Contains Nonbinding Recommendations 
Recommendations for Labeling Medical 
Products to Inform Users that the 
Product or Product Container is not 
Made with Natural Rubber Latex 
Guidance for Industry and  
Food and Drug Administration Staff  
 
Document issued on: December 2, 2014  
 
The draft of this document was issued on March 11, 2013.  
 
 
  For questions regarding medical products regulated by the Center for Devices and 
Radiological Health (CDRH), contact Michael T. Bailey (301-796-6530 or 
michael.bailey@fda.hhs.gov); or Geetha C. Jayan (301-796-6300 or 
geetha.jayan@fda.hhs.gov).   
  For questions regarding medical products regulated by the Center for Biologics 
Evaluation and Research (CBER), contact the CBER Office of Communication, 
Outreach and Development (1-800-835-4709 or 240-402-7800, or ocod@fda.hhs.gov).  
  For questions regarding medical products regulated by the Center for Drug Evaluation 
and Research (CDER), contact Richard T. Lostritto (301-796-1697 or 
richard.lostritto@fda.hhs.gov).  
  For questions regarding medical products regulated by the Center for Veterinary 
Medicine (CVM), contact Cory D. Evans, (240-402-0639 or cory.evans@fda.hhs.gov). 
 
 
              U.S. Department of Health and Human Services 
Food and Drug Administration 
Center for Devices and Radiological Health 
Center for Drug Evaluation and Research 
Center for Biologics Evaluation and Research 
Center for Veterinary Medicine  Contains Nonbinding Recommendations 
 
Preface 
 
Public Comment 
 
You may submit electronic comments and suggestions at any time for Agency consideration to 
http://www.regulations.gov . Submit written comments to the Division of Dockets 
Management, Food and Drug Administration, 5630 Fishers Lane, Room 1061, (HFA-305), 
Rockville, MD 20852. Identify all comments with the docket number FDA-2013-D-
0168Comments may not be acted upon by the Agency until the document is next revised or 
updated. 
 
Additional Copies 
 
Additional copies are available from the Internet. You may also send an e-mail request to 
CDRH-Guidance@fda.hhs.gov to receive a copy of the guidance. Please use the document 
number 1768 to identify the guidance you are requesting. 
 
  ii  Contains Nonbinding Recommendations 
 
Table of Contents 
 
 
1.Introduction .......................................................................................................................... 1 
2.Scope...................................................................................................................................... 2 
3.Background .......................................................................................................................... 2 
4.Recommended Labeling Statement .................................................................................... 4 
  iii  Contains Nonbinding Recommendations 
 
Guidance for Industry and  
Food and Drug Administration Staff  
 
Recommendations for Labeling Medical 
Products to Inform Users that the Product 
or Product Container is not Made with 
Natural Rubber Latex 
 
This guidance represents the Food and Drug Administration's (FDA's) current thinking 
on this topic.  It does not create or confer any rights for or on any person and does not 
operate to bind FDA or the public.  You can use an alternative approach if the approach 
satisfies the requirements of the applicable statutes and regulations.  If you want to discuss 
an alternative approach, contact the FDA staff responsible for implementing this 
guidance.  If you cannot identify the appropriate FDA staff, call the appropriate number 
listed on the title page of this guidance.  
 
1. Introduction 
 
The purpose of this guidance is to make recommendations on the appropriate language to 
include in the labeling of a medical product to convey that natural rubber latex was not used 
as a material in the manufacture of the product, product container, and/or packaging.  FDA is 
concerned that statements submitted for inclusion in medical product labeling, such as latex-
free, does not contain natural rubber latex, or does not contain latex are not accurate 
because it is not possible to reliably assure that there is an absence of the allergens associated 
with hypersensitivity reactions to natural rubber latex in the medical product.  Use of these 
terms may give users allergic to natural rubber latex a false sense of security when using a 
medical product.  FDA is recommending that a consistent, scientifically accurate statement be 
used by all manufacturers who wish to convey that natural rubber latex was not used as a 
material in the manufacture of a medical product, its container and/or packaging. 
 
FDA's guidance documents, including this guidance, do not establish legally enforceable 
responsibilities.  Instead, guidances describe the Agency's current thinking on a topic and 
should be viewed only as recommendations, unless specific regulatory or statutory 
requirements are cited.  The use of the word should in Agency guidances means that 
something is suggested or recommended, but not required. 
  1  Contains Nonbinding Recommendations 
 
2. Scope 
 
This guidance document applies to all FDA regulated medical products (i.e., devices, drugs, 
biologics, and veterinary products) for which: (1) natural rubber latex or synthetic derivatives 
of natural rubber latex were not used as materials in their manufacture; or (2) any container 
and/or packaging was not made with natural rubber latex or synthetic derivatives of natural 
rubber latex.  This guidance contains labeling recommendations for manufacturers who wish 
to include a statement in medical product labeling indicating that natural rubber latex or 
synthetic derivatives of natural rubber latex were not used as manufacturing materials in the 
medical product, its container and/or packaging. 
 
3. Background
 
 
Contact with devices containing natural rubber has been associated with anaphylaxis in 
individuals allergic to natural rubber latex proteins.1  Our medical device regulations include 
provisions that require certain labeling statements on medical devices if the device or device 
packaging is composed of or contains natural rubber that contacts humans.  See 21 CFR 
801.437.  The biologics regulations (21 CFR 610.61(l)) require that the package label or 
package insert declare the presence of known sensitizing substances, but do not specifically 
mention natural rubber latex.  Specific regulations for labeling of natural rubber latex content 
in medical products or their containers do not exist for drugs or veterinary products. 
 
At this time there are no regulations requiring a company to state that natural rubber latex 
was not used as a material in the manufacture of a medical product, its container and/or 
packaging.  However, some manufacturers have included the promotional statements latex-
free or does not contain latex in medical product labeling to inform users that natural 
rubber latex, dry natural rubber or synthetic derivatives of natural rubber latex were not used.  
FDA believes that these labeling statements are not sufficiently specific, not necessarily 
scientifically accurate and may be misunderstood or applied too widely, and therefore, it is 
inappropriate to include such statements in medical product labeling.  
 
First, the term latex in the labeling statements latex-free and does not contain latex 
could refer to natural rubber latex or synthetic latex (not derived from natural rubber latex).    
Labeling statements that do not clearly state the material of concern are not sufficiently 
specific and therefore should not be included in medical product labeling. 
 
Second, users may consider the terms free and does not contain to mean that the medical 
product is completely devoid of natural rubber latex.  However, there are no analytical 
methods currently available that can identify all proteins and components in natural rubber 
latex that may lead to allergic reactions in medical product users.  In addition, the use of the 
                                                           
1 Ahmed SM, Aw TC, and Adisesh A. Toxicological and immunological aspects of occupational latex allergy. 
Toxicol Rev 2004; 23(2):123-34 
  2  Contains Nonbinding Recommendations 
 
term free or does not contain does not address the potential for accidental contamination 
of a medical product and/or its container with natural rubber latex during or after 
manufacturing.  
 
Although there are a number of tests to measure the various compounds related to natural 
rubber latex allergies, FDA is aware of no test method or combination of test methods 
available at this time that can demonstrate the absence of proteins or components from 
natural rubber latex that may cause allergic reactions in susceptible individuals.  A brief 
description of three currently available test methods used to assess levels of total protein or 
natural rubber latex proteins in medical products are provided below: 
 
1.  ASTM D5712  Standard Test Method for Analysis of Aqueous Extractable Protein 
in Natural Rubber and its Products Using the Modified Lowry Method.   
 
This is an FDA- recognized standard.2  The purpose of this test method is to 
determine the protein content in natural rubber latex materials.  This test method does 
not specifically measure antigenic or allergenic natural rubber latex proteins, but 
rather the total aqueous extractable protein content in the sample. 
 
2.  ASTM D6499  Standard Test Method for the Immunological Measurement of 
Antigenic Protein in Natural Rubber and its Products.   
 
This is an FDA- recognized standard2.  The purpose of this test method is to 
determine the amount of antigenic protein in natural rubber and its products using 
rabbit antisera specific for natural rubber latex proteins.  However, the standard 
clearly states that Although this method detects antigenic proteins, it should not be 
considered as a measure of allergenic proteins.  Correlation of protein/antigen levels 
with the level of allergenic proteins has not been fully established.  
 
3.  ASTM D7427  Standard Test Method for Immunological Measurement of Four 
Principal Allergenic Proteins (Hev b 1, 3, 5 and 6.02) in Natural Rubber and its 
Products Derived from Latex.  
 
This standard has not been recognized by the FDA as of the time of issuance of this 
guidance.  The purpose of this test method is to determine the amount of four specific 
known natural rubber latex allergenic proteins. (At least thirteen natural rubber latex 
allergens have been identified.)  Per the test method, the sum of the four allergen 
levels shall be viewed as an indicator of the allergen burden and not as a measure of 
the total allergen content that can be released from the product.  
 
                                                           
2 FDA recognizes national and international consensus standards for use in development of medical products.  A 
database of all recognized standards can be found at: 
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfStandards/search.cfm.  Please see the following site for 
more information: http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Standards/default.htm.   
  3  Contains Nonbinding Recommendations 
 
The specificity and sensitivity of currently available analytical methods are not sufficient to 
demonstrate that a medical product is completely free of natural rubber latex proteins 
which have primarily been associated with causing severe allergic reactions (Type I allergic 
reactions).  FDA recognizes that the complete absence of all natural rubber latex allergens is 
unlikely to be necessary for the safe use of medical products by individuals with natural 
rubber latex allergies.  Threshold allergen levels, exposure below which no adverse reaction 
occurs in the majority of sensitive individuals, have been identified for some non-natural 
rubber latex allergens (e.g., hymenoptera venoms and specific foods).  
 
However, threshold allergen levels are unavailable for natural rubber latex-allergic 
individuals. For example, there are at least 13 distinct allergens identified for natural rubber 
latex allergy and the sensitivity to each varies, not only among individuals, but among groups 
of individuals (e.g., health care providers, industry workers, children with 
meningomyelocele).  Furthermore, thresholds are likely to be route-specific and multiple 
routes of exposure (e.g., respiratory, percutaneous, oral, and parenteral) have been implicated 
in natural rubber latex sensitization and reactivity.  There is no one threshold level of 
exposure that can be considered safe, but rather many levels that are a function of the 
allergen, the risk group, the exposure route, the immune status of the individual and, perhaps, 
other factors as yet unidentified.  Therefore, any preventative strategy should address the 
possible different threshold levels for sensitization and for triggering a reaction in an at-risk 
individual.  
 
Ideally, all threshold levels should be established for each allergen under all conditions, and 
the lowest threshold level identified for each.  This information is unlikely to become 
available without a concerted scientific effort.  Even if this is achieved, the correlation of data 
from ASTM methods D5712 (total protein), D6499 (overall allergen levels), and D7427 (four 
specific allergens) to the established minimum threshold levels would be uncertain. 
 
For the reasons stated above, FDA finds that the use of statements, such as latex-free, 
does not contain latex, or other similar labeling statements are, at this time, not 
scientifically supportable. 
 
FDA strongly recommends that these statements not be used in medical product labeling. 
 
4. Recommended Labeling Statement  
 
Currently, there are no regulations requiring a manufacturer to state that natural rubber latex 
was not used as a material in their medical product, its container and/or its packaging.  If a 
manufacturer elects to include a statement in medical product labeling indicating that natural 
rubber latex or synthetic derivatives of natural rubber latex were not used as materials in the 
manufacture of their medical product and container, FDA recommends the use of the 
statement Not made with natural rubber latex.  If this statement is made without any 
qualification, it would apply to the medical product, its container, and any packaging.  In 
certain cases, statements regarding not made with natural rubber latex may be appropriate 
only for certain components.  In this case a manufacturer may elect to make a statement that 
  4  Contains Nonbinding Recommendations 
 
the specific component is not made with natural rubber latex.  For example, if the particular 
presentation or part of the presentation (e.g., vial stopper or syringe) is not made with natural 
rubber latex, FDA recommends the statement The <vial stopper> is not made with 
natural rubber latex.   
 
These statements Not made with natural rubber latex and The <vial stopper> is not 
made with natural rubber latex communicate that natural rubber latex was not used as a 
material in the finished product or as a material in a specific component, respectively.  At the 
same time, the statement does not make the unsupportable claim that the medical product is 
free of or does not contain natural rubber latex (i.e., materials or contamination), which 
may promote a false sense of safety to users who are allergic to natural rubber latex.  Finally, 
use of a consistent scientifically supportable labeling statement will reduce confusion among 
FDA staff, medical product manufacturers, and medical product users. 
 
Manufacturers who currently include statements such as latex-free or does not contain 
latex in medical product labeling should update their medical product labeling to show the 
recommended labeling statement Not made with natural rubber latex or The <vial 
stopper> is not made with natural rubber latex as appropriate.  Alternatively, 
manufacturers should consider removing latex-free type statements from medical products, 
their containers, and packaging.  Manufacturers may contact the Center that regulates the 
medical product for guidance on the appropriate regulatory mechanism to update the labeling.  
 
 
 
  5