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Latex Allergy Workup

  • Author: Amy J Behrman, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Jan 08, 2016
 

Laboratory Studies

ED diagnosis and management depends on the history and the physical examination.[27] Results of laboratory tests sent from the ED are not generally available in a useful time frame. Several types of diagnostic studies are useful in nonemergent evaluations.

Total serum IgE may be elevated in patients with type I allergy, but it is neither sensitive nor specific.

Radioimmunoassay test (RAST) results for latex-specific IgE range from 50-100% sensitive and 63-100% specific. Predictive value depends on the exact test used, the patient population, and the source of allergen. RAST can be a useful and safe confirmatory test in patients with suggestive clinical histories. The sensitivity and specificity are improving with newer-generation testing methods.[28]

Enzyme-linked assays of latex-specific IgE (ELISA) may serve the same purpose.[29]

Genomic profiling may become a useful tool for predicting risk, guiding therapy, and understanding pathophysiology in latex allergy.[30]

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Other Tests

See the list below:

  • Skin patch testing is useful in identifying specific allergens in patients with type IV hypersensitivity to latex products. [31]
  • Skin prick testing with latex extracts is sensitive, specific, and rapid; however, it carries the risk of anaphylaxis. [32] Significant variability in the allergen content of extracts continues to limit the reliability and reproducibility of skin prick testing.
  • Testing with glove fingertips applied to the patient's skin is useful when the history is consistent with latex allergy but the blood tests are negative. It carries the risk of anaphylaxis in type I-sensitized patients.
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Procedures

If type I latex allergy is suspected, all procedures should be performed with latex-free instruments, devices, and protective clothing.

Preprocedure screening by history should include risk factors such as occupational and nonoccupational risk groups, tropical fruit allergy, and atopy as well as documented latex allergy.

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Contributor Information and Disclosures
Author

Amy J Behrman, MD Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine

Amy J Behrman, MD is a member of the following medical societies: American College of Physicians, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Matthew M Rice, MD, JD, FACEP Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians of TeamHealth; Assistant Clinical Professor of Medicine, University of Washington School of Medicine Pending Approval

Matthew M Rice, MD, JD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, Washington State Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Mark Louden, MD Assistant Professor of Clinical Medicine, Division of Emergency Medicine, Department of Medicine, University of Miami, Leonard M Miller School of Medicine

Mark Louden, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Marilyn Howarth, MD Center for Excellence in Environmental Toxicology, University of Pennsylvania

Marilyn Howarth, MD is a member of the following medical societies: American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

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