Q:

10/24/2013
We have a perioperative services advisory group consisting of surgeons, anesthesia providers, and OR nurses. Our group needs guidance on the following item pertaining to latex allergy: If a patient presents with allergies/reactions to certain foods such as avocados, bananas, tropical fruits, chestnuts, potatoes, tomatoes, celery, etc. or experiences swelling, itching, or hives after handling poinsettia plants, balloons, elastic bandages, clothing with elastic/stretchy fabrics, should they be treated with the same precautions as a known latex allergy? We are considering incorporating questions relating to allergies to the specific foods/items mentioned above. If the patient answers "yes" to having a reaction to any of the items, should we proceed with treating them as a latex allergy patient? What is the risk that the patient would actually have a true latex allergy without officially testing the patient for latex allergy?

A:

Thank you for your inquiry.

I am forwarding your inquiry to Dr. Gordon Sussman, who is an internationally known expert in latex allergy and has written guidelines for prevention of latex reactions. As soon as we hear from Dr. Sussman, we will forward his response to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Gordon Sussman. Thank you again for your inquiry.

Warm regards,
Phil Lieberman, M.D.

Response from Dr. Gordon Sussman:

Patients with type 1 latex allergy can present clinically contact, inhalant, and anaphylactic events.

The contact reactions generally include a hand dermatitis or rash when wearing latex gloves.

However, other possibilities include an allergic contact dermatitis which is a type 4 allergic response to chemical rubber additives and an irritant contact dermatitis, which is not an allergic reaction. Although health care workers with type 1 latex allergy usually have a contact hand rash, this is not always present. The major difficulty however, is that a hand dermatitis is non-specific and much more common. The majority of patients with hand dermatitis do not have a latex type 1 allergy.

Likewise, patients with type 1 latex allergy can present with allergic reactions to many foods most commonly kiwi, banana, and avocado. Many patients with allergies to fruits however, after have either an isolated food allergy or the pollen-food syndrome related to the extensive cross reactivity of fruits and nuts with pollens and not latex.

Also, some reactions that are thought to be related to latex allergy are actually not made of natural rubber and do not contain allergenic proteins that can cause latex type 1 allergy. Elastic bandages clothing and stretchy fabrics are examples of these rubber products. Poinsettia plants have a potential cross reactivity but are not eaten so would pose little to no risk to latex allergic patients.

Because latex allergy is a complex area and there are many misconceptions of what is true latex allergy, patients with potential symptoms or reactions should be referred to an allergy specialist familiar with this area for a full assessment of possible allergy.
While I applaud you on your enthusiasm with latex allergy and recognize the need for hospital guidelines to deal with this, it would be best for these policies to be developed with the aid of allergy specialists familiar with the area. Otherwise many more patients will needlessly be misdiagnosed with latex allergy.

Gordon Sussman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology