Latex Allergy Workup

  • Author: Amy J Behrman, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Nov 30, 2011
 

Laboratory Studies

  • ED diagnosis and management depends on the history and the physical examination.[13] Results of laboratory tests sent from the ED are not available in a useful time frame. Several types of study 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.[14]
    • Enzyme-linked assays of latex-specific IgE (ELISA) may serve the same purpose.
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Other Tests

  • Skin patch testing is useful in identifying specific allergens in patients with type IV hypersensitivity to latex products.[15]
  • Skin prick testing with latex extracts is sensitive, specific, and rapid; however, it carries the risk of anaphylaxis.[16] 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.
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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 Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Marilyn Howarth, MD  Director, Occupational and Environmental Consultation Service, Clinical Assistant Professor, Department of Emergency Medicine, 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.

Specialty Editor Board

Mark Louden, MD, FACEP  Assistant Medical Director, Emergency Department, Duke Raleigh Hospital

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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

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, and Washington State Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

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.

References

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  11. Galindo MJ, Quirce S, Garcia OL. Latex allergy in primary care providers. J Investig Allergol Clin Immunol. 2011;21(6):459-65. [Medline].

  12. Liss GM, Sussman GL. Latex sensitization: occupational versus general population prevalence rates. Am J Ind Med. Feb 1999;35(2):196-200. [Medline].

  13. Taylor JS, Erkek E. Latex allergy: diagnosis and management. Dermatol Ther. 2004;17(4):289-301. [Medline].

  14. Hamilton RG, Peterson EL, Ownby DR. Clinical and laboratory-based methods in the diagnosis of natural rubber latex allergy. J Allergy Clin Immunol. Aug 2002;110(2 Suppl):S47-56. [Medline].

  15. Blanco C, Carrillo T, Ortega N, et al. Comparison of skin-prick test and specific serum IgE determination for the diagnosis of latex allergy. Clin Exp Allergy. Aug 1998;28(8):971-6. [Medline].

  16. Bernardini R, Mistrello G, Pucci N, Roncarolo D, Lombardi E, Zanoni E. Diagnostic value of three different latex extracts. Int J Immunopathol Pharmacol. Apr-Jun 2007;20(2):393-400. [Medline].

  17. Food and Drug Administration. Natural rubber containing medical devices: user labeling.[Docket No. 96N-0119]. 21 CFR Part 801 Fed. Regist. 1997;62:51021-51030.

  18. Korniewicz DM, Chookaew N, El-Masri M, Mudd K, Bollinger ME. Conversion to low-protein, powder-free surgical gloves: is it worth the cost?. AAOHN J. Sep 2005;53(9):388-93. [Medline].

  19. Phillips VL, Goodrich MA, Sullivan TJ. Health care worker disability due to latex allergy and asthma: a cost analysis. Am J Public Health. Jul 1999;89(7):1024-8. [Medline].

  20. Allmers H, Brehler R, Chen Z, et al. Reduction of latex aeroallergens and latex-specific IgE antibodies in sensitized workers after removal of powdered natural rubber latex gloves in a hospital. J Allergy Clin Immunol. Nov 1998;102(5):841-6. [Medline].

  21. LaMontagne AD, Radi S, Elder DS, Abramson MJ, Sim M. Primary prevention of latex related sensitisation and occupational asthma: a systematic review. Occup Environ Med. May 2006;63(5):359-64. [Medline].

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  24. Biagini RE, MacKenzie BA, Sammons DL, Smith JP, Krieg EF, Robertson SA. Latex specific IgE: performance characteristics of the IMMULITE 2000 3gAllergy assay compared with skin testing. Ann Allergy Asthma Immunol. Aug 2006;97(2):196-202. [Medline].

 
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