Latex allergy

Overview & Definition

A six-year-old with spina bifida develops generalised urticaria, wheeze and hypotension 40 minutes into an elective orthopaedic procedure. The anaesthetist has given no new drug since induction. That scenario — delayed intraoperative collapse in a high-risk child — is the archetype of latex anaphylaxis, and it is why every spina bifida patient is managed latex-safe until proven otherwise. [12] [17]

Natural rubber latex (NRL) allergy is an immune-mediated hypersensitivity reaction to proteins in the milky sap of the rubber tree Hevea brasiliensis. The term covers three distinct mechanisms, and confusing them is the commonest error in this topic. Type I is IgE-mediated: immediate, mast-cell-driven, and capable of causing urticaria, wheeze, and anaphylaxis. Type IV is T-cell-mediated allergic contact dermatitis, a delayed eczematous reaction to the chemical accelerators (thiurams, carbamates) added during rubber manufacture. Irritant contact dermatitis is non-immune barrier disruption from wet work and friction. [2] [3]

Only Type I is the dangerous form. It can kill a child on the operating table, which is why latex-safe protocols exist. The other two are chronic skin conditions that impair quality of life and barrier function but do not cause immediate life-threatening reactions. Holding that distinction makes the classification, the diagnosis, and the management fall into place. [1] [4]

The epidemiological backdrop shapes everything: latex allergy was epidemic in the late 1980s and 1990s, then fell sharply after healthcare systems switched to powder-free, low-protein gloves. It is now uncommon in low-risk populations but remains a live threat in the spina bifida, surgical, and previously-sensitised child. [9] [11]

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13. [13]Cox AL, Eigenmann PA, Sicherer SH Clinical Relevance of Cross-Reactivity in Food Allergy. J Allergy Clin Immunol Pract, 2021.PMID 33429724
14. [14]Cardona V, Ansotegui IJ Component-resolved diagnosis in anaphylaxis. Curr Opin Allergy Clin Immunol, 2016.PMID 26945180
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