Sir,

In Cheung and Gillow's1 comprehensive review of latex allergy, they cite their own ‘brief telephone audit’ to assert that the awareness of latex allergy in ophthalmic theatres is ‘fairly low’. In my experience in three UK regions, the reverse is true. There is a heightened awareness of latex allergy among theatre staff, leading to a distorted risk assessment and an over-reactive response in the majority of cases. This can lead to unnecessary cancellations, last-minute disruption to theatres and theatre lists, and exposure of patients to the risks involved in their surgeon using unfamiliar gloves and equipment.

As the authors point out, a history of ‘latex allergy’ is nonspecific and often relates to a contact irritant dermatitis. However once elicited, this usually leads uncritically to latex allergy precautions. The disruption and costs involved in creating a ‘latex free’ environment could be avoided in many cases if healthcare staff distinguished between irritant dermatitis and true allergic skin reactions, or anaphylaxis. As with penicillin allergy, the true prevalence is much lower than that reported by patients; with penicillin it is less than 5% of those claiming allergy.2, 3 The presence of latex antibodies, or positive skin patch testing is no guide to clinically relevant latex allergy.1 In fact, there is no correlation between them.4 It seems that a history of actual allergic reactions has to be relied upon for guiding clinical practice and precautions.

Latex allergy is rare, even among health workers regularly exposed to latex.5, 6 The prevalence may or may not be increasing. What does appear to be increasing is the number of patients citing a history of latex allergy.

A search of the medical literature reveals no reported cases of allergic reactions to latex following an ophthalmic surgical procedure; only a local reaction from a Tonopen cover.7 This suggests that precautions in latex allergy should extend to instruments and products that come into direct contact with the patient, or gases they breath, that is, from anaesthetic equipment. Some of the precautions enforced for latex allergy cases seem excessive, and are unwarranted by the evidence.

The disruption and delay caused by these cases will have been experienced in most ophthalmic theatres, and according to the evidence of potential harm, appear to be out of proportion to the risks involved. It is not clear whether patients with a history of atopy, eczema, or food allergies require referral to dermatologists prior to surgery as Cheung and Gillow seem to suggest, particularly as there is no correlation between in vitro and in vivo testing, and allergic symptoms.

Practice in this area seems to be driven by caution rather than evidence, and is not being led by surgeons, who are often presented with a fait accompli. Should we not inject some reason into latex allergy practice?