Types of latex allergy

If you know or suspect you are allergic to latex, visit your GP and seek a referral to a specialist, even if your symptoms have so far been mild.

There are two types of latex allergy:
  • right_arrow_orange_icon Type I: This is an immediate reaction to proteins in the latex and is potentially life-threatening. It can cause anaphylaxis – the most serious form of allergy.
  • right_arrow_orange_icon Type IV: This is a delayed reaction to chemicals used in the manufacturing process. It’s not life threatening, but it’s essential to seek medical advice. Symptoms appear between 6 and 48 hours after contact with latex and affect the skin. They can range from a mild, localised skin reaction to an extremely unpleasant, itchy rash.

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How common is latex allergy?

According to the Health and Safety Executive (HSE), around 1-6 per cent of the general population is thought to be potentially sensitised to latex, although not everyone who is sensitised will develop symptoms (HSE website). The number of people with latex allergy rose from the 1980s but fell again from the late 90s.

Allergic conditions in general have risen in recent years, including latex allergy. Another major factor from the 1980s onwards was the widespread use of latex gloves, particularly in the healthcare profession. The NHS decided that healthcare workers must protect themselves against the risk of infection from blood-borne diseases such as HIV and Hepatitis B. This led to a high demand for latex gloves and, in order to meet this demand, there were changes in the way gloves were produced and high-protein gloves came onto the market. These gloves were likely to be a major cause of the rise in the number of healthcare professionals with latex allergy from the 1980s.

High-protein gloves are no longer used in hospitals and latex-free alternatives are now more widely used. This led to a sharp fall in latex allergy from the late 1990s.

Who is most at risk of a latex allergy?

People with an allergic tendency (where there is allergy in the immediate family) are more likely to develop latex allergy than families without allergies.

People having multiple surgeries are also at a higher risk of developing latex allergy, for example, children with spina bifida (Rendeli et al., 2006). Their risk depends on how much they are exposed to latex gloves and catheterisation devices.

People with certain food allergies such as banana, avocado, tomato, potato, kiwi and chestnut are also at risk (Brehler et al., 1997; Wagner & Breiteneder, 2002) because the proteins in these foods are similar to the proteins in latex. Potatoes can cause contact reactions when people with latex allergy peel potatoes, but cooked potato is not usually a problem. Other fruits and vegetables that have been linked with latex allergy include lychee, papaya, passion fruit, fig, melon, mango, pineapple, peach, lettuce and cannabis (Cabañes et al., 2012), (Niggemann et al., 2002). If you are allergic to any of these, you may also be allergic to latex, and vice versa.

People who use latex gloves or other products containing latex on a regular basis are particularly at risk from developing latex allergy. These include:
  • right_arrow_orange_icon Healthcare workers, including dental practice staff
  • right_arrow_orange_icon Carers such as residential care home staff
  • right_arrow_orange_icon Cleaners and housekeepers
  • right_arrow_orange_icon Hairdressers
  • right_arrow_orange_icon Caterers who wear gloves at work
  • right_arrow_orange_icon Motor mechanics
  • right_arrow_orange_icon Balloon entertainers

Symptoms of Type I latex allergy

Symptoms usually come on quickly, within minutes of contact with latex. Mild symptoms may include nettle rash (also known as hives or urticaria) anywhere on the body.

More serious symptoms include:

  • Swelling in the face, throat and/or mouth
  • Difficulty breathing
  • Severe asthma
  • Abdominal pain, nausea and vomiting

 

In extreme cases, there could be a dramatic fall in blood pressure, known as anaphylactic shock. The person may become weak and floppy and may have a sense of something terrible happening. This may lead to collapse and unconsciousness.

Having asthma, especially if it’s not well controlled, is a major risk factor for more serious allergic reactions in people with Type I latex allergy.

Some people with Type I latex allergy will have symptoms simply by being in a room where powdered latex gloves are being used. This is because the latex allergens become attached to the cornstarch in powdered gloves. The powder becomes airborne when the gloves are used and can be breathed in. Similarly, some people with serious latex allergy may react if they are near a balloon display.

Treating Type 1 latex allergy

If your allergy is Type I and is thought to be serious, you may be prescribed an adrenaline auto injector (AAI) as well as antihistamines and prednisolone. If you are prescribed an AAI, you will need to know how and when to use it. You could ask for training at your local surgery or from a pharmacist. You will still need to seek medical attention after using your AAI because symptoms may come after a short time and you might need more than one injection of adrenaline to control the reaction.

In the UK, three AAIs are available: Emerade®EpiPen® and Jext® .

Symptoms of Type IV latex allergy

Type IV latex allergy is a delayed reaction to chemicals used in the manufacturing of latex. It affects the skin, which is known as contact dermatitis. Symptoms include a red itchy scaly rash, often in the area where the latex was used such as the wrists and forearms with glove use. Symptoms may spread to other areas of the body.

 

Treating Type IV latex allergy

Type IV latex allergy is treated with emollients (moisturising treatments applied to the skin to soothe and hydrate it) and topical steroid creams. Where practical, you can take steps to avoid contact with latex to reduce the risk of a reaction.

Getting a diagnosis

In all cases, whether you think you have Type I or Type IV latex allergy, it’s important to see your GP as soon as possible. Some GPs have a clear understanding of allergy, but allergy is a specialist subject so it is more likely that they will need to refer you.

We believe strongly that all people with Type I allergy symptoms should be referred to an allergy clinic, although in reality many people with Type I latex allergy are seen in a dermatology clinic. Those with Type IV symptoms are usually seen in a dermatology clinic, but there can be overlap in Type I and Type IV symptoms which makes it difficult to make a diagnosis.

Once you get a referral, the consultant will discuss your symptoms with you in detail as well as your medical history. To diagnose Type I latex allergy, the consultant may perform skin prick tests and blood tests. They may also perform a “challenge” test where you are exposed to latex in strict conditions with medical supervision.

To diagnose Type IV latex allergy, patch testing is used. This is where diluted rubber accelerator chemicals added to latex during processing (not usually the natural rubber protein latex itself) are applied to the skin. The test is run over several days because with a type IV reaction there is a delay between contact with the allergen and the appearance of symptoms. The length of this delay can vary from hours to several days.

Everyday items to be aware of

Latex gloves
Balloons
Erasers (rubbers)
Rubber bands
Condoms
Baby teats/dummies
Hot water bottles
The contraceptive cap
Latex pillows
Stress balls
Washing-up gloves
Carpets
Tyres
Adhesives including hair glue
Underwear elastic
Shoe soles
Sports equipment such as basketballs, hand grips and gym mats
Swimming cap and goggles
Some foam rubbers – latex mattresses are common
Calculator/remote control buttons
Floor screed for levelling floors – although this is usually sealed under tiles or lino

Shoe soles and tyres are made with what is known as ‘dry’ rubber. Our expert advisers believe that allergic reactions to dry rubber products are uncommon and mainly experienced by people with a serious latex allergy. When seeing a consultant, ask about your individual level of risk.

Medical equipment that can contain latex

Examination and surgical gloves
Oral and nasal airways
Endotracheal tubes
Intravenous tubing
Surgical masks
Rubber aprons
Injection ports
Wound drains
Catheters
Bungs and needle sheaths on medicines
Dental dams
Anaesthesia masks
Syringes
Blood pressure cuffs
Stethoscopes
Tourniquets
Electrode pads
Surgical masks

 

Latex urinary catheters are a common cause of allergic reactions, and silicone catheters can be used as an alternative.

Whenever you are having a medical procedure, tell your healthcare providers about your allergy, including doctors, nursing staff, anaesthetists and dentists.

Latex-food syndrome

Some people with Type I latex allergy may also react to certain fruits and vegetables, including banana, avocado, tomato, potato, kiwi, chestnut, lychee, papaya, passion fruit, fig, melon, mango, pineapple, peach and lettuce. This is known as cross-reactivity, where the proteins in latex have a similar structure to the proteins in these foods.

Symptoms normally affect the mouth on contact with the food and are usually mild, although we advise you to discuss this with your consultant. You might have tingling or itching in the lips, tongue or throat, but a few people have more serious reactions. If you have latex allergy, identify any foods that might be causing you a problem.

The influenza vaccine

Some flu vaccines have a latex needle sheath. Public Health England says the risk for people with latex allergy is considered negligible. However, a member of our clinical panel who is an expert on latex allergy has questioned whether this product is in fact safe for people with latex allergy. We strongly recommend that you discuss this at your local surgery before receiving the influenza vaccine and request a vaccine that does not have a latex needle sheath.

Which dental local anaesthetics are made with natural rubber latex?

The NHS Specialist Pharmacy Service provides a list of local anaesthetic preparations used in dentistry and notes whether latex is used as a material in the manufacture of the product, its container and packaging

Key messages

Being diagnosed with latex allergy can be daunting but thinking ahead and having coping strategies can help.

 

For Type I latex allergy

  • Always be vigilant – avoiding latex is the first line of defence
  • See your GP and ask for a referral to a specialist
  • Carry your prescribed medication everywhere
  • If you carry an adrenaline auto-injector, learn how and when to use it
  • If you have asthma, make sure it’s well managed.

 

For Type IV latex allergy

  • Type IV is very different to Type I latex allergy
  • See your GP and ask for a referral. Ideally you will be tested by a specialist who knows about both types of latex allergy
  • Type IV latex allergy is not life threatening, but discuss the possible symptoms thoroughly with your specialist
  • It’s good to take practical steps to avoid latex, but rubber is everywhere so don’t let avoiding latex take over your life

 

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