Allergy to
natural rubber latex products emerged as an important clinical condition following an increase in the use of
latex gloves for barrier protection in the early 1980s. In addition to
latex glove users, other high-risk groups with different
latex exposure include
spina bifida patients and others with multiple
surgical procedures. Subjects with fruit and vegetable
allergy are also at risk due to cross-reactive
allergens. Following the significant advances in the identification and characterization of common aeroallergens,
latex allergy was well placed to become an excellent model of
therapy. Awareness of
latex allergy and modes of sensitization enabled epidemiological studies to inform
allergen avoidance initiatives, substantially reducing inadvertent exposure in major hospitals in Western countries.
Spina bifida is often identified in utero or soon after birth, allowing vigorous
latex allergen avoidance with enhanced efficacy of primary prevention. However, changing demographics of
latex allergy and technological revolution in countries such as China and India are predicted to unleash a second wave of
latex allergy reemphasizing the incentive for improved manufacturing procedures for
latex products. The desirable high tensile strength and elasticity of
natural rubber latex have made the commercial identification of good alternatives very difficult but this would also be attractive for primary prevention. In addition, an effective specific
immunotherapy regimen would be valuable for selected high-risk atopic individuals. Current subcutaneous and sublingual immunotherapy schedules have been tested for treatment of
latex allergy with evidence of efficacy but the risks of adverse events are high. For such potent
allergens as
latex, hypoallergenic but T cell-reactive preparations are required for clinical use. Identification of allergenic components of
latex products, with generation of
monoclonal antibodies and recombinant
allergens, allowed sequence determination and mapping of T cell and
B cell epitopes. Together, these
reagents and data facilitated improved diagnostics and investigation of novel-specific
therapeutics. Potential hypoallergenic
latex preparations identified include modified non-
IgE-reactive
allergen molecules and short
T cell epitope peptides. The co-administration of adjunct
therapies such as
anti-IgE or
corticosteroids and of appropriate adjuvants for induction of regulatory T cell response offers promise for clinically effective, safe
latex-specific
vaccines.