Endotoxin, which is produced by gram-negative bacteria, can contribute to a reaction. Sensitized patients have specific natural rubber IgE receptors on the surface of mast cells. When these are cross-linked by the latex proteins, they produce a cascade of events in the mast cell that results in degranulation. Route of exposure Route of exposure may be important, spina bifida patients are primarily exposed during surgery or catheterization, so their mucosa are exposed, where as HCWs are exposed through the cutaneous route by wearing gloves. Cutaneous exposure, such as when wearing gloves, usually results in urticaria, dermatitis and pruritus.
Airborne exposure can result in rhinitis, conjunctivitis and asthma.
Mucosal exposure, which occurs during surgery, can result in systemic reactions like anaphylaxis. Physicians tend to think about the cutaneous manifestations, but when evaluating a patient for latex sensitivities, ask about airway mucosal and systemic reactions, Warshaw recommended. Reactivity cannot be measured in all individuals, she added. Many patients do not realize they are at risk. Prevalence is higher among blood donors, and that may be because health care workers tend to donate more blood.