Latex allergy. Review of 44 cases including outcome and frequent association with allergic hand eczema

Abstract

Background and design: Latex allergy is a type I reaction to natural rubber latex (NRL) proteins with clinical manifestations ranging from contact urticaria to fatal anaphylaxis. Previous US studies on NRL allergy have largely been reported by allergists with little detailed information on concomitant hand eczema, contact allergy, or on outcome. The charts of all patients with latex allergy seen between 1980 and 1994 in a dermatology department are reported with results of history; prick, scratch, wear, and patch tests; latex radioallergosorbent test; and follow-up questionnaire.

Results: There were 44 patients (37 female) with NRL allergy; 34 of whom had atopy. In 38 it was occupationally related, with all but two in health-related professions. Of the six nonoccupational cases, three had spina bifida. Twenty-nine had local skin reactions of urticaria and/or pruritus; seven, anaphylaxis; and eight, contact urticaria with other systemic symptoms. The diagnosis was based on a positive prick or scratch test to NRL in 37 cases, a class 2 or greater latex radioallergosorbent test in five cases, and strongly positive wear test results to an NRL glove in two cases. Thirty-six patients had hand eczema, with 26 having relevant positive patch test results that included glutaraldehyde, latex and vinyl gloves, and rubber chemicals. Follow-up revealed one patient quit work and eight changed jobs or tasks because of NRL allergy, 33 of 39 continued to have symptoms at work, and 12 had lost work time because of latex allergy symptoms.

Conclusions: Latex allergy was frequently seen in health care or dental workers, which was frequently associated with systemic symptoms, hand eczema, and allergic contact dermatitis. Most continue to work, but remained symptomatic. Patients with NRL allergy should be provided information on nonlatex devices and latex avoidance in medical, dental, and occupational settings. Low-NRL allergen gloves should be worn by coworkers of health care workers with NRL allergy.