[Allergy to latex].

In France 18% of all preoperative allergic shock syndromes result from allergic reactions to latex. IgE antibodies mediate the immediate hypersensitivity reaction to natural latex proteins extracted for the rubber tree (Hevea brasiliensis). Sensibilization occurs after repeated direct contact of the skin or mucosa with latex products including gloves, urinary catheters or after chronic inhalation of airborne particles of latex in the operating theatre. Clinical expressions include skin rash, asthma or anaphylactic shock. During the preoperative period, the shock may occur late after induction of anaesthesia and after the operative procedure has begun or after the arm cuff has been released. In obstetrics oxytocin injection can precipitate the phenomenon. Subjects at risk have been clearly identified: subjects who wear gloves regularly, those working in an environment contaminated with airborne latex, children who have undergone multiple operations on malformations of the urinary tract or who have had repeated catheterisms (40% of the spina bifida patients are sensitized), atopic subjects, those allergic to exotic fruits (banana, avocado, kiwi). These patients should be identified during the preoperative work-up in order to perform allergy tests. The diagnosis of over-sensitivity should be confirmed by prick-tests and perhaps complete antilatex antibody assay and challenge. All material composed of natural latex should be avoided for these patients. Proposed alternatives include synthetic rubber. Hypoallergenic gloves add no further safety. The operative procedure should be conducted using standard techniques.