Friday, 18 Aug 2017

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How to Handle Latex Allergies and Biologics

Question: What do you do when a Latex allergy is a contraindication for the use of injectable biologics. They all seem to have latex components somewhere. Any advice?

Dr. Kathryn Dao: An estimated 0.8-6% of the population is allergic to latex, with the prevalence of latex allergies being much higher in health care workers (8-17%) (1).

At least 10 different low molecular weight soluble proteins have been implicated in latex allergies. Reaction can be a simple nonimmune mediated contact dermatitis to more severe allergic responses as type I IgE hypersensitivity (anaphylaxis) and type IV cell mediated hypersensitivity (2).

Strikingly, approximately 50% of medical devices contain latex, including delivery devices of biologics. Several injectable medications that are commonly used in rheumatology do state in their prescribing information that their needle covers or stoppers contain “dry natural rubber” which is a derivative of latex.

The table below lists the products that contain latex. It is best to avoid these products in patients who are allergic to latex, particularly type I hypersensitive patients who are at risk for anaphylaxis. Sometimes, it is difficult to ascertain if an injection site reactions (ISR) is due to a latex allergy as these are common adverse events (AE) seen with injectable biologics with prevalences reported at 6-70%. If needed, testing for latex can be performed. Typically the radioallergosorbent (RAST) test is ordered which detects IgE specific to latex from the patient’s serum. Inconclusive results may require use of the scratch or skin prick test and/or a provocation test.

Consider using an infusible biologic or one of the products listed in the table that does not contain latex. Despite the frequency of latex allergies and the prevalence of latex in our medical products, little is known about how patients are impacted. More studies should be conducted to determine the extent of the allergic reaction and whether or not manufacturers need to look for latex-free alternatives.

      Rheumatologic Medications According to Latex Content*

Contains Latex

Does Not Contain Latex

 Enbrel Sureclick and PFS

 Enbrel vial for reconstitution

 Humira PEN and PFS

 Cimzia PFS

 Simponi PEN and PFS

 Actemra PFS

 Stelara PFS

 Orencia PFS and vial

 Cosentyx PFS

 Ilaris vial for reconstitution

 Prolia PFS

 Arcalyst vial for reconstitution

 

 Forteo

   Kineret PFS++

*Based on prescribing information of the products and with phone calls to the company who manufacture the products  (PFS = prefilled syringe)

++This table was updated on 1/28/16 (after notice from Sobi NA) to reflect a change in manufacturing by Sobi such that the new syringe has NO latex and has a narrower needle. This is reflected in the new label that says "The prefilled syringe contains an outer rigid plastic needle shield attached to an inner needle cover. The syringe or needle shield components are not made with
natural rubber latex".  EDITORS NOTE: there are still Kineret syringes in circulation that are made with latex - please check the attached package insert for information about the latex warning or exclusion.

References:
1. Reddy S. Latex Allergy. Am Fam Physician. 1998 Jan 1;57(1):93-100.
2. Hepner D, Castells M. Latex Allergy: An Update. Anest Analg. 2003;96:1219–29.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Kathryn Dao, MD, FACP, FACR, is the Associate Director of Clinical Rheumatology at Baylor Research Institute in Dallas. She is in clinical practice at the Arthritis Care and Research Center in Dallas, TX and is actively involved in patient care, medical education, and clinical research.  Her interests include Rheumatoid Arthritis, Systemic Lupus Erythematosus, Gout, Infections with Biologics, Osteoporosis, and Drug Safety. She has served as the co-editor for the American College of Rheumatology “Drug Safety Quarterly” 2010-2013.   

 

Rheumatologists' Comments

Great Pearls Thanks Kathryn John A. Goldman, MD