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The world is running high on healthcare products, and pervasive use of sanitizers, masks, gloves, and other compound based routine products are probing another challenge altogether. Severe skin allergies are putting a section of the population at high risk causing acute skin irritation, and one such compound is Latex
Understanding NRL Allergy
Latex-referred as natural rubber latex (NRL), is a milky sap from the rubber tree Hevea brasilienesis. NRL contains more than 250 different proteins, but only a few are allergenic, the most notable one being Rubber Elongation Factor (REF). During the manufacturing processes, chemicals such as accelerators are added to harden it. The finished item, in addition to latex, may contain residual added (non-latex) proteins and chemicals, which are also factors causing allergic reactions.
Latex is ubiquitous in many everyday products such as, balloons, athletic shoes, tires, tools, rubber toys, baby bottles, nipples, pacifiers, etc. In addition, latex is found in disposable gloves, dental dams, airway, and intravenous tubing, syringes, stethoscopes, catheters, dressings, and bandages. Repeated exposure to proteins in NRL causes sensitivity, i.e., development of an immunologic memory (IgE) to a specific protein (i.e., latex), which turns into Type I hypersensitivity /allergic reaction in mild to moderate cases and leads to anaphylaxis in severe cases.
Latex reactions can be typically classified into three major types.
1. Irritant contact dermatitis: This is the most frequent reaction associated with latex gloves and is a non-allergic reaction of the skin to an irritant.
2. Allergic contact dermatitis or delayed hypersensitivity (type IV): This is a delayed immune reaction that takes place 24 to 48 hours after initial contact.
3. IgE-mediated hypersensitivity (type I): This is the least frequent but most dangerous reaction and typically occurs within 30 to 60 minutes of initial contact. In this, symptoms can range from mild (e.g cutaneous rash, urticaria, edema of the eyes, rhinitis, conjunctivitis, slight hypotension, and tachycardia) to potentially life-threatening anaphylactic reactions.
As per reports, NRL allergy prevalence rate in general population is 0-7.2% allergic (sensitization 30.4 %), with healthcare workers being more prone to higher risk – nearly 11.4% (10% – 17%). It is also estimated that patients who have undergone repeated surgeries and children are at higher risks of allergies caused by latex
There exists a connection between latex and some fruits. People who have experienced a reaction after eating banana, kiwi, avocado, potato, strawberries, peaches or chestnuts apple, papaya, raw potato, and tomato may also have increased risk for latex allergy and vice versa. Association between latex allergy and fruit allergy ranges from 21-58%.
Clinical manifestations can vary from hives, rhinitis, anaphylaxis, contact dermatitis, and as mentioned, even anaphylaxis. Genetics and the environment both play a role in developing latex allergy. Therefore, people are at an increased risk for developing an allergy to Latex if they have other allergic conditions such as Allergy-induced asthma, Eczema (atopic dermatitis), Hives (chronic urticaria), Food allergies.
Expressing her views on the matter, Dr. Shubnum Singh, Advisor CII National Healthcare Council said, “Given that Latex is present in a plethora of medical and consumer products and is fatal to a large section of the population, the logical thing to do is early identification of high-risk people and conduct a thorough assessment. Due to COVID-19, healthcare workers are being exposed to more and more Latex imbibed products, which may harm sensitive people.”
“Appropriate protocols to identify these people and reduce their exposure to latex by leveraging technology at hand in the laboratory settings is the most practical option, “she added.
Testing to increase diagnostic confidence
Conventionally, a diagnosis of allergic or autoimmune disease relies on the case history and physical examination. However, adding diagnostic testing can help to improve the patient’s quality of life and productivity, optimize use of medication, in addition to decreasing unscheduled healthcare visits. Specific IgE tests such as IgE blood testing and skin-prick tests (SPT) can be leveraged as tools to identify sensitizing allergens and increase diagnostic certainty. Up to 80 percent of patients with allergies are sensitized to more than one allergen, however when these allergens add up, they have a cumulative effect, pushing the patient over his/her symptom threshold. Until the symptom threshold is reached, the patient will not show symptoms.
“Often, identifying and understanding allergies is not as a simple “yes” or “no.” Specific IgE blood testing using ImmunoCAP™ Allergen Components play an important role. The ImmunoCAP measures specific IgE antibodies to individual molecular allergens (purified or recombinant proteins) in serum or plasma, to offer a unique opportunity to assess a person’s allergic sensitization pattern at the molecular level,” said Amit Chopra, managing director, India and Middle East, Thermo Fisher Scientific. “Measuring specific IgE for allergen components helps the clinician weigh a patient’s risk and outline a comprehensive exposure reduction plan to keep patients below their symptom threshold,” he added.
In the current scenario, it is now important than ever to continually educate patients, healthcare workers and offer solutions that enable clinicians to identify and understand these allergen components and aid to differentiate between primary sensitization and cross-reactive sensitization for successful immunotherapy treatments.
Disclaimer: The views expressed by Dr. Shubnum Singh, an eminent practitioner in the field of allergology, are independent and should not be viewed as promoting a particular brand or a product.
