problems of the spinal cord (e.g., myelomeningocele), patients with recurrent bladder catheterizations, or any patient with a history of rash, swelling, or itching after blowing up balloons, wearing rubber gloves, or using other latex-containing products. On rare occasions, latex condoms can cause allergic reactions.

Most cases of allergy to latex are mediated by IgE antibodies. However, because of varying source materials, the heterogeneity of immune response, and a variety of test methods, the identities of the specific protein allergens remain to be determined (Jones et al., 1992).

Case reports of latex allergy began to appear in the literature in 1979 (Nutter, 1979). Most early reports were of contact urticaria (Forstrom, 1980; Meding and Fregert, 1984; Nutter, 1979); reports of allergic rhinitis (Carrillo et al., 1986), anaphylaxis (Axelsson et al., 1987a; Slater, 1989; Turjanmaa et al., 1984), and asthma (Seaton et al., 1988) followed. Occupational asthma related to latex hypersensitivity has also been described; the response has been attributed to inhalation exposure to cured latex during the inspection and packaging of finished gloves (Tarlo et al., 1990). Fisher (1987) has also reported contact urticaria and anaphylactoid reaction as a result of exposure to cornstarch surgical glove powder. Swanson and colleagues (1992) support the conclusion that dust from latex gloves is a significant occupational aeroallergen, reporting 28 medical center employees diagnosed with rhinitis or asthma caused by exposure to dust from latex gloves.

In addition to health care workers and manufacturers, children with spina bifida are at increased risk for latex allergy, and credible evidence supports an IgE-mediated mechanism (Slater, 1989; Slater et al., 1990a, 1991; Spanner et al., 1989; Turjanmaa, 1987). One prospective study reported that 5 out of 12 spina bifida patients (41 percent) have IgE antibody specific for rubber proteins (Slater et al., 1990a). Another report suggested that IgE titers to latex allergen might be due to parenteral exposure to latex surgeon's gloves during primary closure of the meningomyelocele and that early initial exposure and frequent reexposures may predispose children with spina bifida to rubber allergy (Slater et al., 1990b).

Recent episodes of fatal and life-threatening anaphylaxis have made it increasingly urgent to identify the specific allergen(s) responsible for these reactions (Kelly et al., 1991). Jones and others (1992) and Turjanmaa and colleagues (1988) have reported large variations in the latex allergen content of gloves from different manufacturers; powder-free gloves were significantly less allergenic in this survey. Slater and Chhabra (1992) reported that all patients with latex-specific IgE had antibodies to a 14-kDa peptide present in an extract made from nonammoniated latex; many sera recognized a 20-kDa peptide as well. They concluded that current data are insufficient to identify definitively the major allergen(s) and suggested that



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