The following covers recommended pre-referral treatment and investigations for children of all ages presenting with a suspected latex allergy.

Latex allergy

• Latex allergies can occur in a number of forms. Some are IgE mediated while others are due to other immune mechanisims.
• Look for risk factors for latex allergy (eg. repeated surgical procedures, spina bifida, VP shunt, repeated catheterisation, latex glove exposure).
• Latex allergic patients may describe oropharyngeal itching and swelling when eating banana, avocado, potato, tomato, chestnut or kiwi fruit as there may be cross reacting IgE antibodies between lates and some other plant allergens.
• RAST has limited sensitivity for latex allergy and may be falsly negative.
• Refer if history is suggestive of allergy even if RAST is negative, as further specialised testing (ie. formal challenge) is usually needed.

Initial work-up

Symptoms

An allergic reaction may involve one or more of the following signs and symptoms.

Mild local allergic reaction

• Swelling of lips, face or eyes.
• Hives or welts.

Moderate local allergic reaction

• Abdominal pain, vomiting.

Severe systemic allergic reaction (anaphylaxis)

• Difficulty breathing.
• Swelling of the tongue and/or throat.
• Difficulty talking.
• Hoarse voice, wheezing or persistent coughing.
• Loss of consciousness and/or collapse.
• Infants and young children appearing pale and floppy.

Severe allergic reaction (anaphylaxis) will typically include multiple organ systems (ie. hives and respiratory symptoms).

Taking a history

History of allergic reaction:

• Latex - type.
• Specific details of nature of reaction, previous or subsequent exposure?
• History of atopy (eg. eczema/asthma).
• Family history of allergies.
• Also read notes below for specific allergies.

Diagnostics

• Detection of latex-specific IgE by RAST test.
• Note: SPT (Skin Prick Test) is not recommended for latex.

Interpretation of RAST test

• Test results should be interpreted together with history.
• Positive latex-specific IgE (RAST) in the presence of a clear history of allergic reaction confirms clinical allergy.
• Refer patient to Allergy and Immunology specialist for further management and instruct patient to avoid all latex.

When to refer

• Refer all patients with suspected latex allergy to a specialist Allergist.
• Provide advice on avoidance of latex exposure e.g. dental procedures, condoms, balloons.

Referral information needed

The GP at first consultation is in the best position to get the most comprehensive information from parents on the details of an allergic reaction. Please collect and include in your referral as much detail as possible. It is increasingly difficult to collect this information later.

Information needed

• CLEARLY INDICATE if child has confirmed or suspected ANAPHYLAXIS. The referral will be triaged as urgent.
• Date reaction(s) occurred.
• Allergic reaction symptoms experienced -
  • Severe systemic reaction (anaphylaxis).
  • Difficulty breathing.
  • Swelling of the tongue or throat.
  • Difficulty talking.
  • Hoarse voice, wheezing or persistent coughing.
  • Loss of consciousness and/or collapse.
  • Young children appearing pale and floppy.
• Moderate systemic reaction -
  • Abdominal pain, vomiting.
• Mild-Moderate local reaction -
  • Swelling of lips, face or eyes.
  • Hives or welts.
• Potential causes of reaction(s):
  • Latex - in WHAT FORM?
• When, where and how did the reaction(s) happen?
• RAST results.
• Treatment given and patient response.
• Previous or subsequent exposure to allergen.

Further information

Please see these guidelines for further information on:

• Food allergies
• Drug allergies
• Insect allergies

Contact information

Resources

• Clinical practice guidelines
• Information booklet
• Parent information website Kids Health Info
• Kids Connect (RCH Primary Care Liaison) www.rch.org.au/kidsconnect
  Contains all referral forms, clinic information, other pre-referral guidelines and parent information.
• Feedback
  We welcome your feedback on this guideline: kids.connect@rch.org.au / tel (03) 9345 4645 / fax (03) 9345 4650.

References

• The Asthma Management Handbook (2006). Asthma and Allergy (pp57-63) National Asthma Council Australia.
• Australiasian Society of Clinical Immunology website www.allergy.org.au.
• ASCIA Education Resources.

Copyright and Disclaimer:

Copyright 2009, Royal Children's Hospital (RCH) Victoria, Australia. The RCH is not responsible in any way for application of the procedures or guidelines to patient care at your facility. They are guidelines only and your professional judgment must always prevail. Guidelines may not be reproduced without permission. RCH Kids Connect - Primary Care Liaison. www.rch.org.au/kidsconnect .   These guidelines were developed by specialists at the Royal Children's Hospital and reviewed by general practitioners in Victoria. Last reviewed April, 2012.