Latex allergy: a health care problem of epidemic proportions.

Latex allergy is one of the major health concerns of the decade. The induction of latex allergy commonly occurs after exposure of skin or mucous membrane to natural rubber latex. It is usually a type I, immediate hypersensitivity reaction mediated by IgE which can range from mild skin erythema to anaphylaxis and death. To manage latex allergy appropriately, prompt and correct diagnosis is essential. This depends primarily on clinical history, latex specific IgE RAST (in vitro) and skin prick test (in vivo). It affects people who are frequently exposed to products made of natural rubber latex, such as, health care workers, workers in the rubber industry and those who have had multiple surgical operations. The prevalence in the general population was estimated at 0.7% in a population study in France, but this can be higher in health care workers (up to 17%) and in patients with spina bifida to almost 65%. Prevention strategies should therefore target at risk population, rather than the population as a whole. At present this primarily involves providing non-powdered latex gloves in hospitals and primary health care centres. However, once latex allergy has been established, the situation becomes more complicated. Health care workers either have to be moved to a latex free environment or in extreme circumstances may have to give up their occupation. For patients undergoing operations most hospitals have adopted a latex free protocol. It is important that this is understood and followed by every member of the staff. Those who have had serious adverse reactions should wear Medi-Alert bracelets and in exceptional circumstances may need to keep epinephrine injections on their person. Future strategies focus on the reduction of allergens during latex manufacture, development of suitable non latex gloves and immunotherapy including desensitisation of latex allergic individuals and development of candidate vaccine.