Latex Allergy Presenting with Allergic Rhinoconjunctivitis and Asthma in a Theatre Nurse: A Case Report
Rashmitha Thippaiah*
Correspondence to Rashmitha Thippaiah, Assistant Professor, Department of Respiratory Medicine, JJM Medical College.
Copyright
© 2026 Rashmitha Thippaiah. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 19 October 2026
Published: 01 November 2026
DOI: https://doi.org/10.5281/zenodo.23910343
Introduction: Natural rubber latex (NRL) allergy is a significant occupational hazard among healthcare workers, driven largely by airborne latex proteins bound to glove powder. Continued workplace exposure can lead to upper and lower airway sensitization, presenting as occupational allergic rhinoconjunctivitis and asthma.
Case Report: A 29-year-old female theatre nurse presented with a six-year history of workplace-related shortness of breath, wheezing, cough, and ocular-nasal symptoms triggered by powdered latex gloves. Laboratory findings were unremarkable, but skin prick testing was positive for latex (5 × 6???????? wheal).
Spirometry demonstrated variable airflow limitation with significant bronchodilator responsiveness (12.2% and 220 mL improvement in ????????????1), supporting a diagnosis of occupational asthma and allergic rhinoconjunctivitis. Symptoms were managed with inhaled therapy and complete avoidance of latex gloves using nitrile alternatives.
Conclusion: Early clinical recognition, detailed exposure history, objective allergy and pulmonary testing, and prompt substitution with non-latex alternatives are critical in managing occupational latex allergy in healthcare settings.
Introduction
Natural rubber latex (NRL) allergy is an important occupational health concern, particularly among healthcare workers with repeated exposure to latex-containing medical gloves. The use of powdered latex gloves can facilitate the aerosolisation of latex proteins, increasing the risk of sensitisation and allergic manifestations. Clinical presentations range from allergic contact symptoms and rhinoconjunctivitis to occupational asthma and, occasionally, systemic allergic reactions [1,2].
Occupational asthma associated with latex exposure became a recognised concern among healthcare professionals following widespread use of latex gloves. Early recognition is important because continued exposure may contribute to persistent respiratory symptoms. This case describes a theatre nurse presenting with workplace-associated respiratory symptoms and allergic rhinoconjunctivitis, with evidence of latex sensitisation and bronchodilator responsiveness.
Case Report
A 29-year-old female working as a theatre nurse presented with a six-year history of progressively increasing episodes of shortness of breath. Her respiratory symptoms were associated with episodic non-productive cough, wheezing, and occasional chest tightness. On detailed history, the symptoms were predominantly experienced during working hours, particularly while using powdered latex examination gloves.
She also reported recurrent sneezing, nasal itching, and ocular itching following exposure to these gloves. The close temporal association between workplace exposure and the onset of respiratory and rhinoconjunctival symptoms raised the suspicion of an occupational allergic disorder related to natural rubber latex exposure.
The patient had experienced respiratory symptoms over several years, with progressive worsening over time. Her clinical history was suggestive of both upper and lower airway involvement in association with occupational exposure. There was no reported history of systemic allergic reactions in the available clinical details.
On general physical examination, the patient was clinically stable, with no significant abnormality detected. Laboratory investigations revealed a normal total eosinophil count and normal total serum immunoglobulin E (IgE) levels. However, these findings did not exclude the possibility of an IgE-mediated occupational allergy.
Skin prick testing with latex extract elicited a wheal measuring 5x6
mm. The histamine positive control produced a 3x3 mm wheal, while the saline negative control showed no wheal formation 0x0cmm. The positive response to latex, in the context of the patient's characteristic exposure-related symptoms, supported sensitisation to natural rubber latex.
Pulmonary function testing demonstrated an FEV1 of 1.81 L (66% predicted), an FVC of 2.64 L (83% predicted), and an FEV1 /FVC ratio of 68.7% before bronchodilator administration. Following bronchodilator administration, FEV1 increased to 2.03 L (74% predicted), representing an absolute improvement of 220 mL and a relative increase of 12.2% from baseline. FVC increased to 3.08 L (97% predicted). The improvement in FEV1 met the conventional bronchodilator responsiveness criterion of at least 12% and 200 mL from baseline, supporting the presence of variable airflow limitation in the appropriate clinical context.
Considering the prolonged occupational exposure to powdered latex gloves, the reproducible association between exposure and respiratory symptoms, accompanying allergic rhinoconjunctivitis, positive latex skin prick test, and significant bronchodilator response, a clinical diagnosis of suspected occupational asthma associated with latex sensitisation, accompanied by occupational allergic rhinoconjunctivitis, was made.
The patient was counselled regarding the importance of reducing occupational exposure and advised to avoid powdered latex gloves. Substitution with suitable non-latex alternatives, such as nitrile gloves, was recommended. Appropriate inhaled therapy was initiated, with advice for clinical follow-up to assess symptom control and response to exposure avoidance.
Discussion
Natural rubber latex allergy is an occupational health problem that most often affects healthcare workers through skin or airborne exposure, with clinical presentations ranging from dermatitis and urticaria to asthma and anaphylaxis [3,4]. Natural rubber latex is widely used in medical devices and consumer products, which creates frequent opportunities for exposure in clinical settings [3].
Latex allergy commonly develops after exposure of the skin or mucous membranes to natural rubber latex [5,6]. The disorder includes both type I IgE-mediated hypersensitivity to latex
proteins and type IV delayed hypersensitivity to rubber additives or accelerators [3]. Symptoms range from contact dermatitis, urticaria, and mucosal swelling to rhinoconjunctivitis, asthma, and life-threatening anaphylaxis [3,5]. In healthcare workers, latex exposure can also cause occupational rhinoconjunctivitis and asthma, although asthma appears less common than upper-airway symptoms [7].
Reported prevalence in healthcare workers varies across studies, but the overall pattern shows higher risk than in the general population [3,8,9]. Accurate diagnosis begins with clinical history and targeted allergologic evaluation. Skin prick testing and latex-specific IgE testing are standard tools for confirming IgE-mediated latex sensitization. Patch testing is used when type IV contact dermatitis from rubber additives is suspected [3]. When history and routine tests do not align, challenge tests or basophil activation tests can help clarify the diagnosis [10,11].
Powdered glove starch can carry latex allergens into the air, which helps explain respiratory symptoms in exposed workers [12]. Latex exposure is associated with higher odds of hand dermatitis, rhinoconjunctivitis, and asthma or wheezing in healthcare workers [3,7].
Avoidance remains the mainstay of management, especially by replacing latex products, reducing airborne exposure, and implementing latex-free workplace protocols [3]. Workplace interventions such as glove replacement, latex-free air environments, job modification, and allergy labeling reduce symptoms in affected workers [13]. Latex-specific immunotherapy showed improvement in rhinitis, conjunctivitis, and cutaneous symptoms in a randomized trial, but asthma outcomes were not significantly different and adverse effects occurred, so evidence remains limited [6,14].
Conclusion
Latex allergy should be considered in healthcare workers presenting with workplace-associated respiratory symptoms and rhinoconjunctivitis, particularly when symptoms occur during exposure to powdered latex gloves. This case highlights the importance of obtaining a detailed occupational history and combining clinical findings with allergy testing and pulmonary function assessment. Early recognition, appropriate asthma management, and reduction or elimination of latex exposure are essential. Further objective evaluation would be required to confirm the occupational relationship of the patient's asthma.