Vol. 87 No.

1 January 1999

ORAL SURGERY,
ORAL MEDICINE,
ORAL PATHOLOGY,

REVIEW ARTICLE

Latex allergy
A review for the dental professional

Anthony M. Spina, DDS, MD,a and Hal J. Levine, DMD, MD,b Lexington, Ky
UNIVERSITY OF KENTUCKY

Reactions to latex products are reportedly occurring with an increased frequency both in patients and in health care
providers. Natural rubber latex is found in numerous products, and adverse latex reactions range from contact dermatitis to
life-threatening anaphylaxis. A complete understanding of the pathophysiology of latex allergy provides the foundation for the
proper diagnosis and treatment of patients with latex allergy. This article provides the reader with a review of latex allergy and
suggests strategies for the management of patients with latex hypersensitivity. (Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1999;87:5-11)

William Halstead introduced surgical gloves made of
latex rubber in 1890. Almost 100 years passed before
Nutter1 reported the first case of latex allergy (in 1979).
Since that time, latex allergy has become an emerging
and serious phenomenon that has implications not just
for health care workers but for all of society. The rising
incidence of latex allergy has been associated with the
introduction of Universal Precautions by the Center for
Disease Control in the mid 1980s. Universal
Precautions set a standard for blood and body fluid
precautions that must be applied to all patients at all
times. Latex surgical gloves are an important compo-
nent of Universal Precautions and act as a deterrent to
the transmission of pathogens such as hepatitis B virus
and HIV. Any anticipated contact between a health care
provider and a patient’s blood or body fluids requires
the provider to wear gloves. Universal Precautions
have increased the exposure of health care workers and
patients to latex products.
Coincidentally, the increased use of latex gloves has
increased the demand for manufacturers to produce and
supply latex gloves. This increased demand for latex
gloves may have temporarily altered manufacturing
procedures, which in turn may have resulted in a poor-
aAssistantProfessor, Division of Oral and Maxillofacial Surgery.
bFormerly, Chief Resident, Division of Oral and Maxillofacial
Surgery; currently in private practice, Orlando, Fl.
Received for publication ; returned for revision ; accepted for publi-
cation .
Copyright © 1999 by Mosby, Inc.
1079-2104/99/$8.00 + 0 7/12/94115
quality, highly allergenic product.2 Although the manu-
facturers have been blamed for the reported increase in
latex allergy, the reason for the increase remains unclear.3
The prevalence of latex allergy in the general popu-
lation is not accurately documented, but it is believed
to be very low. One report found 0.125% of patients
who were tested before surgery to be latex-sensitive.4
In another study of 1000 blood donors, latex antibodies
were demonstrated in 2.4% of the subjects.5 The preva-
lence of latex allergy among non–health care workers
in hospital settings is 0.8%4; hospital health care
workers have a significantly greater incidence of latex
allergy, reported as 5% to 17%,2,4,6 with certain groups
having a very high prevalence. For example, 41.1% of
operating room nurses had symptoms of contact
dermatitis, and 10.7% had positive skin prick tests to
latex.7 The prevalence of latex allergy among physi-
cians is reported at 9.9% in North America8 and 7.4%
in Finland.4 Members of the dental profession are also
at high risk for developing latex allergy. In a survey of
US Army dentists,9 13.7% reported symptoms related
to the use of latex gloves. In a more recent study
conducted as part of the American Dental
Association’s annual health screening, 6.2% of the
participants, among whom were dentists, dental
hygienists, and dental assistants, tested positive for
type I hypersensitivity to latex proteins.10 Hill et al11
found a 19.2% incidence of self-reported latex allergy
and an actual incidence of 3.8% in dental workers.
Safadi et al12 found a 12% incidence of latex allergy by
skin prick testing in dental workers. To date, 16 fatali-

5
6 Spina and Levine
Table I. Common household products that may
contain latex
Infant pacifiers and feeding nipples
Rubber toys
Athletic shoes
Swimming, snorkeling, and scuba equipment
Erasers
Elastic fiber diapers
Elastic bands on clothing
Halloween masks
Adhesives
Balloons
Condoms
Diaphragms
Racquet handles
Rubber bands
Carpet backing
Tires
Rubber mats
Household gloves
ties secondary to latex anaphylaxis have been reported,
none of which was secondary to dental treatment.13
The purposes of this article are to review the latex
manufacturing process and the pathophysiology of
latex allergy, to suggest treatment protocols for the
management of patients with latex allergy, including
the treatment of emergencies, and to discuss Universal
Precaution strategies to accommodate the latex-allergic
health care worker.
LATEX MANUFACTURING PROCESS
Latex, a natural rubber, is a complex mixture of cis-
1,4-polyisoprene particles in a phospholipoprotein
envelope and a serum containing sugars, nucleic acids,
lipids, minerals, and proteins. These proteins are
responsible for the severe, immediate anaphylactic
reactions that constitute type I hypersensitivity.14
Latex is derived from the sap of the commercial
rubber tree, Hevea brasiliensis.15 Primarily cultivated
in Malaysia, Indonesia, and Thailand, rubber trees are
tapped by cutting spiral or diagonal grooves in the bark
and setting collecting cups in place to capture the
oozing sap. After the sap is harvested, ammonia is
added as a preservative to prevent bacterial contamina-
tion and autocoagulation. Ammonia disrupts the
collected sap, resulting in a 2-phase product that is
concentrated by centrifugation. Although ammonia
effectively stabilizes the latex, high levels may cause
skin irritation. To overcome this problem, most manu-
facturers use a low ammonia level in combination with
secondary preservatives. Accelerators and antioxidants
are added to the concentrated material to improve the
strength, stretch, and durability of the latex product.
These accelerators and antioxidants are implicated as
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
January 1999
the cause of contact dermatitis, which constitutes type
IV hypersensitivity.16,17 The latex material is rendered
heat-stable and elastic by vulcanization, a process that
involves curing the latex with heat and sulfur to allow
cross-linking of the polymer chains.
Approximately 90% of the harvested rubber is used
to manufacture extruded rubber products, injection-
molded products, and pneumatic tires. The remaining
10% of the harvested rubber is used to manufacture
dipped products, which include rubber gloves,
condoms, and balloons.18 Dipped products are respon-
sible for most of the anaphylactic reactions to natural
rubber latex.19 Porcelain formers are dipped into the
latex compound and then oven-dried. The oven-dried
gloves are passed through leaching tanks to remove
excess water-soluble proteins and additives, and the
glove is then cured by vulcanization. Powder lubricants
are added, and the gloves are stripped from the formers
and packaged. Powder-free gloves are processed sepa-
rately; their surface is rendered slippery by passing the
gloves through a chlorination wash or coating the
surface with a hydrogel polymer.
Most gloves that are listed as “hypoallergenic” still
contain latex proteins. Hypoallergenic labeling most
commonly refers to a reduction in the chemical addi-
tives that are responsible for the contact dermatitis. Use
of the “hypoallergenic” label has been based on results
of testing to detect sensitization to residual levels of
processing chemicals, not to natural latex proteins. The
US Food and Drug Administration (FDA) believes that
the term “hypoallergenic” on the labeling of a device is
misleading, and as of September 30, 1998, the FDA is
requiring that the hypoallergenic claim be removed
from devices that contain natural rubber.20
Natural rubber latex should not be confused with
synthetic latex products such as water-based paints.
These products use an emulsion of synthetic polymers
or copolymers and do not place the latex-sensitive
person at risk.
LATEX PRODUCTS
Latex rubber can be found both in the home and in
the workplace. It is estimated that over 40,000 products
contain latex rubber. It would be impossible to compile
a list of all latex-containing products. Table I lists some
of the more commonly used home products that may
contain latex.
The list of patient care products that contain latex is
enormous. This list is in a constant state of evolution,
and before any product is used on a latex-allergic
patient, the manufacturer should be contacted to verify
the latex content of the product. Table II lists some of
the more frequently used products in patient care that
may contain latex.
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY Spina and Levine 7
Volume 87, Number 1

PATHOPHYSIOLOGY OF LATEX ALLERGY Table II. Patient care supplies that may contain latex
Latex exposure can occur through various routes, Intravenous supplies
including the skin, mucous membranes, respiratory Latex injection ports on IV tubing and IV fluid bags
system, and vascular system. Cutaneous exposure Multidose medication vials
Disposable syringes
occurs when any product with latex contacts the skin.
IV catheters
Although exposure can occur with intact healthy skin, Tourniquets
certain conditions can increase the susceptibility of the Heparin lock
skin to latex allergens. When the protective barrier of IV medication pumps
Respiratory supplies
the skin is weakened by contact dermatitis, latex Ambu bags
proteins may be more easily absorbed via the cuta- Suction catheters
neous route. In addition, latex proteins are rendered Face masks
more soluble when body sweat accumulates beneath Nasal cannulas
Endotracheal tubes
latex gloves, and in people who use some oil-based Ventilator bellows
lotions deterioration of the gloves may occur, leaching Ventilator circuit
out the latex proteins. Oropharyngeal and nasopharyngeal airways
Mucous membrane contact with latex proteins has Face mask retention straps
Pulse oximeter probes
resulted in a number of severe reactions. Most of the Spacer for metered dose inhaler
reports involve the mucous membranes of the mouth, General patient care supplies
vagina, urethra, and rectum.21 The respiratory route of Latex gloves
exposure occurs mainly from aerosolized powder or Patient identification bands
Band-Aids
from anesthesia circuits.22,23 The cornstarch powder Blood pressure cuff and tubing
used to ease the donning of surgical gloves absorbs Urinary catheters (including condom catheters) and drainage
many of the latex allergens. It is this powder-protein systems
Nasogastric tubes
complex that sensitizes patients, not the cornstarch
Chux (washable underpad)
powder itself.24 The powder-protein complex becomes Electrode grounding pads
aerosolized every time gloves are donned and removed, Fluid circulating warming blankets
and areosolization also occurs as a result of resuspen- Surgical masks, hats, shoe covers, and gowns
Surgical drapes
sion from reservoirs in the room and on clothing. One Reflex hammer
study25 noted that latex levels were not significantly Tape
different in rooms with high laminar flow exchange Teeth protectors for intubation
rates (225 times/hour) and rooms with conventional air Waterproof mattress covers, beds, OR tables and stretchers
Wheelchair cushions
exchange rates (25 times/hour); the investigators Temperature probes
concluded that a more significant reduction in latex Dressings: Dynaflex, Action Wrap, Colban, Elastoplast
aeroallergens might be achieved by using powder-free ACE elastic wraps
latex gloves rather than by increasing the air filtration Enemas (latex valve)
Steri-Strips, Tegaderm, Tegasorb (contain latex in packaging
rate in the operating suite. Vascular exposure has been only)
reported with the use of intravenous supplies such as Stethoscope tubing
tubing, rubber diaphragms on multidose vials, and Suction catheters
rubber stoppers on disposable syringes.26-28 Chest tubes and drainage systems
Bulb syringes
There are 3 types of reactions to latex products: irri- Electrode pads
tant contact dermatitis, allergic contact dermatitis, and Axillary and hand pads for crutches
immediate allergic reactions. The 2 types of contact Dental supplies
Rubber dam
dermatitis account for most clinical reactions to latex
Prophy cup
products. Contact dermatitis may contribute to Orthodontic elastic
increased latex sensitization by reducing the protective Bite blocks
properties of the skin. Reducing the barrier integrity of Nitrous oxide masks
Rubber stoppers on local anesthetic carpules
the skin allows a larger amount of latex allergens to be Penrose surgical drains
absorbed into the skin. Increased frequency and
IV, Intravenous; OR, operating room.
severity of allergic contact dermatitis may precede a
latex allergy.29
Irritant contact dermatitis is a nonimmunologic
inflammation of the skin caused by direct damage to gents, and inadequate hand-drying allow soap residue
the protective layer of the skin, the stratum corneum. to remain on the skin, where it can initiate irritation.
Inadequate rinsing of irritants, such as soaps and deter- Other factors that may exacerbate this condition
8 Spina and Levine
Table III. Latex information sources
1. Education for Latex Allergy/Support (610) 436-4801
Team and Information Coalition (ELASTIC)
2. Spina Bifida Association of America (800) 621-3141
3. Latex Allergy News (860) 482-6869
4. Internet http://allergy.mcg.edu/physicians/ltxhome.html
5. Allergy to Latex Education and Resource (414) 677-9707
Team (ALERT, Inc)
include friction, occlusion, sweating, extremes of
humidity, and extremes of temperature. If a person is
exposed to an irritant of sufficient concentration for a
sufficient amount of time, irritant contact dermatitis
will develop. Certain groups are at high risk, including
people who work in wet environments (such as health
care workers who frequently wash their hands), atopic
patients, and individuals with fair skin. Clinical find-
ings include erythema, dryness, fissuring, chapping,
and vesicle formation as a late manifestation. Irritant
contact dermatitis is a diagnosis of exclusion. The
signs and symptoms are similar to allergic contact
dermatitis, which is ruled out by patch testing.
Treatment is aimed at thorough rinsing and drying of
the hands, avoidance of extremely hot water, and mois-
turization of the skin after handwashing.
Allergic contact dermatitis is a delayed type IV hyper-
sensitivity mediated by T cells. Lesions generally appear
48 to 96 hours after exposure. Accelerators and antioxi-
dants used in latex manufacturing are the most
commonly implicated agents. Allergic contact dermatitis,
however, can be secondary to any of the chemicals used
in latex manufacturing. Clinical manifestations are
similar to those of irritant contact dermatitis and include
pruritus, erythema, scales, crusts, scabs, papules, and
vesicles. The diagnosis of allergic contact dermatitis is by
patch testing; once it is diagnosed, treatment is centered
on avoidance of the allergen.
Immediate type I reactions are IgE-mediated and are
secondary to the proteins present in natural latex
rubber. IgE antibodies are formed and bind to mast
cells with the initial latex contact. Secondary exposure
causes cross-linking of the IgE molecules on the
surface of the mast cells, with resultant degranulation
and histamine release. This mast cell degranulation and
histamine release is responsible for the clinical mani-
festations of immediate type I hypersensitivity. These
symptoms include immediate pruritus and stinging,
with erythema, edema, and a wheal and flare reaction
occurring minutes later. After this initial reaction,
conjunctivitis, generalized urticaria, dyspnea, palpita-
tions, dizziness, laryngeal edema, anaphylaxis, and
death may result. In some cases, general anesthetics or
surgical drapes may mask the early signs of more
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
January 1999
severe allergic reactions, and hypotension or oxygen
desaturation may be the first sign of anaphylaxis.
POPULATIONS AT RISK
Although the risk for latex allergy in the general
population is quite low, certain populations are consid-
ered at higher jeopardy than others for latex allergy.
Anyone with a history of multiple latex exposures, a
personal or family history of atopy, or one or more of
certain food allergies falls into this higher risk group.
Multiple latex exposures are more commonly found in
patients with spina bifida and multiple-surgery patients
as well as in health care and latex industry workers.
Patients with histories of multiple operations may be
at a higher risk for latex sensitization. In one study,30
6.5% of multiply operated patients were sensitized to
latex; this compared with 0.37% of persons without
prior surgeries or other risk factors. One of the highest
risk groups for latex allergy is patients with spina
bifida cystica. The reported incidence of latex sensi-
tivity in the spina bifida cystica pediatric population
varies from 18% to 73%.31,32 Spina bifida is a congen-
ital neural tube defect that occurs when a portion of the
neural tube fails to close or when the neural tube
reopens after successful closure. The management of
infants with spina bifida cystica involves multiple
surgical procedures that include skin closure of thin-
walled defects, ventriculoperitoneal shunting of hydro-
cephalus, lower extremity bracing, gastrointestinal
instrumentation, and genitourinary instrumentation.
The frequent exposure to latex products in this patient
population has been cited as a major risk factor for
latex allergy.33 Frequent latex exposure may also occur
in patients with congenital urologic abnormalities.34
Gold et al35 reported 19 episodes of intraoperative
anaphylaxis in 15 children with either congenital
urologic abnormalities or spina bifida.
Health care providers, including members of the
dental profession, are regularly exposed to a variety
of latex products. The Occupational Safety and
Health Administration estimates that more than 5
million American health care workers use latex
gloves, with over 7 billion pairs of latex gloves used
annually in the United States.36 The frequent expo-
sure of health care workers to latex products is
responsible for the increased risk of latex sensitiza-
tion in this population group.19,37
Workers in the latex industry have frequent exposure
to latex allergens and probably have an incidence of
latex allergy similar to that of health care workers. One
study found that 11% of workers at a latex glove factory
had positive allergy skin tests to latex.38 Research in
this area has been scant, and not much is known about
the true prevalence in this subset of patients.
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
Volume 87, Number 1
Atopy is a type I hypersensitivity with a genetic
predisposition and has an incidence in the general
population that approaches 20%.39 Atopic individuals
have a tendency to develop one or more of the
following diseases: asthma, allergic rhinitis, dry skin,
and eczema. Moneret-Vautrin30 identified a 9.4%
prevalence of latex sensitization by skin prick tests in a
group of atopic subjects without other risk factors. An
individual with a personal or family history of atopy
should be considered at high risk for latex allergy.
Individuals with certain food allergies may also have
a coexisting latex allergy because many of the polypep-
tides found in rubber are also found in certain foods,
especially fruits. Kurup et al40 studied the cross-reac-
tivity of food allergens in latex allergy. Antibodies
were obtained from latex-sensitive patients by affinity
absorption with various food and latex allergen
extracts. The antibodies were then evaluated for reac-
tivity with antigens by enzyme-linked immunosorbent
assay. The results indicated that IgE cross-reactivity
existed between different latex and food allergens. The
foods most often implicated include banana, avocado,
chestnut, apricot, kiwi, pineapple, peach, nectarine,
plum, cherry, melon, fig, grape, papaya, passion fruit,
potato, tomato, and celery.40 Food sensitivity may or
may not precede the latex sensitivity. In some instances
the latex sensitivity may occur before or at the same
time as the food sensitivity. The American College of
Allergy, Asthma and Immunology recommends ques-
tioning people with certain food allergies about latex
allergy. In addition, consideration should be given to
skin and serologic testing. However, not all patients
with these high-risk food allergies will require latex
avoidance; conversely, not all patients with latex aller-
gies will have adverse reactions with these foods.41
DIAGNOSIS
The diagnosis of latex allergy begins with a thorough
history and physical examination. In 1991, the US Food
and Drug Administration recommended that all patients
be questioned in connection with potential latex
allergy.42 Patients who have positive histories for latex
allergy require no further workup and are treated with
latex avoidance. Persons who have a very high risk for
latex allergy, such as patients with spina bifida, should
be considered latex-allergic. Such a patient is treated
with latex avoidance and should be referred to an aller-
gist for definitive testing. Individuals in other high-risk
categories should be questioned thoroughly about latex
hypersensitivity; if a positive history is obtained, latex
allergy testing is performed. Some controversy exists
regarding high-risk patients with negative clinical histo-
ries. At present, the recommendation is to encourage
these patients to have latex testing.43 Latex allergy
Spina and Levine 9
Table IV. Treatment of latex anaphylactic reactions
Activate EMS (initiate a “code” if in a hospital setting)
Initiate basic life support (ABCs)
Remove latex exposure
Discontinue all intravenous or inhalational medications
Administer 100% oxygen
Secure airway with endotracheal tube if indicated (laryngeal
edema, bronchospasm)
Restore intravascular volume with fluids IV
Administer epinephrine 1:1000 (0.2-0.5 mg IV or SQ every 5-15
minutes as necessary)
Administer diphenhydramine (l mg/kg IV; maximum 50 mg)
Administer methylprednisolone (l mg/kg IV; maximum 100 mg)
Administer bronchodilators
Advanced cardiac life support if cardiac arrest develops
Transportation to hospital by means of EMS
ICU admission for the detection of delayed anaphylaxis
Obtain blood samples in red-top tube for RAST and tryptase level
EMS, Emergency medical services; ABCs, airway, breathing, and circulation
check; IV, intravenously; SQ, subcutaneously
testing is not recommended for low-risk patients with
negative clinical histories. However, all patients,
including low-risk patients who have positive clinical
histories of latex reactions, should be tested.
Positive findings in the history and physical exam
that may suggest latex allergy include dermatitis,
eczema, atopy, and food allergies. Other clues may be
subtle; for example, some health care providers and
latex industry workers may relate histories of respira-
tory symptoms such as rhinitis, sinusitis, or asthma
while at work, with resolution of these symptoms once
they are outside the workplace.
Definitive testing for latex allergy is completed with
either in vitro or in vivo tests. In vivo tests are more
sensitive than in vitro tests and are clinically more rele-
vant. At present, no gold standard exists for the diag-
nosis of latex allergy. In vitro serologic tests measure
the serum level of latex-specific IgE. The most common
IgE assay method used is the radioallergosorbent test
(RAST), which has not been shown to be an accurate
indicator of latex allergy. In comparison with skin tests,
the RAST has a sensitivity rate of only 53%.44,45
Currently, skin prick testing is the most reliable
method of diagnosing a latex allergy; it has a sensi-
tivity of 90% to 95%.46 Skin prick testing may cause
anaphylaxis, and testing should therefore be performed
by a trained allergist in a hospital setting with adequate
resuscitation equipment available. The reported inci-
dence of anaphylaxis with latex skin prick testing is
2%.37 Although skin prick testing is the most common
in vivo test, it has several limitations. Currently, no
standardized, approved latex skin extract is available.
Allergists must prepare their own extract from latex
surgical gloves, which have variable amounts of anti-
10 Spina and Levine
genic content. This has the potential to cause serious
anaphylactic reactions if latex products with extremely
high antigenic proteins are used in the preparation of
the extract; conversely, false negative results are
possible if extracts are produced with gloves that have
low antigenic content. In addition, no standard criteria
for a positive result have been established. Skin prick
testing is performed by applying a latex extract on the
skin, scratching or pricking the skin with a needle, and
comparing the reaction to a histamine control. Skin
testing by the intradermal method is not advised and
can cause anaphylaxis.
Other in vivo tests include the use test and the patch
test. The use test is performed with a fingertip cut from
a latex glove and moistened with saline solution. The
latex is applied to the skin of a patient for 15 minutes.
A positive result is documented if urticarial pruritus or
erythema develop. If no reaction occurs, an entire
saline-soaked surgical glove can be applied to the
patient’s hand until a reaction occurs or for a maximum
of 15 minutes.
Patch testing is used to differentiate irritant contact
dermatitis from allergic contact dermatitis; it is the
definitive diagnostic test for type IV latex hypersensi-
tivity. The allergen is applied on normal skin and
covered with a semiocclusive dressing. The patch test
is left in place for 24 to 48 hours, and results are first
read 30 minutes after removal of the patch, with a
repeat reading 24 to 48 hours later. If the concentration
of the allergen is too strong, it may produce a positive
reaction on normal nonsensitized skin. Therefore, the
results of the patch test are always correlated with the
clinical history.
MANAGEMENT
Once a person has been diagnosed with a latex
allergy, the treatment is centered on avoidance of all
latex products. Such a patient should be encouraged to
wear a medical alert bracelet to indicate the allergy,
and he or she should also carry an epinephrine self-
injection kit at all times.
Management of the latex-allergic patient in any
health care facility requires some treatment modifica-
tions. The patient’s chart should be flagged with a latex
allergy label, and a latex allergy sign may be posted
outside the treatment room. Latex-allergic patients
should be treated as the first cases of the day, before
high levels of aerosolized latex proteins are present in
the treatment area. Every health care facility, including
dental offices and ambulatory surgery centers, should
have a latex-free policy manual and a latex-free cart to
simplify management of latex-allergic patients. The
supplies on the cart should include materials used to
deliver care to latex-allergic patients, as well as latex-
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY
January 1999
free resuscitation supplies. Currently, manufacturers
are not required to list latex content on packaging
labels. After September 30, 1998, the FDA will require
labeling of all medical devices, including device pack-
aging containing natural rubber latex.20 If the latex
content of any product is in question, the manufacturer
should be contacted for information on the latex
content and allergy potential. To assist in the construc-
tion of a latex-free cart, an excellent review of latex-
free products has been developed by ALERT, Inc,
(Allergy to Latex Education and Resource Team).
Information regarding latex allergy is in a constant
state of evolution. Numerous sources are available
regarding this topic and are listed in Table III.
Premedication with antihistamines and corticos-
teroids has been suggested when a patient with spina
bifida or a history of latex allergy is being treated.
Premedication may reduce the severity of an allergic
response in case of inadvertent latex exposure;
however, it should not be considered an alternative to
latex avoidance. There is no evidence to suggest that
premedication can prevent anaphylaxis.47
The treatment of latex reactions is based on severity.
In all cases the first step is removal of the allergen.
Mild reactions may be treated with antihistamines,
corticosteroids, and, in the case of asthmatic reactions,
bronchodilators. The treatment of anaphylactic reac-
tions is summarized in Table IV.
The management of a latex-allergic health care
provider is based on avoidance of the allergen. In the
case of contact dermatitis, investigation of the latex
product may identify the allergen. If possible, choosing
an alternative product that does not contain the
offending allergen may relieve the symptoms. Health
care providers who have type I sensitivities to latex
proteins are managed with complete avoidance of the
allergen. These providers must be careful around
coworkers who use latex products, especially gloves. A
person who is very sensitive may have an adverse reac-
tion from a brief cutaneous latex exposure or from
aeroallergens. Health care providers with latex aller-
gies must be fastidious in latex avoidance; before any
new product is introduced into the health care facility,
the latex content must be evaluated.
CONCLUSIONS
Allergic reactions to latex products are becoming
more frequent. Strategies for the management of
patients with latex allergy must be developed and
incorporated into the daily practice of health care
providers. Practitioners must be able to screen accu-
rately for latex allergy, refer patients to an allergist for
definitive diagnosis, and render treatment with avoid-
ance of latex products. In addition, practitioners must
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY Spina and Levine 11
Volume 87, Number 1

be able to recognize and treat latex exposure emergen- 25. Swanson MC, Bubak ME, Hunt LW, Yunginger JW, Waener
MA, Reed CE. Quantification of occupation latex aeroallergens
cies. With adequate knowledge and preparation, health in a medical center. J Allergy Clin Immunol 1994;94:445-51.
care providers can minimize the risk of adverse latex 26. Schwartz HA, Zurowski D. Anaphylaxis to latex in intravenous
reactions. fluids. J Allergy Clin Immunol 1993;92:358-9.
27. Kearns CF, Norris A. A latex allergy and plastic syringes. Anesth
REFERENCES Analg 1996;82:429.
28. Hamilton G. Contamination of contrast agents by rubber compo-
1. Nutter AF. Contact urticaria to rubber. Br J Dermatol
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1979;101:597-8.
29. Charous BL, Hamilton RG, Yunginger JW. Occupational latex
2. Sussman GL, Beezhold DH. Allergy to latex rubber. Ann Intern
exposure: characteristics of contact and systemic reactions in 47
Med 1995;122:43-6.
workers. J Allergy Clin Immunol 1994;94:12-8.
3. Gerchufsky M. Issues and answers in latex sensitivity. Ostomy
30. Moneret-Vautrin DA, Beaudouin E, Widmer S, Moutan C,
Wound Management 1997;43:42-53.
Kanny G, Prestat F, et al. Prospective study of risk factors in
4. Turjanmaa K. Incidence of immediate allergy to latex gloves in
natural rubber latex hypersensitivity. Dev Med Child Neurol
hospital personnel. Contact Dermatitis 1987;17:270-5.
1993;35:540-8.
5. Ownby DR, Ownby HE, McCulloch J, Shafer AW. The preva-
31. Slater JE, Mostello LA, Shaer C. Rubber-specific IgE in chil-
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