Are That Many Patients Really Allergic To Latex?

Back down at the Himalayan base camp, time passed very slowly and one could only down so much fermented yak milk, which my Sherpa guides called “archi.” Damn, how I would kill for a nice cabernet. Hell, for that matter I was so desperate, I would even drink a pinot noir.

I was surrounded by yak for that matter. My clothes were made of its wool. The fire keeping me from freezing was burning because of the tinder of dried yak dung. The butter and cheese on the snack tray were made of you guessed it -- yak stuff. Anyway, with this type of isolation and yak attack, and being subject to such harsh conditions, the old noodle starts to play some strange games with you. I was not scheduled for a visit to the Bari Tass (if you don’t know what that is, you need to read my previous blog at https://tinyurl.com/nq8cvld ) for another day, and I started thinking of what question I wanted to ask next.

Then it hit me. Why are we seeing so many latex allergies in our patients now? Back in the day, this was relatively scarce, was it not? What prompted this thought train? When I was on the airplane coming over here, they announced on the plane that they were not serving peanuts because someone on that plane had a peanut allergy.

Really? No peanuts? I like peanuts and think I have an “allergy” due to lack of peanuts when flying. So I did the only thing a thoughtful and caring person would do. I opened my own stash and wafted each single nut to and fro, casting peanut protein into the air like a dandelion shedding in a late summer gale force wind before masticating voraciously.

Guess what? No one went into anaphylactic shock but turning my head around constantly looking for a response to my aerosolization gave me a little pull in my trapezius. I quickly came to the conclusion that this “peanut allergy” from an aerosol vector was probably more of a lawyer-induced allergy than a real one.

Now peanut allergies are very serious and people do die from them. However, what I wanted to know is what is the chance that anaphylactic reaction can occur without ingesting the protein and simply having a peanut in the air? Turns out it is not likely. Based on a study of 30 highly peanut allergenic patients, who they had sniff an open peanut butter jar, none of them had any reaction to 10 minutes of huffing the stuff close up (https://www.peanutallergy.com/boards/airborne-allergies ).

So what about latex allergies? We know they exist but one has to question why there are so many now, and are all of them real? Basically, like food allergies, reaction can range from mild such as a contact dermatitis to death from anaphylaxis.¹ Interestingly, it was not until 1979 when a study documented an immediate type latex reaction.² Now considering that latex has existed as far back as 1600 BCE and the medical literature reported a true reaction some 3,500 years later, something interesting has to be going on. What could be the culprit? Perhaps that demon we all don prior to performing the magic of surgery — the rubber glove. Not only the rubber glove but the powdered rubber glove. Seems like this is like the inoculator magnus of the “epidemic.”³

When those patients come to your office with a self-described latex allergy, ask them if they have spina bifida, are a healthcare worker, work in an industry that involves a lot of exposure to rubber products or had multiple surgeries in the first year of life. These are the risk factors.⁴ If you have the history, what can you do to test these patients? There are several tests: the skin prick text, serum evaluations and maybe most importantly, a good history and physical.⁶ If you are going to prick them, you might want to be prepared with some epinephrine. The better option is to send them to the allergist.

Latex allergies are real and sometimes deadly. We have to err on the side of caution, but wouldn’t it be nice if we could eliminate those pseudo allergies, which are more psychogenic than real, and save our centers time and expense?

Tomorrow, when I get back from the cyberbrain, I think I am going to find a food allergy test for yak. I am not feeling so well.

Postscript: I did not actually wave peanut protein on the plane. I just put that in there so we could have some fun. Please do not send any anti-peanut comments to me. Send them to Planters.

References

1. McLeskey SW, Korniewicz DM. Understanding latex allergy. Semin Periop Nurs. 1998; 7(4):206-215.

2. Ownby DR. A history of latex allergy. J Allergy Clin Immunol. 2002; 110(2 Suppl):S27-32.

3. Sussman GL, Beezhold DH, Liss G. Latex allergy: historical perspective. Methods. 2002; 27(1):3-9.

4. Pollart SM, Warniment C, Mori T. Latex allergy. Am Fam Phys. 2009; 80(12):1413-1418.

5. Nettis E, Di Leo E, Calogiuri GF, Delle Donne P, Di Staso M, Ferrannini A, Vacca A. Diagnosis of latex allergy: the importance of hev B 11. Int Archives Allergy Immunol. 2012; 159(2):147-148.