History

Symptoms of delayed (type IV) hypersensitivity usually develop within 1-2 days of exposure. Immediate (type I) hypersensitivity causes symptoms within minutes of exposure. Immediate symptoms may include the following:

Pruritus of exposed skin and mucous membranes
Edema of the skin, mucous membranes, or subcutaneous tissues
Hoarseness
Tearing
Rhinitis
Dyspnea
Lightheadedness, syncope
Abdominal cramping
Nausea, vomiting
Diarrhea

Physical

See the list below:

Rash
- Erythema, edema, papules, and vesicles in areas of direct contact (type IV)
- Erythema, thickening, and pigment changes with chronic exposure (type IV)
- Urticaria, localized or generalized (type I)
Angioedema
Conjunctivitis
Rhinitis
Stridor
Wheezing
Hypotension, shock

Causes

The source of latex exposure may be obvious or occult. The history of latex allergy may be known or unknown. Individuals may be exposed to latex through their skin, mucous membranes, or airway (ie, oral, nasal, or endotracheal tissue). Medical procedures may cause reactions in sensitized providers or patients. Inadvertent inhalational exposure is frequent in medical settings where aerosolized latex-laden glove powder may remain airborne for hours; this risk is reduced when powder-free products are used. Inhalational exposure also may occur outside hospitals from use of powder-lubricated latex products or even tire particles in heavy traffic areas. Common sources of latex exposure include, but are not limited to, the following:

Gloves (eg, examination, surgical, household)
Tourniquets, blood pressure cuffs
Stethoscopes
Catheters
Intravenous tubing, devices, and ports; syringe plungers
Electrode pads
Goggles
Respirators
Wound drains and tubes
Multidose vial tops
Dental dams
Tires
Handgrips
Carpeting
Shoe soles, elastic in clothing
Condoms, diaphragms
Balloons
Pacifiers, baby bottle nipples
Erasers, computer mouse pads, and rubber bands

Differential Diagnoses

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Author

Constantine K Saadeh, MD President, Allergy ARTS, LLP; Principal Investigator, Amarillo Center for Clinical Research, Ltd

Constantine K Saadeh, MD is a member of the following medical societies: American Academy of Allergy, Asthma and Immunology, American College of Rheumatology, American Medical Association, Southern Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Nicole Davey-Ranasinghe, MD Rheumatologist, Allergy ARTS, LLP, Amarillo Center for Clinical Research, Ltd

Nicole Davey-Ranasinghe, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology

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

Amy J Behrman, MD, FACOEM, FACP Professor, Department of Emergency Medicine, Medical Director, Division of Occupational Medicine, Perelman School of Medicine at the University of Pennsylvania

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

Disclosure: Nothing to disclose.

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.

Jarrod D Matthei, MD, MPH Resident Physician in Occupational Medicine, Hospital of the University of Pennsylvania

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.