Type I latex allergy diagnosis ends career of Florida dental assistant

Dental Assistant, The, Nov-Dec, 2003 by Chuck Mills

Ronna Williams, a former dental assistant from Brandon, Florida, had no idea that the chronic contact dermatitis she suffered in the 1980s, would later be diagnosed as symptoms of latex allergies.

Williams, who began her career as a dental assistant shortly after high school graduation in 1971, also experienced "respiratory attacks at home," a condition she mistakenly attributed to "something in the house." Unable to pinpoint the cause of these "strange reactions," she sought the medical help of Dr. Alan Halsey, an allergist from Valrico, FL, who diagnosed her condition as a type I allergy to NRL.

"I didn't know what it could be until I was diagnosed with respiratory problems related to my latex allergies in 1992," she said.

Placed on a regimen of steroids, Williams continued to work for her employer, a general dentist in Apollo Beach, FL. However, repeat exposure to NRL on the job, particularly to latex gloves, jeopardized her health. Shortly after her latex allergy diagnosis, Williams suffered her first episode of anaphylactic shock while working--an allergy attack so severe it ended her career on the spot.

"I was cleaning up after patients and all of a sudden my eyes went blurry and I couldn't breathe. I went up to the reception desk and collapsed. I felt like I was going to die. They threw me in an ambulance and I heard them say, 'Don't touch her. She's allergic to latex,'" she recalled.

What Are Latex Allergies?

Latex allergies represent an antigenic response to the complex compounds known as proteins found in NRL. More than a dozen proteins identified in NRL can cause allergic reactions, though which one(s) remains uncertain. Latex proteins react with the body's IgE antibodies, a group of structurally related human serum proteins responsible for allergies, to produce a host of unpleasant symptoms. These include sneezing, wheezing, watery eyes and skin rashes to anaphylaxis, a condition characterized by breathing difficulties and low blood pressure that can cause shock or even death. (1)

The three recognized reactions to latex include nonallergic irritant contact dermatitis, type IV cell-mediated allergies and type I IgE-mediated allergies. Nonallergic irritant contact dermatitis, a skin rash, is the most common reaction affecting regular wearers of powdered and nonpowdered latex gloves. Symptoms include dry, crusted patches in the glove area also caused by certain types of cleaners, repeated hand washing and incomplete hand drying. (2)

Type IV cell-mediated allergies, the most common immune system reaction to latex, affect 82 percent of individuals allergic to rubber products. (3) Type IV latex allergies represent a delayed hypersensitivity to one or more of the 300-plus chemicals used to manufacture latex and cause allergic contact dermatitis within 48 to 96 hours of exposure. Continued exposure puts individuals with a type IV allergy at risk of developing the antibodies that can trigger a type I latex allergy. (4)

Type I IgE-mediated allergies represent an immediate hypersensitivity to actual latex proteins and include two subgroups. The first causes hives, itchy and watery eyes, runny nose, sneezing, wheezing, asthma, abdominal pain, nausea, diarrhea and skin rashes. The second and more serious causes anaphylaxis.

Latex Allergies Rise

The incidence of latex allergies ha risen dramatically over the past 20 year for several reasons. The introduction c universal precautions--including the use of latex gloves to prevent the spread of bloodborne diseases such as AIDS, HIV and hepatitis B--primarily contributed to the rise seen after 1979. Increased awareness and reporting c latex allergies also revealed a higher prevalence of this hypersensitivity. (5)

Manufacturers, that failed to adequately wash latex gloves, inadvertently may have contributed to the increase in latex allergies. In 1991, the FDA outlined to manufacturers a two step washing process, the first to occur during leaching and the second after product completion, to better remove allergenic proteins from latex. (6)

In addition to her latex allergies Williams also suffers from "bad reactions to bananas, avocados and ware chestnuts." Latex allergies often trigger food cross-reactions because certain plant products--including bananas avocados, kiwis, plums, peaches, cherries, apricots, figs, papayas, tomatoes, potatoes and chestnuts--contain the same allergy-producing proteins a NRL. Latex-sensitive individual should avoid the aforementioned fruits, vegetables and nuts as well a genetically engineered fruits and vegetables that contain the same DNA markers as latex. (7)

Treating and Preventing Latex Allergies

Though no cure exists, nonallergic skin rashes can be treated with doctor prescribed or over-the-counter ointments, creams or jellies. Petroleum jelly should not be applied before glove use since petroleum product can destroy the barrier of protection provided by latex.

Individuals with type IV allergies car use the aforementioned treatments to relieve skin irritations. They also should avoid the latex gloves or rubber products suspected of causing the dermatitis. (8)