Itching and rashes on contact with latex among patients attending community contraceptive clinics.

©FSRH J Fam Plann Reprod Health Care 2008: 34(2) Background Itching following contact with latex condoms is a familiar problem in contraceptive services, and popular textbooks still maintain that it is frequently an excuse for avoiding condoms, or that spermicide is to blame.1 If a patient experiences symptoms on contact with other latex items as well as condoms then it would be reasonable to suspect sensitivity to something in the rubber material, either natural rubber latex (NRL) or accelerator chemicals used to convert liquid latex into solid rubber. ‘Latex allergy’ is a loose term applied to allergic reactions following contact with rubber material used to make condoms, surgical gloves, etc. Reactions fall into two groups: Type I immediate hypersensitivity to NRL protein, causing a range of symptoms from transient urticaria and sneezing to coughing, wheezing and full-blown anaphylaxis; and Type IV delayed hypersensitivity response causing prolonged dermatitis. Type IV reactions are usually due to accelerator chemicals rather than NRL.2 Latex allergy gained notoriety in the late 1980s following a series of fatal anaphylactic reactions during barium enemas in the USA. The Health & Safety Executive (HSE) issued recommendations,3 however serious anaphylactic reactions continued to occur in patients with known Type I NRL allergy because staff were not aware of hidden latex in drugs and equipment. In 2004 a survey by the National Patient Safety Agency revealed that 40% of NHS Trusts still did not have operational latex policies.4 In order to address this, the HSE published a toolkit to identify symptoms suggesting NRL allergy in patients about to have surgery, and new employees required to wear latex gloves.5 The toolkit highlights the importance of a history of itching and rashes following contact with latex gloves, condoms and balloons, and advises that affected individuals should not have further contact with latex until this has been investigated. The risk of developing Type I NRL allergy is increased by frequent contact with latex through occupation or medical treatment, atopic tendencies, and allergy to foods that share common allergens with NRL protein (e.g. kiwi, banana, avocado, raw potato, chestnuts).