the form of itchy and watery blisters on the skin, allergic contact dermatitis due to latex should be considered. It is caused by exposure to chemicals added to latex gloves or other products during the manufacturing process. These chemicals can cause erythema, pruritus and vesicles. The rash usually begins 24-48 hours after contact, but may appear as early as eight hours or as late as five days.
Allergens that are responsible for latex-induced allergic contact dermatitis are all kinds of chemicals added during the production phase as accelerator or antioxidant, such as thiuram, carbamate, mercaptobenzothiazole and phenyldiamine.
Natural rubber latex should not be confused with synthetic rubber latex made from chemicals. Many latex-containing products, including house paints, are created from synthetic latex. They are not created with natural latex and trigger allergic reactions in people allergic to products produced with natural rubber latex.
Type I (early type) allergic reactions that develop against many allergens in latex and involve IgE antibodies can start with itching, urticaria, runny nose, sneezing, itching, shortness of breath and end with dizziness and loss of consciousness. The extent of exposure required for sensitization and symptoms to latex proteins is unknown. Even low levels of exposure can trigger symptoms in some susceptible individuals.
The most common reaction in latex allergy is contact urticaria, which develops especially where it comes into contact. Symptoms usually begin within minutes of exposure to latex, but can occur hours later. It is seen locally as redness, swelling or itching in the areas where the glove contacts. The presence of contact urticaria in people with latex sensitivity can sometimes be a warning for patients. Contact urticaria, which develops due to latex, may appear after contact with latex-containing products and may go away on its own, and may be an important clue indicating that the patient’s sensitivity to latex has started.
Type I (early type) reactions due to latex, except for skin lesions; It can manifest itself with symptoms such as runny nose, rhinitis, conjunctivitis, asthma. Although latex allergy is more common in healthcare workers, it also occurs in other jobs where latex gloves are used, such as in a pastry shop or bakery. Recognition of occupational latex allergy and asthma is important. Allergic reactions due to latex include clinical pictures such as nose and eye cold (rhinoconjunctivitis), asthma and fatal allergic reaction (anaphylaxis). As with other types of occupational asthma, early intervention and leaving the workplace environment can stop the development of irreversible hyperreactive airway disease. As a classic syndrome, latex occupational asthma is wheezing and shortness of breath that occurs or worsens at work. However, sometimes the relationship of this deterioration with exposure at work may not be clearly demonstrated.
Most of the patients who develop latex allergy are atopic individuals with previous complaints of allergic rhinitis and asthma. Sometimes there may be only latex sensitization. Atopic people are more likely to develop latex-related allergies and more severe reactions.
The most serious clinical picture that can be caused by latex allergy is fatal allergic shock (anaphylactic shock). The most serious consequence of latex allergy is anaphylaxis. Allergic shock is usually caused by mucosal absorption of latex proteins during surgery or medical or dental procedures in previously sensitized healthcare workers or other individuals.
Latex antigen exposure can occur in many ways. These can be skin, respiratory tract, mucous membrane and parenterally. Serious reactions may occur after skin and respiratory exposure, but direct mucosal and vascular exposure in surgical procedures poses the greatest risk for the development of anaphylaxis. Intravenous exposure to latex may lead to more severe anaphylaxis in people with atopy, and atopic individuals are at greater risk of developing anaphylaxis. It is very important that high-risk individuals with a history of atopic dermatitis or allergies are examined with latex-free materials and that latex-free products are used in their procedures.
In recent years, it has been shown that cross-reactions between pollen and fruits and similar allergic reactions may occur. There are many allergens that cause latex allergy, and some of them are also found in fruits and vegetables. Sensitivity to fruits such as banana, avocado, kiwi, and chestnut has been detected in a significant portion of people with latex allergy, and a picture called latex-fruit syndrome has been defined, considering that this is due to cross-reactive allergens. Allergic reactions to various fruits and vegetables are seen much more frequently than normal in patients with latex allergy, and the same allergic pictures that occur with latex occur with these foods. In some patients with latex allergy, allergic shock may develop with fruits. In people with latex-fruit allergy syndrome, after taking foods that cross-react with latex, itching on the palate and lips may begin in the mouth and then itching may occur all over the body. loss of consciousness develops, that is, allergic shock occurs.
In patients with latex allergy, sensitivity to foods is also detected. Although it is seen that food sensitivity does not cause serious reactions in some patients with latex allergy, it is important to demonstrate food sensitivity in patients. Generally, latex allergy occurs first, and food allergies are added later. Sometimes, latex allergy may develop on the basis of food allergy.
Fruits that most frequently cause allergies in patients with latex allergy; avocado, kiwi, banana, chestnut, walnut, hazelnut, celery, potato, tomato and papaya. Fruits and vegetables that have less clinical allergy but are susceptible to include figs, melons, watermelons, peaches, pineapples, pears, celery, apples, cherries, sour cherries, strawberries, carrots, and turnips.
WHO IS AT RISK FOR LATEX ALLERGY IN ADULTS?
Allergic reactions to latex can be serious and very rarely fatal. Latex allergy is now recognized as an international health problem as it has been shown to cause an increasing number of health problems in recent years.
Compared to data published at the beginning of the 21st century, the current prevalence of latex allergy is 9.7% in healthcare workers, 7.2% in susceptible patients and 4.3% in the general population, and its prevalence in the general population seems to be increasing.
With millions of latex and products containing latex, there are many ways to be exposed to latex. It is therefore not surprising that around 4% of the general population worldwide have a latex allergy. To reduce latex allergy, avoiding contact with latex-containing products and reducing the prevalence of latex allergy may be more difficult than we expected.
With the emergence of latex allergy among healthcare workers in the late 1980s and 1990s, large numbers of latex-afflicted individuals were identified in some patients and the general population. More latex exposure may be seen, especially in some jobs. We can list the high-risk groups for latex allergy as follows.
a. Occupational exposures to latex
Healthcare workers, Rubber factory workers, Construction workers, Cleaners, Food workers, Gardeners, Painters, Hairdressers, Toy makers, Restaurant workers, Bakery workers, biology and chemistry lab workers
b. Those exposed to multiple surgical interventions
Patients with spina bifida, Dandy-walker cysts, Patients with congenital genitourinary anomalies, cesarean delivery, bladder exstrophy,
c. Frequent contact with latex products
Dental interventions, frequent urinary catheterization, diabetic patients using insulin
d. Atopic people with hay fever (allergic rhinitis) or other allergies such as allergies to certain foods, Asthma, Eczema, Fruit allergy constitute the risk group for latex allergy.
Latex allergy is increasing day by day, because as the number of products containing latex increases in our daily lives, we are more likely to encounter it.
Latex allergy affects not only workplaces such as healthcare, where latex gloves are frequently used, but also the general population, even if we are not occupationally exposed to latex products. Therefore, latex allergy is increasing day by day as a serious problem.
HOW SHOULD I PREPARE FOR DIAGNOSIS OF LATEX ALLERGY BEFORE GOING TO THE DOCTOR?
Latex allergy is now recognized as an international health problem as it has been shown to cause an increasing number of health problems in recent years. After skin contact with latex-containing products, complaints such as itching and redness on the skin occur, while respiratory contact may cause nasal discharge, sneezing, itching or shortness of breath, wheezing. Symptoms of latex allergy range from contact urticaria, which is seen in the form of itching, redness, and swelling, where it comes into contact with the body, and anaphylaxis.
For the diagnosis of latex allergy, it is absolutely necessary to go to allergy specialists who have been trained in this subject. The diagnosis of latex allergy, which manifests itself in many different clinical manifestations, is made by allergy specialists.
Going to the allergist What can you do?
Write down your symptoms and complaints (including those that seem unrelated.)
What kind of reaction you had when you were exposed to latex, you can document hospital records if needed.
Make a list of all the medications you take (including vitamins and supplements).
If possible, go to the doctor with a family member or friend. Someone accompanying you may remember something you missed or forgot.
If you think you have a latex allergy, try to stay away from products containing latex
Stop Some Medications One Week Before Going to the Doctor
If you have decided to go to the doctor for latex allergy and if possible, oral allergy medications, cough and cold medicines, antihistamines and antidepressants should be discontinued. Because when allergy test is required for the diagnosis of latex allergy, these drugs should be discontinued 1 week before as these drugs will affect the results of the allergy test.
No Need to Fast
There is usually no need to fast for the tests required for the diagnosis of latex allergy. Therefore, it is beneficial to come with breakfast.
HOW IS LATEX ALLERGY DIAGNOSED IN ADULTS?
Diagnosis of latex allergy begins with taking a comprehensive history of past allergic reactions. However, a careful physical examination is performed for examination findings compatible with latex-related allergic reactions. Depending on the history and physical examination results, the diagnosis can be made by performing skin tests, blood tests and, if necessary, latex provocation tests. Therefore, if latex allergy is suspected, an experienced allergist is required who can perform these diagnostic methods as well as evaluate them.
Diagnosis of latex allergy in people who have had urticaria or unexplained allergic shock when exposed to latex-containing products, especially if they experience irritation and redness of the hands, or itching in the eyes, nose, runny nose, or itching or shortness of breath, wheezing, cough, especially when they go to work. must be excluded. Appropriate evaluation, for example, of healthcare workers in high-risk groups with these complaints, is important because once a latex allergy has started, there is always a high probability of developing more serious reactions later on.
The skin prick test is the most reliable test for determining latex susceptibility. It is used to show latex type I (early type) sensitivity in patients with suspected latex allergy. It is important to perform skin prick tests, especially in patients who develop complaints immediately after latex contact. Since those with latex allergy may also have complaints with fruits, it is important for the patient to look at cross-reactive fruits and vegetables as well as latex allergy.
RAST from blood in latex allergy, etc. Tests measuring specific latex-specific IgE are less reliable. It has been observed that allergic reactions may develop in latex prick test positive but RAST negative patients. Measurement of specific IgE in serum can be performed in patients with extensive skin lesions, severe reaction to latex, or patients with dermographism who cannot discontinue drugs that affect tests, but does not definitively indicate that they are not allergic to latex.
Atopy patch testing has been shown to be useful for skin reactions in patients with skin lesions who complain of contact dermatitis. The patch test with chemicals in latex is very helpful in the diagnosis of dermatitis, which is thought to be due to latex-containing products. Patch test 48-72. hours are evaluated. In irritant contact dermatitis, the patch test is negative. In contact dermatitis, type IV (late type) allergy to chemicals in latex is detected.
Latex provocation tests may be required to explain the complaints in people with whom we suspect latex allergy. Provocation tests with latex should be done under the supervision of an allergist, as it can cause very serious reactions.
HOW TO TREAT LATEX ALLERGY IN ADULTS?
The best treatment for latex allergy is to avoid any product containing latex. Patients who have had a severe latex allergic reaction must carry
Allergy card and an epinephrine (adrenaline) auto-injector for emergency treatment.
Healthcare workers who have a history of latex sensitization and need to wear gloves should stop wearing latex gloves. When a latex allergy develops, special precautions are needed both at work and during medical procedures.
If allergic to latex, he should avoid direct contact with all products and devices containing latex. It is recommended to avoid foods that cause an allergic reaction, as it may cross-react with foods near the nose.
Latex allergy problems prior to any dental procedure, medical or surgical procedure can be avoided by alerting healthcare providers of a latex allergy prior to any testing or treatment. Required to carry a latex allergy card or identification card
People with a latex allergy may receive medical or dental care in a latex-safe area. Hospitals and clinics using only low-protein latex gloves and non-latex gloves have seen dramatic reductions in latex allergy cases. Taking precautions about latex is very important in this regard.
Patients who have anaphylactic shock due to latex allergy must carry an adrenaline autoinjector with them. Patients need to learn to use an adrenaline autoinjector.
There are studies showing that allergy vaccine (immunotherapy) is effective in latex allergy, but immunotherapy is not performed for latex in our country. There are positive results regarding anti-IgE, one of the newly developed drugs, apart from the prevention of latex allergy.
Avoiding contact with latex allergens is more important than we expected in reducing the prevalence of latex allergy.
