How to Diagnose Latex Allergy

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

A 22-year-old African American female is referred to the clinic for suspected latex allergy. She is to start work as a nurse at the local medical center and she is referred by occupational medicine. The patient has a history of intolerance to latex. Three years ago, she was taking care of her ailing grandmother and was using latex gloves when she reacted with “bumps” on her hands. She also reports that she used an eyelash extender with latex-based glue 5 months ago and she had eyelid swelling after she removed the eyelashes. She also reports history of irritation and itching in the vaginal area when using condoms. A month ago, she was at the hairdresser who was applying hair extenders to her scalp using a latex-based glue. Within six minutes of applying the extenders, she started to complain of feeling a lump in her throat; she started to have shortness of breath, and hives which affected her face, arms, legs, and back. She was sent to the ER where she was given an injection of Benadryl and injection of corticosteroid. Her symptoms resolved within an hour. She has not used the same hair extenders with latex glue or the eyelash application with latex base since then. She denies any reactions to food that may closely react with latex allergens, including kiwi, papaya, passion fruit, bananas, or almonds.

Past medical history (PMH)

Negative.

Medications

None.

Social history

Nonsmoker. No pets. Nursing student.

Family history

No history of allergic disease or reaction to latex.

Physical examination

Vital signs stable. Normal nose and throat exam. Respiratory system: Clear to auscultation bilaterally. Cardiovascular system: Clear S1, S2. Abdomen: Soft, non-tender, non-distended. Extremities: no edema. Skin: no rashes.

What tests would you suggest?

Skin prick testing with latex. If negative, ImmunoCAP test for specific IgE for latex allergens.


Sample form for latex skin prick testing (click to enlarge).

What happened?


Test results (click to enlarge).

Skin prick testing with latex was done using the standard protocol at the clinic. She reacted to histamine with 5 x 5 mm wheal, erythema 20 x 15 mm. She reacted to "wet glove one" with a wheal 5 x 6 mm, erythema 25 x 25 mm. She reacted to "wet glove one solution" with a 3 x 7 mm, erythema 15 x 20 mm. She reacted to "wet glove 2" with a wheal 3 x 10 mm, erythema 15 x 20 mm. She reacted to "wet glove 2 solution" with a wheal 1 x 1 mm, erythema 2 x 2 mm. She reacted to "dry glove" with wheal 2 x 2 mm, erythema 3 x 3 mm. The reaction to saline was negative.

What treatment would you suggest?

This is a patient with latex allergy and she was advised to avoid all latex products including gloves, latex-based glue, hair extenders, condoms, etc. She was advised to discuss workplace avoidance measures and also to avoid foods, which may cross react with latex. She was prescribed an EpiPen and education was provided how to use the EpiPen. Considering the relatively strong reaction to latex during the skin prick test, we gave her Alavert (loratadine) oral dissolving tablet 10 mg x 1 and she was discharged from the clinic without symptoms. A comprehensive list of latex-containing products and cross-reactive foods was provided to the patient.

Final diagnosis

Latex allergy.

Summary

Latex is most often referred to the cytoplasmic exudate of the Hevea brasiliensis tree, hence the name Hev b allergens. There are more than 250 latex proteins but only 13 proteins have been characterized and designated as Hev b allergens. Skin prick reactivity to Hev b 5, 6, 7 identifies 93% of workers allergic to latex.


Latex being collected from a "wounded" rubber tree. Image source: Wikipedia, public domain.


Hevea brasiliensis (Rubber Tree). Image source: Wikipedia, public domain.


Latex allergy, a mind map diagram (click to enlarge).

35% of sensitized patients develop allergic reactions to fruits and vegetables that contain proteins that cross-react with latex allergens (passion fruit, kiwi, avocado, banana, chestnuts, papaya, mango, tomato, and wheat).

Patients with history of anaphylaxis should be prescribed emergency epinephrine kits.

References

Latex Allergy: A Short Review. V. Dimov. Allergy Cases, 2008.
Latex Allergy. AFP, 1998.
Latex Allergy. eMedicine Specialties > Emergency Medicine > Allergy & Immunology, 2008.
Latex allergy. Constance H Katelaris. MJA 2006; 185 (6): 339.
Hidden Hazard: Hospitals Target Lurking Latex. WSJ, 02/2008 (subscription may be required)

Multiple choice questions

Chapter 58: Latex Allergy. Allergy and Immunology Review Corner: Chapter 58 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.

Patient information

Latex Allergy. National Institutes of Health.
Latex allergy. Mayo Clinic staff.
Tips to Remember: Latex allergy. AAAAI.

Published: 04/15/2009
Updated: 07/15/2009