DECATUR, Ga. -- An allergy to natural rubber latex may trigger a life-threatening reaction -- including difficulty breathing, increased heart rate and low blood pressure -- or it may simply cause an ugly, itchy, red rash.
That's because there are different types of latex allergy. The dangerous "anaphylactic" Type I allergy is a potentially fatal immune-system reaction that affects multiple organ systems and can lead to death; avoiding it requires numerous precautions. But people who simply break out after contact with latex gloves or another latex product may have either irritant dermatitis (skin inflammation) or contact dermatitis (often called a Type IV allergy) which only affects the skin.
Still, many people are told they have a latex allergy based on a skin reaction -- without clarifying these differences or investigating other causes. That makes this often-misunderstood allergy a good teaching tool for what to do when you suspect you may have an allergy, experts say.
Allergies occur when your immune system is hypersensitive to a particular substance. One of the nation's fastest growing chronic diseases, more than half of all Americans (54.6 percent) test positive to one or two allergens. Allergic diseases, such as asthma, affect as many as 50 million Americans, according to the American Academy of Allergy, Asthma and Immunology (AAAAI). The first step to developing an allergy is exposure, said Dr. Jackie Eghrari-Sabet, a Gaithersburg, Md.-based allergist. You cannot have an allergy to something the first time you encounter it.
In 2000, 1 percent to 5 percent of the general population, 5 percent to 15 percent of health workers, and up to 60 percent of people with spina bifida, which requires numerous surgeries, were estimated to have latex allergy, according to the AAAAI.
This "epidemic" led most hospitals and medical facilities to eliminate latex gloves, said Sue Lockwood, executive director of the American Latex Allergy Association, an educational and support organization.
At first, allergists and health-care workers who either had or suspected they had the allergy were her most frequent contacts, but now she more often hears from pediatricians, primary-care physicians and gynecologists, as well as restaurant employees, postal workers, hairdressers and people who got a rash on their chin after visiting the dentist, Lockwood said.
"The reason is that things are getting better, but also allergists are no longer the ones treating or diagnosing the patient," she said. "Now the patient is more likely to be a consumer, a layperson, a child, a student." On the two to three days a week she spent in the operating room, Lockwood, a former surgical technician, would develop itchy hives, a runny nose, and a cough, and her eyes would become teary and almost swell shut, she said. Then she'd go home for several days and return to normal.
Her symptoms worsened over several months until she suffered anaphylaxis for the first of eight times. "It comes on quickly and each person is probably a bit different with the symptoms, but mine were that my mouth started to itch, I could feel something swelling in my throat, and then I would start to wheeze," Lockwood said.
A general guideline for identifying that you may have a Type I allergy is having a reaction in at least two organ systems such as skin and respiratory, said Dr. Andy Nish, an allergist in Gainesville, Ga. Other examples of Type I allergies include hay fever, asthma, eczema, and food and drug allergies.
Irritant dermatitis, an immediate rash reaction, is technically not an allergy at all, while with contact dermatitis, skin redness and swelling may appear 24 to 48 hours after exposure, a familiar case being poison ivy, Nish said. Both are not related to immune system antibodies, he said. "The worst that is ever going to happen is your skin gets itchy and it goes away within several days," Nish said, adding that dermatitis is not known to progress into Type I allergy.
However, the best way to know whether a suspected latex allergy is a particular one of the three types is to be tested by an allergist, Eghrari-Sabet said. Often primary-care physicians and others will make a diagnosis solely based on patient history of exposure, which, while important in narrowing down what's happening, doesn't always reveal the whole story, she said.
In some cases, you may be allergic to something else, said Dr. Rebecca G. Piltch, a San-Francisco-based allergist. Of the few patients with suspected new-onset latex allergy she sees now, many work in the cleaning industry and present with a hand rash, she said.
Sometimes chemicals in the cleaning products or other ingredients or compounds in the gloves are the culprit, Piltch said. "History alone doesn't always tell you exactly what's going on, so testing is very important in establishing an accurate diagnosis."
In the best-case scenario, an allergy specialist may determine that you don't have the suspected allergy, Eghrari-Sabet said.
She recently saw a health-care worker convinced he had latex allergy. The hospital where he worked, however, was latex-free, and his inflammation turned out to result from excessive sweating.
WHAT TO DO IF YOU ARE ALLERGIC
"If you are diagnosed with a Type I allergy, you need first and foremost to try to avoid the substance to which you are allergic," said Dr. Rebecca G. Piltch, a San-Francisco-based allergist.
However, because avoidance doesn't always work, Lockwood also carries two EpiPens, fast-acting portable shots of the drug epinephrine, which counteracts anaphylaxis. For example, while she was teaching Sunday school, a bunch of children ran into her classroom unexpectedly with balloons, triggering a reaction.
Read labels, and consider that other common products may contain latex, including rubber stoppers in flu shot bottles, kitchen gloves, band-aids, balloons, baby pacifiers and condoms, Lockwood said.
Latex-allergic restaurant workers, housekeeping staff, hairdressers and others need to wear non-latex gloves and advocate for their workplaces to go latex-free, she said. ALAA launched a campaign to convince restaurants to become latex-free because of the threat both to workers and to latex-allergic diners who can get a reaction from food handled with the gloves, Lockwood said.
People with Type I latex allergy also may need to avoid certain foods which have cross-reactive allergies to rubber, such as bananas, avocados, kiwis and chestnuts.
ALAA also recommends informing your medical and dental providers, local hospital, local emergency medical services, 911 dispatch, family members, friends, employers and co-workers of your latex allergy.
If you have irritant or contact dermatitis allergy, you need to avoid latex contact to your skin, but you don't have to take the same high level of precautions, Eghrari-Sabet said.
For tips on when to seek diagnosis and treatment for an allergy, visit the following websites: AAAA&I www.aaaai.org, American College of Allergy, Asthma and Immunology www.acaai.org/Pages/default.aspx, National Institutes of Health www.nih.gov/.
For fact sheets on latex allergy and a list of everyday products that may contain latex and latex-free alternatives, visit ALAA's site. See the site. www.latexallergyresources.org