Hand dermatitis: A risk factor for latex hypersensitivity

Abstract

Three groups of patients have been described to be at significant risk for developing allergic reactions to latex products: children with spina bifida who have undergone multiple surgical procedures, health care workers who are frequently exposed to latex gloves, and workers exposed to latex on the job.1Boxer MB. The dangers of latex allergy.Emerg Med. 1993; 25: 18-26Google Scholar Described are two patients with hand eczema and no risk factors for latex allergy who have experienced significant latex allergic symptoms. Patient 1 is a 31-year-old homemaker with a 6-year history of eczema of her fingers of uncertain cause. She consulted with a dermatologist and was advised to wear latex gloves for dishwashing and while bathing her children to lessen the drying effect to her hands from repeated exposure to water. She was also advised to apply Temovate cream and Lac-Hydrin lotion to her hands. Within a few months of using latex gloves, the patient noted ocular swelling, itching, sneezing, throat irritation, and hives after contact with the latex gloves. She reported no history of food allergies. She had had a tonsillectomy performed approximately 2 years before the onset of her latex allergy symptoms. Patient 2 is a 38-year-old postal worker with a 17-year history of seasonal allergic rhinitis, conjunctivitis, and atopic dermatitis. Her eczema primarily involved her arms, neck, and hands. She had been advised by her dermatologist to wear latex gloves for dishwashing and while bathing her children. In addition, she applied Temovate cream and various moisturizers to her hands. Approximately 6 years after she began using latex gloves, she noted swelling and itching of her hands after wearing the latex gloves. Soon thereafter, she noted sneezing and facial swelling during dental examinations performed with latex gloves. She denied any history of food allergies. Thyroid surgery had been performed more than 10 years before the onset of her symptoms. Latex-specific IgE, as determined by RAST, was positive in both patients. These two cases demonstrate that patients with a history of hand dermatitis, unrelated to latex allergy, appear to be another group of patients who are at risk of developing latex allergy. Patients with hand dermatitis, caused by latex glove exposure, have previously been shown to be at increased risk of developing systemic reactions to latex products.2Charous BL Hamilton RG Yunginger JW. Occupational latex exposure: characteristics of contact and systemic reactions in 47 workers.J ALLERGY CLIN IMMUNOL. 1994; 94: 12-18Abstract Full Text Full Text PDF PubMed Scopus (116) Google Scholar Advising patients with hand dermatitis to wear latex gloves to prevent the drying effect of water exposure may result in sensitization to latex proteins. A disrupted cutaneous barrier appears to be the route of sensitization in these patients. The role of both topical cortisone creams and moisturizers may have also enhanced the sensitization to latex as well. Both of these patients had been advised by their dermatologists to begin using latex gloves, which in turn resulted in latex allergy symptoms. As allergists-immunologists, we should advise our colleagues to recommend nonlatex gloves as an alternative for patients with a history of hand eczema. 1/8/74668