Allergic reactions to natural rubber latex at home, to rubber products, and to cross-reacting foods.

The prevalence of clinical sensitivity to natural rubber latex (NRL) has increased dramatically in the last 15 years. In the health care setting this has been associated with the increased use of latex gloves. It does not, however, explain the observation that IgE antibodies to NRL are detected in equal rates in both health care workers and the general population, with the numerous reactions occurring in homes and in health care settings in non-health care workers. This increase in NRL sensitivity has occurred at the same time as our observation of an increase in atopy. In addition, atopy is a definite risk factor that has been associated with NRL sensitivity in all studies. Exposure to NRL products outside the health care environment is significant and ubiquitous. Exposure to NRL epitopes also occurs by ingestion of foods, food additives, and pollen. This exposure is sufficient to induce IgE antibodies to both the food and NRL proteins. It is therefore difficult in an individual patient to implicate any single product as the cause of NRL sensitization leading to the development of symptoms. Outside of the health care environment there does not appear to be an increase in exposure to NRL products or to cross-reacting materials. This would suggest that there is an increase in the susceptible population, which clearly appears to be the atopic individual. A great deal of attention is devoted to reducing exposure to latex gloves in the health care setting, which may be only the visible portion of the iceberg. More attention should be devoted to reducing the antigens present in all NRL products and consideration given to developing vaccines for the food-sensitive individuals.