Since the symptoms of the latex allergy can be mild to severe, it is segregated here accordingly,

• Mild symptoms: Itching, redness of the skin or hives and rash.
• Severe symptoms: Sneezing, runny and itchy nose and eyes, wheezing, cough and difficulty in breathing, 
• Anaphylactic shock symptoms: This is the most severe reaction of latex allergy. Though anaphylactic reactions rarely develop immediately after latex exposure, it is life-threatening. Signs and symptoms of anaphylactic reactions are: wheezing, hypotension, dizziness, weak or rapid pulse and confusion [4].

Presentation

There are different types of reactions that can occur upon contact with latex:

• Delayed-type contact dermatitis: This type of reactions occurs within 12 to 36 hours after the exposure to the latex. The symptoms of the patient are dry, scaly and itchy skin. These reactions are caused by the additives in the rubber. Though the symptoms are irritating, they are rarely life-threatening.
• Immediate allergic reactions: When the patients are previously exposed to latex, they become sensitive to the allergen (latex) triggering the immune system. Re-exposure to the same allergen causes immediate allergic reactions. Some of the symptoms are sneezing and running nose, coughing, itchy throat and watery eyes.
• Anaphylaxis: In this type of allergic reaction, the symptoms occur quickly, causing damage to the multiple organ systems, and is often life-threatening. Some of the important symptoms are red rash, swollen throat, hoarse voice, nausea, vomiting, diarrhea, and pale or red color of the face and body [5] [6].

• Inguinal Hernia

  We report the case of a 43-year-old man with anaphylactic shock and concurrent ST-elevation myocardial infarction during a planned inguinal hernia surgery. This event occurred shortly after introduction of latex into the surgical field. [ncbi.nlm.nih.gov]

• Nausea

  Latex allergies could cause the following symptoms: Dry skin Hives Low blood pressure Nausea Respiratory problems Tingling sensations People with high-risk factors for latex allergy include those who have undergone multiple surgical operations, have spina [myshelbydentist.com]

  People with this allergy have symptoms such as urticaria or hives, itching or flushing, swelling, sneezing, runny nose, cough, wheeze, shortness of breath, chest tightness, nausea, dizziness or lightheadedness. [midwestallergy.net]

  Signs & Symptoms of anaphylaxis include: Difficulty breathing Hives or swelling Nausea and vomiting Wheezing Drop in blood pressure Dizziness Loss of consciousness Confusion Rapid or weak pulse Latex Allergy Medical IDs- The Most Reliable Choice is MedicAlert [medicalert.org]

• Abdominal Pain

  The symptoms experienced by latex-sensitised workers were rhinitis (100.0%), asthma (50.0%), dermatitis (25.0%), severe anaphylaxis (8.3%), abdominal pain (8.3%) and angio-oedema (8.3%). [ncbi.nlm.nih.gov]

  These can include: swollen and red skin, lips, or tongue runny or stuffy nose shortness of breath (with or without wheezing) abdominal pain diarrhea vomiting rapid heartbeat dizziness Anaphylaxis is a rare reaction to latex, and it can be life-threatening [healthline.com]

  […] localized skin rash or itching (generally on the hands); hives; swollen red skin; swollen lips and tongue with difficulty breathing, wheezing; shortness of breath; dizziness; fainting; abdominal pain; diarrhea; anaphylactic shock. [health.ny.gov]

• Eczema

  These symptoms were all local, cutaneous symptoms, ranging from hand pruritus (64.5%), hand eczema (19.4%) and contact urticaria (16.1%). [ncbi.nlm.nih.gov]

  This dermatitis is recognized by the eczema and blisters on the back of the hands. It resembles a poison ivy rash, and begins 1 to 3 days after wearing rubber gloves. [acaai.org]

• Forgetful

  Just don't forget the lube. Lubricants: You can safely use both water and silicone based lubricants with polyisoprene condoms. You should not use oil-based lubricants. They can break down the condom and increase the risk of breakage. [std.about.com]

Signs and symptoms of allergic reactions such as skin rash, hives, and irritation of the eyes and skin, appear when the patient is exposed to the latex or natural rubber products, making it easy to diagnose.

Skin allergy testing: Sometimes, the patient does not exhibit the signs or symptoms of the allergy, but knows about the risk of latex allergy with a positive blood or skin test. It is important that the skin allergy test be performed under the close guidance of allergy specialist to evade the risk of severe reactions [7].

• ST Elevation

  We report the case of a 43-year-old man with anaphylactic shock and concurrent ST-elevation myocardial infarction during a planned inguinal hernia surgery. This event occurred shortly after introduction of latex into the surgical field. [ncbi.nlm.nih.gov]

• Removal of the allergen: As for most of the allergic reactions, latex allergy can be combated by removing the products containing latex. However, if the symptoms persist, the patient must contact a health care professional at the earliest. 
• In case a person is having contact dermatitis, antihistamine or corticosteroid can help treat the symptoms of latex allergy. In case of severe reactions, patient may be treated with epinephrine, or intravenous fluids. 
• The patient with latex allergy is advised to wear a MedicAlert bracelet, in case of emergency. 
• Since there is no cure of latex allergy, prevention is the best strategy that can be adopted [8].

Most of the patients with latex allergy can recover completely with prompt treatment. In severe conditions, the allergic reaction can lead to severe anaphylaxis and even death.

Complications

The complications of latex allergy can be life-threatening, referred to as anaphylactic shock.

The exact cause of latex allergies is unknown, but it is thought that repeated exposure to latex and rubber products may induce symptoms.

Routes of latex exposure include:

• Skin: As occurs when latex gloves are worn. 
• Mucous membranes, such as the eyes, mouth, vagina, and rectum.
• Inhalation: Rubber gloves that contain a powder which can be inhaled.
• Blood, as may occur when some medical devices containing rubber are used [2].

About 5% to 10% of health-care workers have some form of allergy to latex. This type of allergy is most common among people who are in regular contact with latex, as the body starts treating it as an allergen, causing allergic reactions.

Half of the patients, who have latex allergy, have a history of another type of allergy such as food allergies (kiwi, bananas, avocado, and tomato). The latex allergy can be mild to severe, and each year there are several cases of anaphylactic shock due to the allergic reactions.

There are three types of latex reactions:

• Irritant contact dermatitis: Contact dermatitis is the least threatening type of latex reaction. It is often classified as a non-allergenic skin reaction. When there is repeated exposure of the body to the chemicals of the latex gloves (say), it often results in dryness, burning and itching with lesions on the skin. 
• Allergic contact dermatitis: A delayed reaction to additives used in latex processing. The response of the body to this type of reaction is itchiness, dryness, lesions and scaling of the skin. The reaction, though, is more severe, spreads to most parts of the body, and lasts longer.
• Immediate allergic reaction (latex hypersensitivity): Latex hypersensitivity is considered as the most serious type of reaction to latex and the symptoms mimics’ hay fever or rhinitis with cramps, and severe itching. This kind of reaction is rare but the symptoms may lead to rapid heartbeat with chest pain, problems in breathing, hypotension, anaphylactic shock, or death [3].

Life-style modification, namely latex-safe environment, is advised for the patients with latex allergy. The following can be done to ensure safety for such patients:

• Avoid the regular use of products that may contain latex, such as bath mats, rubber toys, condoms, sanitary napkins, rubber electrical cords, pens with rubber grip, bathing caps, camera, telescope, etc. 
• Use of the latex alternatives. 
• Read the information/instruction regarding the material used in the shoes, boots or sneakers or containers. 
• Patient with known allergic profile must never travel alone. 
• The friends and family members of the patient must be aware of the allergic profile of the patients [10] [11].

Rubber trees produce a milky secretion or sap which is called latex. Chemicals are often blended to the sap to produce rubber of variable elasticity. Common uses of natural rubber are in the manufacturing of gloves, erasers, condoms, balloons and toys [1].

Definition

Latex allergy is the hypersensitive allergic complication arising from the exposure to latex (allergen) in patients sensitive to this allergen.

Cause

As soon as the immune system detects the allergen (or latex), the body produces antibodies (as a reaction to the allergen) and chemicals such as histamine, within the body. Histamine causes the redness, itching, formation of hives, runny nose, swollen eyes and swelling which is the hallmark of the allergic reactions. Histamine also causes severe allergic reactions (with symptoms such as an increase in pulse, sudden low blood-pressure, and swelling of tissues) if not contained on time.

Symptoms

The patient does react after the first exposure to the latex. However, the allergen sensitizes the immune system. Significant reactions are therefore seen in subsequent exposures. Symptoms of contact dermatitis, rashes, blistered skin are common in delayed allergic reactions. If the patient is sensitive to the protein in the latex, more serious complications such as runny nose, hives formation and allergic asthma is common. In rare cases, severe anaphylaxis reactions can occur, with symptoms such as sudden drop in the blood pressure, altered pulse rate and difficulty in breathing. 

Diagnosis

History of the patient to different allergens helps to ascertain the latex sensitivity. Some of the allergic conditions are hay fever, asthma or dermatitis. A blood test called RAST can help to determine the sensitivity to latex. Skin testing can also be done.

Treatment

Avoiding the contact with latex and latex products is the best treatment strategy. There is no cure of latex allergy. Once the symptoms are recognized, the patient may be given antihistamines. Patients are also advised to wear MedicAlert bracelet.

1. Meeropol E. Latex allergy update: clinical practice and unresolved issues. J Wound Ostomy Continence Nurs. 1996;23:193–196
2. Freeman GL. Cooccurrence of latex and fruit allergies. Allergy Asthma Proc. 1997;18:85–88.
3. Banov C. Latex hypersensitivity: a worldwide crisis. J Investig Allergol Clin Immunol. 1997;7:322.
4. Warpinski JR, Folgert J, Cohen M, Bush RK. Allergic reaction to latex: a risk factor for unsuspected anaphylaxis. Allergy Proc. 1991;12:95–102.
5. Zuskin E, Mustajbegovic J, Kanceljak B, Schachter EN, Macan J, Budak A. Respiratory function and immunological status in workers employed in a latex glove manufacturing plant. Am J Ind Med.1998;33:175–181.
6. Ownby DR. Mechanisms in adverse reactions to food: the whole body. Allergy. 1995;50(20 suppl):26–30.
7. Zak HN, Kaste LM, Schwarzenberger K, Barry MJ, Galbraith GMP. Health-care workers and latex allergy. Arch Environ Health. 2000;55:336–346.
8. Kellett PB. Latex allergy: a review. J Emerg Nurs. 1997;23:27–36. 
9. Gliniecki CM. Management of latex reactions in the occupational setting. AAOHN J. 1998;46:82–93.
10. Preventing allergic reactions to natural rubber latex in the workplace. National Institute for Occupational Safety and Health Alert. Available at: http://www.cdc.gov/niosh/latexalt.html. Accessed July 28, 1998.
11. Evangelisto M. Latex allergy: the downside of standard precautions. Today's Surg Nurse. 1997;19:28–33.