Allergic reactions occur when a person's immune system reacts to a substance in the environment that is harmless to most people. These substances are known as allergens, and are most commonly found in dust mites, pets, pollen, insects, ticks, moulds, foods, latex and some drugs (medications).

Anaphylaxis is the most severe type of allergic reaction and should always be treated as a medical emergency. Anaphylaxis requires immediate treatment with adrenaline (epinephrine), If treatment with adrenaline is delayed, this can result in fatal anaphylaxis.

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Alcohol Allergy

Latex Allergy

Pet Allergy

Sulfite Sensitivity  

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Webpage updated April 2025

ASCIA PCC Latex allergy 2019136.22 KB

Allergies to latex rubber have been recognised in the last few decades. The reasons are uncertain, although increased use of latex gloves in health care settings, and changes in manufacturing practices may have contributed.

The risk of developing latex allergy increases with frequent exposure

Most people who are allergic to latex have had frequent exposure to latex over many years. The majority are nurses, doctors, dentists, or patients who have had many operations. Many people with latex allergy usually already have other allergic disease such as asthma, allergic rhinitis (hay fever), or eczema.

Latex is used in a large number of products

Latex or natural rubber is the substance obtained from the sap of the Hevea brasiliensis tree. After the addition of preservatives and stabilisers, it is dipped into a mould, then heated and dried. During manufacturing, chemicals are added to render latex elastic and stable to heat by vulcanisation (heating in the presence of sulfur). Further chemicals are added for strength and durability, including mercaptobenzothiazole, thiurams and carbamates. Sometimes a dry powder lubricant (usually corn-starch), is added to the surface of the latex to prevent the rubber surfaces from sticking together.

Allergic reactions can occur to latex protein as well as the chemicals added to it, but not to cornstarch itself. However, when gloves are worn, latex protein can be leached from the glove and stick to the cornstarch particles. When gloves are changed, these particles can become airborne and spread latex allergen into the local environment.   

Many commercial products contain natural rubber latex. These include bandages, baby bottle teats, baby dummies, rubber bands, clothing elastic, rubber toys, rubber grips and a wide range of medical equipment. Allergic reactions usually occur after exposure to dipped products like gloves, balloons and condoms. Products made from crepe latex rubber (like shoe soles), are unlikely to cause allergic reactions.

By contrast to natural latex rubber, synthetic rubber is produced from petrochemicals, and does not contain allergenic latex proteins. Products containing synthetic rubber (like most latex paints), do not cause allergic reactions.

Immediate allergic reactions to latex

Immediate allergic reactions (also known as Type 1 or IgE antibody mediated), are the most serious adverse reactions to latex. In people who have developed sensitivity to natural latex proteins, contact with latex releases the histamine into the tissues. The result is itching and hives (urticaria) with direct contact, like after wearing rubber gloves, or itchy swollen lips, face or tongue after blowing up balloons. Some people will develop irritation after wearing a condom, inserting a diaphragm for contraceptive purposes, or after visiting the dentist or hairdresser and coming into contact with latex. 

Reactions can also occur when latex is inhaled, resulting in allergic rhinitis (hay fever), or asthma like symptoms. This occurs most commonly in hospitals. The latex proteins can leach out of the gloves with sweaty hands and become attached to the powdered lubricant.

In environments where gloves are being changed frequently, latex on these fine particles can become suspended in the air like pollen. 

Anaphylaxis is the most severe allergic reaction to latex and usually occurs in very sensitive patients where latex protein is absorbed rapidly via moist surfaces such as the mouth, nose, throat, vagina, rectum or internally (such as during a surgical operation). Symptoms include severe difficulty in breathing and a drop in blood pressure.

Irritant dermatitis is the most common adverse reaction to latex

Most adverse reactions to latex are irritant dermatitis, which is not an immediate allergic reaction. It results in rough, dry and scaly skin, sometimes with weeping sores. It is made worse by sweating and friction under rubber gloves, but can also occur from frequent hand washing with harsh soaps.  

Even though irritant dermatitis is not an allergic reaction, absorption of latex through damaged skin increases the risk of developing latex allergy with ongoing exposure. Recognition and treatment of this condition is therefore recommended to reduce the risk of developing latex allergy.

Allergic contact dermatitis is a common immune reaction to latex

Allergic contact dermatitis is the most common immune system reaction to latex. The symptoms look similar to irritant dermatitis symptoms, but the cause is different. The rash is rough, dry and scaly, sometimes with weeping sores. It usually occurs 12-48 hours after contact with latex rubber. Contact allergic dermatitis is usually due to an inflammatory reaction to the chemicals added to rubber during manufacture. However, it may also result from contact with latex protein.

Contact allergic dermatitis is annoying but not dangerous. As with irritant dermatitis, treatment is recommended to reduce the risk of developing more serious immediate allergic reactions to latex.
 

Latex allergic people may also be sensitive to certain foods

Some proteins in latex are also present in foods, and some people with latex allergy find that certain foods cause an itchy mouth or throat swelling. The most common foods described are banana, avocado, kiwi fruit, passionfruit, plums, strawberry and tomato. These foods do not have to be avoided routinely, unless they cause problems.

Awareness and diagnosis are important first steps

Your doctor will normally ask a series of questions that may help to identify the cause of your problem. This will often be followed by allergy testing to help confirm or exclude the presence of sensitivity to natural latex proteins or chemical preservatives. The types of tests commonly used are skin tests or blood tests for allergen specific IgE, to confirm or exclude immediate sensitivity and patch tests to confirm or exclude contact allergic dermatitis (which has a delayed reaction). Information on allergy testing is available on the ASCIA website. 

You may be referred to a clinical immunology/allergy specialist for testing.

It is important to note that other so-called allergy tests, including vega testing, alcat tests, kinesiology, pulse testing and Rinkel’s intradermal testing are not medically or scientifically proven methods to confirm any form of allergy. More information about these tests is available on the ASCIA website.  

Management of latex allergy involves careful avoidance

If you are latex allergic you should:

• Avoid latex in all its forms, and particularly avoid latex coming near your skin, face, eyes, nose or throat.  Latex substitutes exist and can be used if required. 
• Be aware that some condoms and diaphragms used for contraception contain latex and should be avoided. Latex-free condoms are now available from stores and websites. 
• Wear a medical identifications bracelet, stating you are allergic to latex. If you are unconscious or confused and need emergency treatment, then the nurses and doctors will be made aware of this.
• Carry your own supply of non-latex gloves (such as vinyl or synthetic rubber), in case of an emergency.
• Advise doctors and dentists well in advance of any surgical operation, dental treatment, Pap smear, blood tests or x-ray to ensure that latex is not used.
• Use vinyl or synthetic rubber gloves, if it is necessary to wear gloves.
• Avoid takeaway food which is prepared or served by food handlers wearing latex gloves. 
• Consider avoiding occupations where latex is very difficult to avoid such as nursing, dentistry, medicine, veterinary science, hairdressing or food preparation.

Measures should be taken if your job involves exposure to latex

If you are latex allergic and your job involves frequent exposure to latex, you should: 

• Use latex free gloves.
• Request that non-powdered latex gloves be supplied to others in your area of work. This reduces airborne latex particle exposure, and has been shown to dramatically reduce the risk of developing latex allergy in occupational settings.
• Look after your hands and have any irritation or rash evaluated by a doctor. An intact skin barrier reduces the risk of developing latex allergy.
• It is important to note that avoiding any contact with latex is also an effective method of preventing latex allergy, particularly for non-medical use such as food handlers and hairdressers.

Reducing the risk of latex allergy in the future

Manufacturers have developed latex products containing less allergen and non-latex alternatives. As more of these products become available, the risk of reactions in latex sensitive people will decrease, and it is likely that fewer people will develop latex allergy. In the meantime, increased awareness of latex allergy and its risk factors should help to reduce the frequency of latex allergy. 

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to immunology/allergy research go to www.allergyimmunology.org.au

Updated April 2019

ASCIA PCC Pet allergy 201999.9 KB

Allergies to pets and other animals are a common cause of allergic rhinitis (hay fever) and asthma. However, up to 50% of people who are allergic to animals do not get immediate symptoms. If there is doubt as to whether a pet is causing allergy symptoms, a clinical immunology/allergy specialist can confirm the suspicion using skin tests or allergen specific IgE allergy tests.

The main source of cat allergen is in the sebaceous glands in the cat's skin

Cats often lick themselves and this helps spread cat allergen, which is sticky, and glues itself to dander, dust particles and all parts of the home. As all cats have sebaceous glands, all cat breeds can potentially cause allergies.

Cat allergen can remain distributed throughout the home for up to six months and in the cat's bedding for up to four years. The allergen spreads so much that it can be measured in the homes of non-pet owners and on the clothing of co-workers of cat owners. Cat allergen has been detected in the Antarctic, even though cats have never been there.

The main source of dogs allergen is saliva

As the main source of dog allergen is saliva, dander (material shed from skin, hair and fur particles) can spread the allergen. All dog breeds cause allergies, although some do not shed as much dander (and therefore allergen).

Allergies to other animals

Allergies to other animals such as horses, mice, rats, rabbits, guinea pigs and birds are not as common as cat and dog allergy. However, the presence of these allergens from clothing and other items may be sufficient to trigger allergic rhinitis (hay fever), and asthma.

What can be done to prevent pet allergy?

Studies about increased exposure to animals reducing or increasing allergies are ongoing. In people who are already sensitised to animals and have symptoms, avoidance is well documented to prevent or reduce symptoms. Changes that are simple to implement and have been proven to be effective are:

• Do not bring a pet into the home.
• Find an existing pet a new home.
• Do not smoke, as exposure to environmental smoke makes allergies more likely to develop.

Changes that are difficult to implement or have not yet been proven are:

• Restrict the pet to one area or keep the pet out of the allergic person's bedroom.
• Use high efficiency air cleaners.
• Remove carpet or other reservoirs for allergens from the bedroom.
• Wash pets weekly.

Treatment options

In cases when it is difficult to avoid exposure to an animal, treatment options include medications such as intranasal cortocosteroid sprays (INCS), antihistamines and allergen immunotherapy (AIT), also known as desensitisation. AIT should only be initiated by a clinical immunology/allergy specialist. 

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.

ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice.

 The content of ASCIA resources is not influenced by any commercial organisations.

For more information go to www.allergy.org.au

To donate to allergy and immunology research go to www.allergyimmunology.org.au/donate

Content updated April 2019

ASCIA PCC Alcohol allergy 2019208.95 KB

In contrast to flushing, irritant and toxic reactions to alcohol, allergic reactions to alcohol are relatively uncommon. In people with alcohol allergy, as little as 1 ml of pure alcohol (equivalent to 10ml of wine or a mouthful of beer) is enough to provoke severe rashes, difficulty breathing, stomach cramps or collapse. Alcohol can also increase the likelihood of severe allergic reactions (anaphylaxis) from other causes like food.

Allergy tests to alcohol are usually negative

The human body constantly produces small amounts of alcohol itself. Normal levels of 0.01 to 0.03 mg of alcohol/100 ml are contained in the blood. By contrast, a blood alcohol limit for driving of 0.05 per cent is equal to around 50 mg of alcohol/100 ml of blood. Since the human body produces alcohol itself, the reasons why some individuals develop allergic reactions when they drink alcohol is curious. Allergy tests using alcohol are usually negative, but are sometimes positive to breakdown products of ethanol such as acetaldehyde or acetic acid (vinegar).

Flushing is not an allergic reaction

Some people develop severe facial flushing if they drink small amounts of alcohol. This is not an allergic reaction and is most common in those with an Asian background. Other side effects may also occur, including fluttering of the heart (palpitations), feeling hot, headache, tummy discomfort or a drop in blood pressure  These may be related to high blood acetaldehyde levels. Not all flushing is due to alcohol. Flushing can occur in skin conditions like rosacea, menopause, low blood sugar levels (hypoglycaemia), or as a response to some antibiotics or medicines used to treat diabetes or high blood fat levels.

Alcoholic beverages contain ethanol and other substances

The liver breaks down the alcohol (ethanol) that we drink and converts it to a chemical called acetaldehyde. Acetaldehyde is then transformed to acetic acid (vinegar). Problems occur if alcohol cannot be broken down. As well as ethanol, alcoholic beverages contain a complex mixture of grape, yeast, hop, barley or wheat derived substances, natural food chemicals (such as salicylates) and wood derived substances or preservatives like sodium metabisulfite. Severe allergic reactions have been described in people with allergies to proteins within grapes, yeast, hops, barley and wheat. These people are not sensitive to alcohol itself. Furthermore, fining agents (such as egg or seafood proteins) are sometimes used to remove fine particles. Whether these occur in sufficient amounts to trigger allergic reactions is unknown.

Asthmatic reactions may occur due to metabisulfite

Up to a third of people with asthma complain that wine will worsen their asthma, and ess often with beer or spirits. Beer, wine and champagne contain sodium metabisulfite (additive 220, 221) which have been used as a preservative since Roman times. Some people, particularly those with unstable or poorly controlled asthma, may wheeze when they consume these drinks. In general, there is more preservative in white wine than red wine, and more in cask wine than bottled wine. The amount of metabisulfite also varies from brand to brand. Some low sulfite wines are available, although those with extreme sensitivity may not be able to tolerate them. This is because some grape growers will dust sulfur powder over grapes in the weeks leading up to harvest. Other sources of metabisulfite include vinegar, pickled onions, dried fruit, crustaceans, some restaurant salads and fruit salads. Even when people complain that wine triggers asthma, metabisulfite may not be the only explanation. Information on Sulfite allergy is available on the ASCIA website: www.allergy.org.au/patients/other-allergy/sulfite-allergy

Asthma can also be due to enzyme deficiency

People with low levels of aldehyde dehydrogenase may accumulate high levels of acetaldehyde after drinking alcohol, as they cannot break it down easily. Acetaldehyde has been blamed for asthmatic reactions to alcohol in up to half of Japanese people with asthma.

Histamine and other substances may also cause problems

Histamine can trigger sneezing, runny nose and sometimes wheeze, stomach upset and headache. Although the actual amounts vary between different wines, in general there is more histamine in red than white wines and more in Shiraz than Cabernet. Some challenge studies suggest that antihistamines may reduce the severity of problems after wine, but as the challenges were equivalent to only one glass, these medicines probably won't prevent a hangover! Others substances in wine may also cause problems to some individuals, but these are not well defined.

The presence of alcohol may not always obvious

There are many less obvious sources of alcohol in our diet. These include alcoholic soft drinks, mixes, spiked drinks, food marinades or tomato puree. Over ripe fruit can ferment, resulting in enough alcohol production to trigger a reaction. Some medicines like cough syrups and some injected medicines also contain alcohol to help them dissolve and stay in liquid form.

Management of alcohol allergy

Accidental exposure to alcohol may lead to unexpected reactions. Severe alcohol allergy should be managed in the same way as other severe allergic reactions (anaphylaxis): identify and avoid the cause, wear a medical identification bracelet, and carry adrenaline (epinephrine) as part of an emergency action plan if individuals are at risk of potentially life threatening allergic reactions in the future. Information on anaphylaxis is available on the ASCIA website: www.allergy.org.au/patients/about-allergy/anaphylaxis   

Milder reactions to alcohol may also occur

Alcohol sometimes worsens symptoms in people with hives (urticaria) and occasionally alcohol can trigger hives. As with more serious allergic reactions, the mechanism is unclear. Contact rashes from alcohol are very uncommon.

Not all adverse reactions to alcohol are due to allergy

Other effects of alcohol toxicity are well known, including its effect on the liver, stomach, brain and mental functioning when consumed in large amounts. Even though alcohol has a relaxant effect on the brain, some individuals will experience agitation and anxiety. and these symptoms are due to the drug like activity of alcohol. These reactions do not represent allergy anymore than a hangover does.

© ASCIA 2019

ASCIA is the peak professional body of clinical immunology/allergy specialists in Australia and New Zealand.
ASCIA resources are based on published literature and expert review, however, they are not intended to replace medical advice. The content of ASCIA resources is not influenced by any commercial organisations.
For more information go to www.allergy.org.au  
To donate to immunology/allergy research go to www.allergyimmunology.org.au 

Updated March 2019