Latex allergy: types, symptoms, testing and avoiding latex

Natural rubber latex is a milky fluid from the rubber tree, used in thousands of everyday and healthcare items according to Anaphylaxis UK. Cambridge University Hospitals explains it is produced from the sap of tropical rubber trees and processed into household, industrial and medical goods.

It is important to tell the two reactions apart because the implications differ. Type 1 is a reaction to the rubber proteins driven by IgE antibodies, which Cambridge calls true latex allergy. Type 4, which Cambridge calls rubber dermatitis, is a reaction to chemicals such as thiurams or carbamates used in making rubber goods, and causes contact dermatitis, a rash, rather than a true latex allergy. Anaphylaxis UK notes there can be overlap between the two, which sometimes makes diagnosis hard.

Anaphylaxis UK says type 1 symptoms usually come on within minutes of contact. Mild to moderate ones include a red raised itchy rash (hives), swelling of the face, lips or eyes, a tingling or itchy mouth, mild throat tightness, and stomach pain, vomiting or diarrhoea. Cambridge adds a watery inflamed nose and eyes and chest tightness. The North West Allergy Network leaflet describes immediate reactions as occurring within 30 minutes.

The more serious reaction is anaphylaxis, described by Anaphylaxis UK using ABC: airway symptoms such as throat or tongue swelling, a hoarse voice or difficulty swallowing; breathing symptoms such as sudden wheeze, noisy breathing or persistent cough; and circulation symptoms such as dizziness, feeling faint, confusion, pale clammy skin, collapse or loss of consciousness. Call 999 for suspected anaphylaxis and use prescribed adrenaline if you have it.

For type 4, Cambridge says the skin becomes itchy, red and inflamed and may blister or scale like eczema, starting hours after contact and peaking at 24 to 48 hours, locally at the site of contact. It is usually mild and not potentially dangerous, and Anaphylaxis UK gives a window of 6 to 48 hours.

• Within minutes: hives, facial swelling, itchy mouth, stomach upset

• Serious signs: throat swelling, wheeze, difficulty breathing, dizziness, collapse

• Hours later: itchy, red, scaly or blistering skin where latex touched

• Mouth tingling after certain fruits or vegetables in some people

Anaphylaxis UK says people with allergies in the immediate family, people who have had multiple surgeries such as children with spina bifida, people with certain food allergies, and those who use latex frequently are more likely to develop latex allergy. Occupations it lists include healthcare workers, carers, cleaners, hairdressers, caterers wearing gloves, motor mechanics and balloon entertainers.

It estimates 1 to 6 out of 100 people could be sensitised to latex, which means the immune system has made antibodies, although not everyone who is sensitised has symptoms. A leaflet from the North West Allergy Network describes latex allergy itself as uncommon in the UK, affecting less than 1 in 1,000 people. The two figures measure different things, sensitisation versus allergy, so they are not in conflict. Anaphylaxis UK says cases rose after the 1980s when powdered latex gloves became widely used and fell from the late 1990s as powder-free low-protein and latex-free gloves were introduced.

Anaphylaxis UK advises seeing your GP, who can refer you to an allergy clinic, and says everyone with type 1 symptoms should be referred even if the symptoms were mild, while type 4 symptoms are usually seen in a dermatology clinic. The consultant will discuss your history and symptoms. For type 1, you may be offered skin prick tests and or blood tests, and sometimes a medically supervised challenge test in which you are exposed to latex under strict conditions.

For type 4, patch testing is used. Anaphylaxis UK explains the clinician applies diluted rubber accelerator chemicals to the skin, usually not the latex protein itself, and the test runs over several days because the reaction is delayed. The North West Allergy Network leaflet notes the diagnosis is suggested by the history of a typical reaction after exposure, particularly to balloons and gloves, and that blood or skin prick tests may support it if the reaction was immediate.

Anaphylaxis UK says type 1 with mild symptoms may be treated with oral antihistamines, while people at risk of anaphylaxis may be prescribed adrenaline, available as auto-injectors or as a needle-free nasal spray. It stresses carrying two in-date forms at all times because a second dose may be needed if symptoms do not improve after five minutes or get worse. Cambridge says people with severe reactions are usually given an adrenaline pen, and that a letter stating the allergy should be shown to medical staff before any treatment, with a medical alert emblem also recommended.

Type 4 is treated with emollients and topical steroid creams, plus practical latex avoidance where possible. Anaphylaxis UK adds that if you have asthma it should be well managed, because poorly controlled asthma can make a reaction worse.

Cambridge says stretchy goods such as gloves, condoms, diaphragms, balloons and liquid latex such as glues pose more of a risk than hard rubber goods such as hot water bottles or tyres. Anaphylaxis UK lists everyday items that may contain latex, such as balloons, erasers, rubber bands, plasters, baby teats and dummies, washing-up gloves and some sports equipment, and notes that dry rubber such as tyres and shoe soles rarely causes reactions except in people with serious allergy.

Medical settings carry higher risk. Cambridge says surgery, dental work and vaginal examinations pose a high risk, particularly where latex touches the inside of the mouth, vagina or body, and that procedures can be performed under latex-free conditions if staff know. Gloves marked hypoallergenic still contain latex. For short non-sterile tasks, vinyl or nitrile gloves are suitable alternatives. Anaphylaxis UK adds that latex urinary catheters are a common cause of reactions and silicone catheters can be used, and that the risk from latex in flu vaccine needle sheaths is extremely small, though people with a history of anaphylaxis should be offered a latex-free alternative where possible.

Some people with type 1 latex allergy also react to foods whose proteins resemble latex proteins, known as latex-food syndrome. Anaphylaxis UK lists banana, avocado, tomato, potato, kiwi and chestnut, among others. Symptoms normally affect the mouth, with tingling or itching of lips, tongue or throat, and are usually mild, but more serious reactions can occur. Cambridge advises you do not need to avoid fruits and vegetables unless you have had a reaction to them, and the North West Allergy Network says to seek medical advice before excluding foods because it may not be necessary.