Latex Allergy

Natural rubber latex, which comes from the sap of rubber trees, contains a number of proteins that can cause allergic reactions in susceptible individuals. Synthetic latex products, including those made of nitrile or vinyl materials,¹ are not made with this protein. On this page, latex refers specifically to natural rubber latex products.

Latex allergy (type I [immediate] hypersensitivity mediated by immunoglobulin E) is rare—affecting approximately 1 percent of the general population and 8-12 percent of healthcare workers.^1-3 However, exposure to latex allergens through skin contact, ingestion or inhalation can induce immune responses that range from minor skin irritation to potentially more severe reactions such as anaphylaxis, which could result in death.

Many dental professionals come into contact with latex products every day (i.e., examination gloves, dental dams, tubing, local anesthetic cartridges, etc.). Residual proteins from natural rubber latex (NRL) can sensitize dental professionals who wear NRL gloves, resulting in Type I NRL protein allergy, which can be a serious reaction involving the skin (itching, swelling, contact urticaria), the respiratory system (sneezing) and the eyes (conjunctivitis).³ This repeated exposure can increase the risk of developing a latex allergy. Oil-based hand lotions can cause gloves to deteriorate and solubilize latex proteins, increasing the risk of allergic skin response, such as itching, redness or rash.¹

Up until 2017, powdered latex gloves were used in healthcare settings. At that time, the U.S. Food and Drug Administration (FDA) banned powdered latex gloves because the natural rubber latex protein combined with the powder and could became airborne when the gloves were removed. The airborne mix could then be inhaled, triggering an allergic reaction. The powder used in latex gloves may also be related to cutaneous reactions, such as delayed wound healing.⁴

Other types of reactions to latex exposure include irritant or allergic contact dermatitis; the latter condition is also known as type IV hypersensitivity, which is defined as a delayed immune response of the skin to chemical allergens. Allergic contact dermatitis may arise, though, from exposure to other non-latex contact allergens in dentistry, such as glutaraldehyde, methacrylates, and the rubber-processing chemicals found in gloves (e.g., thiurams, carbamates).⁵ Type IV hypersensitivity is typically diagnosed through the process of patch testing combined with an extensive patient history, physical examination, and other laboratory test results.⁶

In addition, people who are allergic to certain foods, including apples, avocados, bananas, carrots, celery, chestnuts, kiwi, melons, papaya, raw potato and/or tomatoes are at an increased risk of latex allergy.⁶ Conversely, people with latex allergy may also be allergic to these foods.⁶ People who are sensitive to other allergens, like mold and pollen, may be allergic to latex as well.¹ Individuals who have had multiple surgeries also may be at increased risk of latex allergy.

The Centers for Disease Control and Prevention (CDC) note that the vial stoppers of the mRNA COVID-19 vaccines are not made with natural rubber latex, so there is no contraindication or precaution to vaccination for persons with a latex allergy.

Symptoms of latex allergy include^{4, 7}:

• Skin reactions like itching, redness, rash or hives
• Itchy nose, throat or eyes
• Nausea, abdominal cramps
• Difficulty breathing, including a runny nose, sneezing, coughing or wheezing

While most reactions occur within minutes of exposure, some skin reactions may not develop for 24-48 hours afterward.¹

Anaphylactic shock, which could be life-threatening, can also occur. This systemic reaction can cause a drop in blood pressure, difficulty breathing, and swelling of the throat, tongue and nose.^{4, 8}

It is worth noting that the intensity of an individual’s previous reaction does not predict severity of future reactions. Moreover, mucosal exposure to latex may be associated with more severe reactions such as anaphylaxis.⁹ If you suspect that you may have a latex allergy, see your physician for testing. If an allergy is diagnosed, you may need to use products not made with natural rubber latex.^{1, 10} The 2003 CDC Guidelines for Infection Control in Dental Health-Care Settings¹¹ recommend screening patients about latex allergy history or history of latex allergy symptoms, and referring them for medical consultation when latex allergy is suspected. Some patients may require use of products during treatment that are not made of latex (e.g., nitrile, vinyl). The 2003 CDC guidelines recommend that patients and dental personnel with latex allergy should not have direct contact with latex-containing materials, and may also require a latex-safe treatment environment with all latex-containing products removed.¹¹

If there are concerns about latex content in the products you use, contact the manufacturer. The FDA recommends that labeling for non-latex products state that they were “not made with natural rubber latex.” They note that the claim “latex free” could be inaccurate as the agency is not aware of any tests that show a product does not contain any natural rubber latex proteins, which can cause allergic reactions.¹²

1. Caballero ML, Quirce S. Identification and practical management of latex allergy in occupational settings. Expert Rev Clin Immunol 2015;11(9):977-92.
2. Occupational Safety and Health Administration. Latex Allergy. "https://www.osha.gov/SLTC/latexallergy/index.html". Accessed July 19, 2023.
3. Nucera E, Aruanno A, Rizzi A, Centrone M. Latex allergy: current status and future perspectives. Journal of Asthma and Allergy 2020:385-98.
4. American College of Allergy Asthma and Immunology. Latex Allergy. "http://acaai.org/allergies/types/skin-allergies/latex-allergy". Accessed July 14, 2023.
5. Warshaw EM, Ruggiero JL, Atwater AR, et al. Occupational contact dermatitis in dental personnel: a retrospective analysis of the North American Contact Dermatitis Group Data, 2001 to 2018. Dermatitis 2022;33(1):80-90.
6. Parisi CAS, Kelly KJ, Ansotegui IJ, et al. Update on latex allergy: New insights into an old problem. World Allergy Organ J 2021;14(8):100569.
7. Centers for Disease Control and Prevention. Latex Allergy: A Prevention Guide (DHHS (NIOSH) Publication Number 98-113).
   "https://www.cdc.gov/niosh/docs/98-113/default.html". Accessed July 10, 2024.
8. Goto T. Management of anaphylaxis in dental practice. Anesthesia Progress 2023;70(2):93-105.
9. Minami CA, Barnard C, Bilimoria KY. Management of a patient with a latex allergy. JAMA 2017;317(3):309-10.
10. Occupational Safety and Health Administration. Standards Interpretations, Standard No. 1910.1030. 1995. "https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=21987". Accessed July 20, 2023.
11. Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care settings-2003. 2003.
12. U.S. Food and Drug Administration Don't be Misled by "Latex Free" Claims. 2015. "https://www.fda.gov/cosmetics/cosmetic-ingredients/latex-cosmetics". Accessed July 20, 2023.

• Search JADA for latex allergy-related articles
• ADA Library Services

• NIOSH Alert: Preventing Allergic Reactions to Natural Rubber Latex in the Workplace
• CDC: Latex Allergy: A Prevention Guide (DHHS (NIOSH) Publication Number 98-113).
• Latex Allergy (Cleveland Clinic)
• Latex Allergy (American College of Allergy, Asthma & Immunology)