Latex Allergy: Current Status and Future Perspectives

Figures & data

Table 1 Foods That Cross-React with Latex^10–12

Foods with high latex proteins	Avocado, kiwi, banana, chestnut
Foods with moderate latex proteins	Apple, carrot, celery, melon, papaya, potato, tomato
Foods with low or undetermined latex proteins	Apricot, buckwheat, citrus, cherry, coconut, fig, grape, hazelnut, lychee, mango, peach, pear, persimmon, pineapple, plum, shellfish, soybean, strawberry, sunflower seed, walnut, watermelon, zucchini

Table 2 Allergenic Components of Latex from Hevea brasiliensis www.allergen.org)

Allergen	Trivial Name	MW (kDa)	Predicted Physiological Role
Hev b 1	Rubber elongation factor	14	Rubber synthesis
Hev b 2	β-1,3-Glucanase	35	Defense-related protein
Hev b 3	Small rubber particle protein	24	Rubber synthesis
Hev b 4	Lecithinase homologue	53–55	Microhelix component
Hev b 5	Acid latex protein	16	Structural protein
Hev b 6	Hevein and its precursor	20	Lectin, latex coagulation
Hev b 7	Patatin-like protein	42	Defense-related protein
Hev b 8	Profilin	15	Cytoskeletal actin binding
Hev b 9	Enolase	51	Glycolytic enzyme
Hev b 10	Superoxide dismutase	26	Enzyme, radical destruction
Hev b 11	Class I chitinase	30	Defense-related protein
Hev b 12	Non-specific lipid transfer protein type 1	9	Defense-related protein
Hev b 13	Esterase	42	Defense-related protein
Hev b 14	Hevamine	30	Defense-related protein
Hev b 15	Serine protease inhibitor	7.5	Defense-related protein

Note: : Modified from Allergen nomenclature. Available from: http://www.allergen.org/search.php?allergensource=Hevea+brasiliensis. 108⁴⁴

Table 3 Features of Latex Immunotherapy Trials

Route of Administration	First Author, Year	Study Design	Study Population (Active/Control)	Age Range (Years)	Prevalent Symptoms	Induction Phase	Maintenance Dose	Total Duration	Main Results
Percutaneous	Patriarca, 2002^76	Case series	5	26–45	Urticaria–angioedema, asthma, hand eczema	Gradual increments starting from 10 s once a day in one hand	1 h, both hands, 3 times a week	1 year	Significant clinical improvement with no remarkable side effects
SCIT	Leynadier, 2000^Citation79	RDBPC	9/8	22–41	Rhinitis, conjunctivitis, asthma, angioedema	2 days	100 IR	1 year	Decrease in symptoms except for asthma; systemic reaction in 47% in active group
SCIT	Sastre, 2003^Citation80	RDBPC	16/8	21–51	Rhinitis, conjunctivitis, asthma, urticaria	98 days	5±3 to 186±14 µg protein according to max tolerated dose	6 months	No change in symptoms, decrease in specific reactivity; systemic reaction in 69% in active group
SCIT	Tabar, 2006^Citation81	RDBPC	11/12	24–58	Rhinitis, conjunctivitis, asthma, urticaria	2 days	80 IR	1 year	No significant change in any parameters; systemic reaction in 81.8% in active group
SLIT	Patriarca, 2002^Citation85	RDBPC	12/12	8–64	Rhinitis, asthma, urticaria	4 days	300 µg/week	3 months	Challenge tests turned negative; 2 spontaneously resolving local side effects
SLIT	Cistero, 2004^Citation86	Open	26	15–45	Respiratory and cutaneous symptoms	4 days	300 µg/week	2,5 months	Significant improvement in glove use; systemic reaction in 3.6% of doses
SLIT	Bernardini, 2006^Citation89	RDBPC	12/8	4–15	Rhinoconjunctivitis, asthma, urticaria	4 days	210 µg/week	1 year	Decrease in symptoms; no side effects observed
SLIT	Nettis, 2007^Citation88	RDBPC	20/20	18–47	Asthma, urticaria	4 days	300 µg/week	1 year	Decrease in symptoms, significant improvement in glove use; rare local side effects
SLIT	Nucera, 2008^Citation92	Random open	12/11	5–64	Urticaria–angioedema, asthma, rhinoconjunctivitis	2 days vs 3 days	–	–	3-day protocol was better tolerated and safer than the 2-day protocol
SLIT	Buyukozturk, 2010^Citation93	RDBPC	8/4	26–32	Rhinitis, conjunctivitis, asthma, urticaria	4 days	300 µg/week	1 year	Improvement in glove use, decrease in symptoms; 3 severe systemic events
SLIT	Gastaminza, 2011^Citation97	RDBPC	14/14	24–57	Rhinoconjunctivitis, asthma, urticaria	4 days	210 µg/week	1 year + 1 year	No significant difference in any parameters; 4 mild adverse events
SLIT	Lasa Luaces, 2012^Citation94	Open	18/5	–	Rhinoconjunctivitis, asthma, urticaria	4 days	300 µg/week	1 year	Decrease in symptoms, no significant changes in IgE, IgG4 and BAT
SLIT	Nucera, 2018^Citation95	Open	76	Mean age 34	Rhinoconjunctivitis, hand eczema, urticaria	4 days	500 µg/week	3 years	Symptoms, provocation tests and mean wheal diameters of SPT significantly improved

Abbreviations: SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy; RDBPC, randomized, double-blind, placebo-controlled; IgE, immunoglobulin E; IgG₄, immunoglobulin G₄; BAT, basophil activation test; SPT, skin-prick test.

Brehler R, Theissen U, Mohr C, Luger T. Latex‐fruit syndrome: frequency of cross‐reacting IgE antibodies. Allergy. 1997;52:404–410. doi:10.1111/j.1398-9995.1997.tb01019.x9188921

 PubMed Web of Science ®Google Scholar

Werfel T, Asero R, Ballmer-Weber BK, et al. Position paper of the EAACI: food allergy due to immunological cross-reactions with common inhalant allergens. Allergy. 2015;70(9):1079–1090. doi:10.1111/all.1266626095197

 PubMed Web of Science ®Google Scholar

Allergen nomenclature. Available from: http://www.allergen.org/search.php?allergensource=Hevea+brasiliensis . Accessed September 17, 2020.

 Google Scholar

Leynadier F, Herman D, Vervloet D, Andre C. Specific immunotherapy with a standardized latex extract versus placebo in allergic healthcare workers. J Allergy Clin Immunol. 2000;106(3):585–590. doi:10.1067/mai.2000.10917310984382

 PubMed Web of Science ®Google Scholar

Sastre J, Fernández-Nieto M, Rico P. Specific immunotherapy with a standardized latex extract in allergic workers: a double-blind, placebo-controlled study. J Allergy Clin Immunol. 2003;111(5):985–994. doi:10.1067/mai.2003.139012743562

 PubMed Web of Science ®Google Scholar

Tabar AI, Anda M, Bonifazi F, et al. Specific Immunotherapy with standardized latex extract versus placebo in latex-allergic patients. Int Arch Allergy Immunol. 2006;141(4):369–376. doi:10.1159/00009546316943675

 PubMed Web of Science ®Google Scholar

Patriarca G, Nucera E, Roncallo C, et al. Sublingual desensitization: a new approach to latex allergy problem. Anesth Analg. 2002;95:956–960. doi:10.1097/00000539-200210000-0003112351276

 PubMed Web of Science ®Google Scholar

Cistero Bahima A, Sastre J, Enrique E, et al. Tolerance and effects on skin reactivity to latex of sublingual rush immunotherapy with a latex extract. J Investig Allergol Clin Immunol. 2004;14:17–25.

 PubMed Web of Science ®Google Scholar

Bernardini R, Campodonico P, Burastero S, et al. Sublingual immunotherapy with a latex extract in paediatric patients: a double-blind, placebo-controlled study. Curr Med Res Opin. 2006;22(8):1515–1522. doi:10.1185/030079906X11571116870076

 PubMed Web of Science ®Google Scholar

Nettis E, Colanardi MC, Soccio AL, et al. Double-blind, placebo-controlled study of sublingual immunotherapy in patients with latex-induced urticaria: a 12-month study. Br J Dermatol. 2007;156(4):674–681. doi:10.1111/j.1365-2133.2006.07738.x17493066

 PubMed Web of Science ®Google Scholar

Nucera E, Schiavino D, Sabato V, et al. Sublingual immunotherapy for latex allergy: tolerability and safety profile of rush build-up phase. Curr Med Res Opin. 2008;24(4):1147–1154. doi:10.1185/030079908X29190318334054

 PubMed Web of Science ®Google Scholar

Buyukozturk S, Gelincik A, Ferhan F, Colakoğlu B, Dal M. Latex sublingual immunotherapy: can its safety be predicted? Ann Allergy Asthma Immunol. 2010;104:339–342. doi:10.1016/j.anai.2010.01.01420408345

 PubMed Web of Science ®Google Scholar

Gastaminza G, Algorta J, Uriel O, et al. Randomized, double-blind, placebo controlled clinical trial of sublingual immunotherapy in natural rubber latex allergic patients. Trials. 2011;12:191. doi:10.1186/1745-6215-12-19121827704

 PubMed Web of Science ®Google Scholar

Lasa Luaces EM, Tabar Purroy AI, García Figueroa BE, et al. Component-resolved immunologic modifications, efficacy, and tolerance of latex sublingual immunotherapy in children. Ann Allergy Asthma Immunol. 2012;108(5):367–372. doi:10.1016/j.anai.2012.03.00522541410

 PubMed Web of Science ®Google Scholar

Nucera E, Mezzacappa S, Buonomo A, et al. Latex immunotherapy: evidence of effectiveness. Postepy Dermatol Alergol. 2018;35(2):145–150. doi:10.5114/ada.2018.7523529760613

 PubMed Web of Science ®Google Scholar