Clinical presentations of patients sensitive to natural rubber latex

Eczematous reactions to natural rubber latex (NRL) have been associated with both immediate and delayed hypersensitivity.

To determine clinical cases that might require testing for immediate sensitivity or patch testing for delayed hypersensitivity to latex fabric.

Patients with suspected sensitivity to NRL were given in vitro testing by radioallergosorbent test (RAST) or ImmunoCAP test and if negative, were prick-tested. If prick-test results were negative and the patients were still available, patch testing was done with latex glove fabric. Case histories of persons with positive results on RASTs, ImmunoCAP tests, prick tests, and patch tests were reviewed for clinical presentation and relevance.

Of 92 persons with positive responses, 26 had positive RAST results, 26 had positive ImmunoCAP test results, 33 had positive prick-test results, and 7 had a positive patch-test result. Presentations included hand urticaria or eczema (46 patients), eyelid dermatitis (14), shoe dermatitis (10), atopic eczema (6), waistband dermatitis (5), clothing dermatitis (3), contact eczema to elastic in a mask (2), urticaria to a phlebotomy tourniquet, and eczema over the elbows and from an elastic bandage used for occlusive dressing therapy. Several other presentations were less likely to be relevant.

Persons with putative contact dermatitis in areas that may come into contact with NRL deserve not only to be patch-tested with rubber chemicals but also to be tested for immediate sensitivity and, if results are negative, to be patch-tested with NRL.