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Natural rubber latex allergies from dental local anaesthetic: a review and guidance for the dental practitioner Joel Thomas Christopher Bell Dental Update 2024 43:8, 707-709.
Authors
JoelThomas
BDS, MFDS, RCSEd
Oral and Maxillofacial Surgery Dental Core Trainee, (jt6215@my.bristol.ac.uk)
Natural rubber latex (NRL) is present within many dental products including local anaesthetic (LA) cartridges. Patients with NRL sensitivity are at risk of developing type I and type IV allergic reactions from exposure to these products. Evidence from current literature is inconclusive yet highly suggestive that NRL contamination may occur in medicines stored within vials containing natural rubber components. It would therefore be prudent to avoid using such products in patients with a known NRL allergy. For dental practitioners this applies to LA cartridges and is easily achievable, as manufacturers now produce products not made with NRL. This article aims to provide guidance for dental health professionals regarding the use of LA in patients with a known NRL hypersensitivity.
CPD/Clinical Relevance: NRL allergies are a rising concern amongst medical professions and these reactions should be avoided wherever possible.
Article
Natural rubber latex (NRL) is present in many medical products used within dentistry. Examples that are often forgotten include adhesive tape, fluid or gas tubing and bungs in medicine vials. Patients with NRL sensitivity are at risk of developing type I or type IV allergic reactions from exposure to either NRL proteins or chemical residues from the processing of NRL.
Type I reactions have immediate onset mediated by immunoglobulin E (IgE) antibiodies. This reaction is characterized by conjunctivitis (sore eyes), rhinitis (nasal congestion) and urticaria (itching of the skin). Type I reactions can also precipitate rapid bronchospasm or anaphylaxis requiring urgent medical treatment.
Type IV reactions often have delayed onset mediated by T-lymphocytes and are characterized by dermatitis (skin rash). This usually presents 6–48 hours following exposure and is managed with corticosteroids.
Those with NRL hypersensitivity should avoid contact with all products that contain it. Patients must be educated that NRL can be present not only in the product itself but also in the packaging or may be introduced to the product during the manufacturing process. The incidence of NRL-induced anaphylaxis has increased dramatically over the past two decades, especially in high-risk groups such as children, adults requiring multiple surgical procedures and healthcare workers.1 It is estimated that approximately 1% of the general population suffer from latex hypersensitivities.2
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