Natural rubber latex (NRL) allergy is discussed in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, in Section 8.5, Natural Rubber Latex Allergy, and refers to an IgE-mediated immediate hypersensitivity reaction to one or more protein allergens in latex devices, especially gloves. Among health care workers, NRL allergy is the most common cause of occupationally induced rhinoconjunctivitis and asthma, and clinical manifestations range from dermatitis and contact urticaria, allergic rhinoconjunctivitis, and asthma, to anaphylaxis. Evaluating physicians must be cognizant that a suggestive clinical history is necessary but not sufficient to diagnose NRL allergy, and FDA-approved NRL-specific IgE serum tests may have sensitivity as low as 75% and up to 27% false-positive results. No FDA-approved skin test reagent is available for testing. In evaluating impairment due to NRL allergy, evaluators should determine if the individual's problem can be resolved by avoidance of wearing latex gloves. Most patients who have asthma or air passage disruption impairment due to NRL have problems with bronchospasm only when they are exposed, and these patients may not necessarily have any ratable impairment due to NRL (but individuals who have atopic dermatitis may have ongoing symptoms due to pre-existing allergic rhinitis). Efforts to decrease the incidence of NRL allergy have been encouraging, and some patients diagnosed with NRL allergy may return to work in a latex-safe environment.

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