Be aware: latex reaction risks in the dental surgery

Types of allergic reaction

The ubiquity of latex is not without its flip side. Studies suggest that around 4.3% of the world’s population has an allergy to latex.[iv] Two types of allergic reactions have been identified. Type 1 is an immediate response caused by exposure to the proteins in latex – via direct contact with skin or mucosa, for instance, or the inhalation of airborne protein particles carried on powder used to lubricate products such as gloves.[v] A Type 1 reaction can trigger symptoms within thirty minutes, ranging in severity from a rash to potentially deadly anaphylaxis.[vi] Type 4 is a delayed inflammatory response to chemicals added to latex during manufacturing and can include itching and allergic contact dermatitis – but not anaphylaxia.[vii]

Sensitisation

Research suggests that regular exposure to latex proteins can cause sensitisation and a higher risk of allergic reaction.[viii] The 1980s and 1990s saw a dramatic increase in the use of latex personal protective equipment (PPE) – gloves in particular – within the healthcare sector, in the quest to halt the transmission of newly emergent pathogenic diseases including human immunodeficiency virus (HIV) and hepatitis C. A corresponding increase in latex allergy was reported.[ix] Healthcare workers and patients undergoing multiple surgical procedures remain susceptible to sensitisation today,[x] due to their regular proximity to products containing latex, such as gloves and masks.

Studies show that latex sensitisation and allergy can also occur amongst people outside of these categories,[xi]notably those with allergies to foods containing similar protein structures to the Brazilian rubber tree: avocado, kiwi and banana, for example. This cross-reactivity can also occur in reverse.[xii] Theories suggest that this ‘latex-fruit syndrome’ can be the result of certain antibodies recognising and reacting defensively to protein structures in other entities.[xiii] [xiv] Factors such as the method of exposure can influence the risk level of hypersensitivity reaction: direct contact with a high-protein-level dam during dental treatment, for example.[xv]

Minimise the risk of reactions

While the flexibility and durability of latex continues to play a significant protective role in today’s healthcare settings, including dental practices, the availability of both latex and non-latex equipment is increasingly prevalent in practice store rooms, offering a greater level of protection to the dentist, dental team and patient. Non-latex gloves, for instance, are now commonplace in all healthcare settings including dental practices. Products containing a low level of latex proteins will help to reduce the risk of sensitisation and potential symptoms.[xvi] With appropriate management of equipment and information, the risk of latex exposure to vulnerable people in your surgery can be significantly mitigated. The Control of Substances Hazardous to Health (COSHH) regulations class NRL proteins as hazardous to health and states that a risk assessment must be carried out for areas where exposure may occur; exposure must be adequately controlled and information and training must be provided for those likely to be exposed to NRL proteins.[xvii]

Alternative solutions

Advances in synthetic elastomer manufacturing means there are now safe, practical and readily available alternatives to latex equipment for carrying out treatment on patients with a known allergy to latex. A dental practice should ensure it has adequate supplies of both latex and non-latex equipment in stock for patients and the practice team. The clear identification of latex-derived products, too, ensures the safe management of potentially hazardous equipment. Taking this step, in addition to having alternative materials ready to use, is an effective way to manage the risks of latex exposure.[xviii]

Many people will experience no problems whatever with latex equipment. Others will require complete avoidance of latex components entirely. Worldwide dental specialist COLTENE is committed to developing safe, clever solutions to meet the practical requirements of dentists, which is why their HySolate dental dam range is available in both non-latex and low-protein, powder-free latex options. The innovative, pre-printed latex BLACK EDITION is ideal for high-contrast photography; the fruit-scented, pastel-coloured latex Fiesta dams offer greater patient comfort. The COLTENE HySolate non-latex dam range offers high-elasticity performance, with options for strong and soft retraction as well as a flexible framed model for quick and easy fitting.

Cautious optimism

Heightened awareness of the allergen risks associated with latex, along with manufacturing advances that have led to a greater range of non-latex and low-protein latex products to enable practices to meet the requirements of susceptible patients, will lead to a safer, more accommodating environment, within the dental practice and beyond.

For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.

Nicolas Coomber COLTENE National Account & Marketing Manager

[i] Wu M, McIntosh J, Liu J. Current prevalence rate of latex allergy: Why it remains a problem? J Occup Health. 2016 May 25;58(2):138-44. doi: 10.1539/joh.15-0275-RA. Epub 2016 Mar 24. PMID: 27010091; PMCID: PMC5356959. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356959/ Accessed 27 April 2023.

[ii] Ibrahim S, Riahi O, Said SM, Sabri MFM, Rozali S. Biopolymers From Crop Plants. Reference Module in Materials Science and Materials Engineering. Elsevier, 2019. ISBN 9780128035818. Available at: https://doi.org/10.1016/B978-0-12-803581-8.11573-5. Accessed 27 April 2023.

[iii] Royal College of Physicians of London. Latex allergy Occupational aspects of management: a national guideline. NHS Plus. Available at: https://www.nhshealthatwork.co.uk/images/library/files/Clinical%20excellence/Latex_allergy_full_guidelines.pdf. Accessed 27 April 2023.

[iv] Wu M, McIntosh J, Liu J. Current prevalence rate of latex allergy: Why it remains a problem? J Occup Health. 2016 May 25;58(2):138-44. doi: 10.1539/joh.15-0275-RA. Epub 2016 Mar 24. PMID: 27010091; PMCID: PMC5356959. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356959/ Accessed 27 April 2023.

[v] Royal College of Physicians of London. Latex allergy Occupational aspects of management: a national guideline. NHS Plus. Available at: https://www.nhshealthatwork.co.uk/images/library/files/Clinical%20excellence/Latex_allergy_full_guidelines.pdf. Accessed 27 April 2023

[vi] Royal College of Physicians of London. Latex allergy Occupational aspects of management: a national guideline. NHS Plus. Available at: https://www.nhshealthatwork.co.uk/images/library/files/Clinical%20excellence/Latex_allergy_full_guidelines.pdf. Accessed 27 April 2023.

[vii] Allergy UK. Rubber latex allergy article. Available at: https://www.allergyuk.org/resources/rubber-latex-allergy/. Accessed 28 April 2023.

[viii] Nguyen K, Kohli A. Latex Allergy. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK545164/ Accessed 28 April 2023.

[ix] Nucera E, Aruanno A, Rizzi A, Centrone M. Latex Allergy: Current Status and Future Perspectives. J Asthma Allergy. 2020 Sep 28;13:385-398. doi: 10.2147/JAA.S242058. PMID: 33061465; PMCID: PMC7532063. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532063/#:~:text=The%20emergence%20of%20human%2Dto,considerable%20increase%20in%20latex%20allergy. Accessed 27 April 2023.

[x] Wu M, McIntosh J, Liu J. Current prevalence rate of latex allergy: Why it remains a problem? J Occup Health. 2016 May 25;58(2):138-44. doi: 10.1539/joh.15-0275-RA. Epub 2016 Mar 24. PMID: 27010091; PMCID: PMC5356959. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356959/ Accessed 27 April 2023.

[xi] Wu M, McIntosh J, Liu J. Current prevalence rate of latex allergy: Why it remains a problem? J Occup Health. 2016 May 25;58(2):138-44. doi: 10.1539/joh.15-0275-RA. Epub 2016 Mar 24. PMID: 27010091; PMCID: PMC5356959. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356959/ Accessed 27 April 2023.

^[xii] Zuberbier T. Latex Allergy. European Centre for Allergy Research Foundation (ECARF). July 2016. Available at: https://www.ecarf.org/en/information-portal/allergies-overview/latex-allergy/ Accessed 28 April 2023.

[xiii] Wagner S, Breiteneder H. The latex-fruit syndrome. Biochem Soc Trans. 2002 Nov;30(Pt 6):935-40. doi: 10.1042/bst0300935. PMID: 12440950. Available at: https://pubmed.ncbi.nlm.nih.gov/12440950/#:~:text=Approximately%2030%2D50%25%20of%20individuals,is%20called%20latex%2Dfruit%20syndrome. Accessed 2 May 2023.

[xiv] Beezhold DH, Sussman GL, Liss GM, Chang NS. Latex allergy can induce clinical reactions to specific foods. Clin Exp Allergy. 1996 Apr;26(4):416-22. PMID: 8732238. Available at: https://pubmed.ncbi.nlm.nih.gov/8732238/. Accessed 2 May 2023.

[xv] Martin KM, Martin MV, Birss AJ, Field EA. The protein content of dental rubber dams. J Dent. 1997 May-Jul;25(3-4):347-50. doi: 10.1016/s0300-5712(96)00034-6. PMID: 9175367. Available at: https://pubmed.ncbi.nlm.nih.gov/9175367/ Accessed 28 April 2023.

[xvi] EUROPEAN COMMISSION HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL. Opinion On Natural rubber latex allergy. Adopted by The Scientific Committee on Medicinal Products and Medical Devices 27 June 2000. Available at :https://ec.europa.eu/health/ph_risk/committees/scmp/documents/out31_en.pdf. Accessed 28 April 2023.

^[xvii] Health and Safety Executive: Natural rubber latex sensitisation in health and social care. Available at: https://www.hse.gov.uk/foi/internalops/sims/pub_serv/071106.htm . Accessed 28 April 2023.

[xviii] Wu M, McIntosh J, Liu J. Current prevalence rate of latex allergy: Why it remains a problem? J Occup Health. 2016 May 25;58(2):138-44. doi: 10.1539/joh.15-0275-RA. Epub 2016 Mar 24. PMID: 27010091; PMCID: PMC5356959. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356959/ Accessed 28 April 2023.