Cutaneous Reactions to Rubber

Abstract

Abstract The three major adverse cutaneous reactions to rubber include natural rubber latex allergy, irritant contact dermatitis and allergic contact dermatitis. An overview of relevant aspects of the types of natural and synthetic rubber, rubber production, and specific chemicals used in compounding and vulcanization, as well as latex proteins is essential to an understanding of these reactions. Natural rubber latex allergy is a type I, IgE mediated, immediate hypersensitivity reaction to one or more proteins present in natural rubber latex with clinical manifestations ranging from contact urticaria to allergic rhinitis, asthma, and anaphylaxis. Over the past decade, natural rubber latex allergy has become a major medical, occupational health, and medicolegal problem. Individuals at highest risk are patients with spina bifida and health care workers. Diagnosis is based largely on clinical history and examination, and serologic and intracutaneous testing. Irritant contact dermatitis is non-immunologic and is the most common cutaneous reaction to rubber. Cumulative exposure to low-grade irritants impairs the barrier function of the skin and allows penetration of potential irritants and allergens. Diagnosis is based on history of exposure to known irritants, cutaneous examination, and exclusion of allergy. Allergic contact dermatitis is a type IV cell mediated, delayed hypersensitivity reaction which occurs primarily from exposure to rubber chemicals either directly or from residual amounts present in rubber products. Most cases present with an eczematous dermatitis, but purpura, lichenoid dermatitis, and depigmentation occasionally occur. Diagnosis is made on the basis of history, examination, and epicutaneous patch testing with rubber chemicals and rubber products. Treatment is with allergen and irritant avoidance and substitution, environmental control, personal protective equipment and topical and systemic pharmacologic therapy. A unified approach is needed in the diagnosis and treatment of adverse cutaneous reactions to rubber and it is important to remember that some patients may have both contact dermatitis and natural latex allergy. Determining the bioavailability and elicitation threshold of rubber allergens may be helpful in reducing allergic reactions from consumer and industrial rubber products.