In the 1980s and 1990s an epidemic of type 1 hypersensitivity IgE-mediated reactions to latex began due to precautions to prevent blood transmitted HIV infection. The use of rubber gloves increased in the healthcare industry and especially in the hospital setting. ⁽¹⁾

Data is being published on the COVID-19 pandemic and its impact on latex allergic people. It would be interesting to see what happened regarding new sensitisations. ⁽²⁾

Sensitisation to latex in the general public ranges from less than 1% to 7.6% but is much higher in the Healthcare setting ranging up to 50% in surgeons and nursing staff in theatre and 30% in dentists. ⁽³⁾ Using powder-free gloves in hospitals decreased the incidence in developed countries but this is not the case in developing countries. ⁽¹⁾ Patients needing recurrent surgical interventions and other medical care is at higher risk but, latex allergy is not exclusive to these groups of people.

Back to latex and avo on Rye!

In latex allergic patients, between 20% and 58% ⁽⁴⁾ have an allergic reaction to a variety of foods, mainly fruits. The first case of cross-reactivity was published in 1991. ⁽⁵⁾ The patient reacted to banana although botanically there is no relationship between the rubber and banana. In 1992 avocado sensitisation was observed ⁽⁶⁾ and since then a list of mainly fruits but also other foods were added to the cross-reactivity list with latex.

In most cases, the latex-fruit syndrome or latex-food syndrome will cause only minor symptoms including peri-oral symptoms, urticaria and angio-edema but, it could lead to exacerbation of acute asthma in asthmatics and in a small percentage of latex allergic patients, it can lead to anaphylaxis.

With modern technology available, component allergen testing, a true diagnosis and risk assessment can be done to guide treatment and lifestyle adjustments. Fifteen latex allergens have been identified up to date. Sensitisation to Panallergens present in foods, including Hev b 8 which is a Profilin, would put the patient in a low-risk category for sever symptoms. Sensitisation in health care workers would mainly be to Hev b 5 and Hev b 6 that would indicate higher risk for systemic reactions. Hev b 6 sensitisation can lead to cross-reactivity to avo, banana and chestnut and Hev b 5 in kiwi. ⁽¹⁾ These were the first fruits implicated all those years ago!

One of the important reasons to diagnose latex allergy would be to protect a patient if unconscious and needing medical or surgical intervention to avoid contact with latex and possibly an anaphylactic reaction that might be fatal. More commonly, patients may be exposed to latex in many products used daily and advise will be given according to sensitisation.

Reference List:

1. Update on Latex Allergy: New insights into an old problem. Parisi CAS et al; Worl Allergy Organization Journal 2021
2. Clinical and quality of life assessment in patients with latex allergy during COVID-19 pandemic: Possible protective role of continuous latex immunotherapy. Di Rienzo A et al; Int J Immunopathol Phamacol. 2022
3. Self-reported prevalence of latex allergy and associated factors in healthcare workers. Bedolla-Barajas M et al; Rev Alerg Mex 2017
4. Latex-Fruit Syndrome. Blanco C; Curr Allergy and Asthma Reports. 2003
5. Cross-reactivity between latex and banana. M’Raihi et al. J Allergy Clin Immunol. 1991
6. Latex allergy in patient with allergy to fruit. Ceuppens JL et al; Lancet 1992
7. Exercise induced anaphylaxis in kiwi allergic patient: case report. Ukleja Sokołowska N et al; Allergy Asthma Clin Immunol (2021) 17:91
8. Anaphylaxis related to avocado ingestion: a case and review. Abrams EM et al; . Allergy, Asthma & Clinical Immunology 2011, 7:12