Adverse Reactions to Latex Products: Preventive and

Therapeutic Strategies for Oral Healthcare Settings

Michaell A. Huber, DDS; Gza T. Terzhalmy, DDS, MA
Continuing Education Units: 2 hours

Online Course: www.dentalcare.com/en-US/dental-education/continuing-education/ce81/ce81.aspx

Disclaimer: Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or
procedures into their practice. Only sound evidence-based dentistry should be used in patient therapy.

This course is based on a review of the literature and presents the etiology and epidemiology of adverse
reactions to latex products, clinical manifestations of adverse reactions to latex products, and strategies for
the prevention and treatment of adverse reactions to latex products.

Conflict of Interest Disclosure Statement

Dr. Huber reports no conflicts of interest associated with this course.

Dr. Terzhalmy has done consulting work for Procter & Gamble and is a member of the dentalcare.com
Advisory Board.

ADA CERP

The Procter & Gamble Company is an ADA CERP Recognized Provider.

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying
quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses
or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
Concerns or complaints about a CE provider may be directed to the
provider or to ADA CERP at: http://www.ada.org/cerp

Approved PACE Program Provider

The Procter & Gamble Company is designated as an Approved PACE Program Provider
by the Academy of General Dentistry. The formal continuing education programs of this
program provider are accepted by AGD for Fellowship, Mastership, and Membership
Maintenance Credit. Approval does not imply acceptance by a state or provincial board
of dentistry or AGD endorsement. The current term of approval extends from 8/1/2013 to
7/31/2017. Provider ID# 211886

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

Overview

Evidence-based infection control/exposure control practices are evolutionary in nature. Elements of

1
historical note were first recorded with the suggestions of Lister for guidelines on aseptic procedures.
Others, like Semmelweis, promoted the practice of hand washing by medical students and physicians prior
2
to leaving autopsy suites and before entering the labor and delivery areas of hospitals. Halstead is credited
3
with being the first to use surgical gloves in a clinical setting. While the use of latex surgical gloves became
routine by the end of World War I, it wasnt until the adoption of universal precautions by the Centers for
Disease Control and Prevention in 1987 that the use of gloves was officially expanded to cover virtually
4
all aspects of patient care. Since then the ubiquitous use of latex gloves and other latex products in
healthcare has resulted in a parallel increase in latex-associated adverse reactions. To provide for a safe
environment for both oral healthcare workers (OHCWs) and patients alike, clinicians must understand the
basis for latex-related adverse reactions, recognize associated signs and symptoms, and initiate appropriate
preventive and therapeutic strategies. The recommendations for preventing or minimizing latex-related
adverse reactions in the oral healthcare setting are based on current knowledge and a common sense
approach to the problem.

Learning Objectives

Upon completion of this course, the dental professional should be able to:
Discuss the etiology and epidemiology of adverse reactions to latex products.
Recognize the clinical manifestations of irritant contact dermatitis, allergic contact dermatitis, and
immediate allergic reactions.
Discuss diagnostic issues related to adverse reactions to latex products.
Establish strategies for the prevention of adverse reactions to latex products.
Implement strategies for the treatment of adverse reactions to latex products.

Course Contents

Etiology and Epidemiology

Latex is a product of the Brazilian Hevea

brazilienses rubber tree harvested mainly in
Malaysia, Indonesia, and Thailand.5-6 A milky sap
flows in lactifers under the surface of the bark,
which is collected by making diagonal cuts in
the bark of the tree. Once collected, ammonia
is added to the sap to prevent autocoagulation
and bacterial contamination of the latex.5,7,9 There
are two types of ammonia-latex concentrates:
high ammonia-latex concentrate (0.7% ammonia
by weight) and low ammonia-latex concentrate
(0.2-0.3% ammonia by weight). While the
higher ammonia concentration is more effective
in stabilizing the latex, it also increases the
incidence of irritant contact dermatitis.7,10

Etiology and Epidemiology

Clinical Manifestations
Irritant Contact Dermatitis
Allergic Contact Dermatitis
Immediate Allergic Reactions
Urticaria
Angioedema
Allergic Rhinoconjunctivitis and Asthma
Anaphylaxis
Diagnosis
Medical History
Laboratory Testing
Skin-patch Testing
Skin-puncture Testing (SPT)
Radioallergosorbent Test (RAST)
Glove Provocation Testing (GPT)
Preventive Strategies for the Oral Healthcare
Setting
Treatment Strategies
Conclusion
Course Test Preview
References
About the Authors

Natural rubber latex contains cis-1,4polyisoprene (the major component), proteins,

lipids, carbohydrates, and numerous inorganic
constituents such as potassium, manganese,
copper, zinc, and iron.11 Over 250 proteins have
been identified in latex and, depending on the
source; the overall protein content varies from
2

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

formers. Donning powder (typically cornstarch) is

recognized as a major vector for the development
of latex sensitivity.8,14,16-26 Free extractable proteins
not removed during the glove manufacturing
process may be adsorbed by the cornstarch.
During the donning, use and removal of these
gloves, the cornstarch-protein complexes come
in direct contact with skin and mucosal surfaces
or become suspended in the air (aeroallergens)
for up to six hours.27 Following direct contact,
mucosal surfaces appear to absorb latex proteins
much more readily than intact skin and exposure
to aeroallergens is considered the predominant
method of inducing latex sensitization in
healthcare workers.18.19,25,28 While an allergy to
cornstarch is rare, evidence exists that it may act
as an immunoadjuvant further increasing the risk
of latex-induced allergic reactions.7,18,29

1-1.8%. These proteins are involved in numerous

processes of biosynthesis and defensive,
structural, and housekeeping functions.9 While
about 30-60 latex proteins are believed to be
responsible for virtually all of the immediate
hypersensitivity reactions (Gell and Coombs Type
I), only 13 of these proteins have been classified
and labeled by the International Nomenclature
Committee of Allergens.5,11,12

Improvements in the manufacturing of latex

gloves includes the use of enzymatic processes
to breakdown raw latex proteins; increased
centrifugation of the raw latex liquid to separate
out more latex proteins; refined leaching
protocols; and chemical deproteinization during
the leaching process.8 In addition the use of
oat starch in lieu of cornstarch as a donning
powder appears to be associated with reduced
aeroallergen formation.25 An increasing number
of latex-free alternatives are also becoming
available; however, residual chemicals associated
with the manufacturing of non-latex gloves may
also induce delayed hypersensitivity reactions.8

Gloves are produced by one of two processes:

coagulant dipping or straight dipping.8 In
coagulant dipping a destabilizing chemical is
deposited on the formers, while in straight dipping
no destabilizing agent is used. After dipping, the
latex product on the former is washed (leached)
to remove residual chemicals and proteins.
In order to enhance elasticity, strength, and
stability it is then subjected to the process of
vulcanization (heating in the presence of sulfur).
To reduce the time and temperature required
for vulcanization, numerous accelerators and
promoters (thiurams, mercaptobenzothiazoles,
and carbamates) are added. After vulcanization,
post-cure leaching further removes residual
chemicals and proteins. Residual chemicals are
primarily responsible for allergic contact dermatitis
associated with latex glove use (Gell and Coombs
Type IV).7,9,10,13-15

The incidence of latex allergy in the general

population is 1 to 2 percent.30 Patients with spina
bifida, because of repeated exposure of mucous
membranes to latex during various medical/
surgical procedures, are at highest risk of latex
allergy with a prevalence rate that ranges from
20 to 67 percent.30 Healthcare workers have the
second highest risk of developing latex allergy
with sensitization rates that are three times higher
than in the general population.30,31,32 Healthcare
workers who are exposed to latex products on a
regular basis are at higher risk than those who are
not routinely exposed.7 There is also a positive
correlation between the risk of latex allergy and
the length of employment in healthcare.33 Finally,
exposure to powdered gloves appears to be
associated with symptoms of asthma, allergic
rhinitis, conjunctivitis, and angioedema.7,30,32

If the gloves are destined to be free of donning

powder, another washing followed by chlorination
and further washing is undertaken to reduce
the inherent tackiness of latex.8 Alternatively,
donning powder may be added by dipping the
gloves into slurry prior to removal from the
3

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

Clinical Manifestations

natural rubber latex during harvesting, processing,

or manufacturing.5,7,9,10,13,15,24,35,39 Many of these
processing chemicals are also utilized in the
manufacturing of nitrile and neoprene gloves.15
ACD is a T cell-mediated immune response. It is
characterized by a papular, pruritic rash; redness;
and itching, which usually begin 24 to 48 hours
after contact with offending products and may
progress to oozing vesicles and blisters and
spread to areas of skin untouched by latex15,41,42
(Figure 1). The reaction is similar to those caused
by nickel and poison ivy. A skin rash may be
the first sign of allergy to latex and more serious
reactions could occur with continued exposure.
Since the clinical signs and symptoms of ACD
are similar to ICD, it is necessary to confirm the
allergic nature of the reaction in order to avoid
further sensitization. The most frequently cited
allergen for glove-related ACD is the accelerator
thiuram.5,43 ACD can develop upon re-exposure to
an antigen many years after initial exposure.7

Adverse reactions following exposure to latex

products may be categorized as: (1) irritant
contact dermatitis, (2) allergic contact dermatitis,
or (3) immediate hypersensitivity reactions
(urticaria, angioedema, allergic rhinitis, asthma, or
anaphylaxis).5,7,10,14,34
Irritant Contact Dermatitis
The most common reaction to latex products,
specifically to latex gloves, is irritant contact
dermatitis (ICD). ICD, characterized by dry,
cracked, itchy, irritated areas of the skin (usually
of the hands) is not an allergy. The time of onset
is gradual (over several days) and may result
from abrasion and maceration from wearing
gloves constantly, repeated hand washing and
drying, incomplete hand drying, the use of
cleaners and sanitizers, exposure to powder
added to gloves, and exposure to other workplace
products and chemicals.5,7,10,35 These signs and
symptoms are similar to those associated with
allergic contact dermatitis, which can only be
ruled out by allergy testing. In one study, only
9 percent of healthcare workers who reported
symptoms of allergic contact dermatitis actually
had a latex allergy; the remainders had ICD.36 In
a study of dental students, of the 10 percent who
reported reactions to latex, only 1 percent had
confirmed diagnosis of latex sensitization.31 Other
studies suggest that 80 percent of the cases
of hand dermatitis are a result of ICD.34,37 It is
important to note that ICD increases the potential
for allergic sensitization.9,20,30,35-40

Immediate Allergic Reactions

The risk of progression from ACD to more
serious reactions is unknown, but at least some
patients initially develop ACD; then urticaria;
then allergic rhinitis, sneezing, scratchy throat,
conjunctivitis, angioedema, wheezing, asthma
(coughing, difficulty breathing); and, rarely,
anaphylaxis. Immediate allergic reactions are all
IgE mediated.24,34
Urticaria
Urticaria (local or generalized) is the most common
presentation of a type I hypersensitivity reaction to
latex (Figure 2). It likely reflects an IgE-mediated
immediate hypersensitivity reaction in response to
contact with latex proteins, although not all cases
are associated with detectable latex-specific IgE
antibodies. Symptoms usually occur within 10 to

Allergic Contact Dermatitis

Allergic contact dermatitis (ACD) is a delayed
hypersensitivity reaction (Gell and Coombs
Type IV) caused primarily by the accelerators,
promoters, and antioxidants that are added to

Figure 1. Allergic contact dermatitis characterized by rash, redness, and itching,

which began about 24 hours after dental treatment under a rubber dam.

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

Figure 2. Acute urticaria characterized by pruritic, red wheals that range from 1.5 to
3.0 cm in diameter, which began about an hour after exposure to latex gloves.

Figure 3. Angioedema characterized by localized, well-circumscribed, non-pitted

swelling affecting the lips.

15 minutes of direct contact and is characterized

by itching, redness, and wheal and flare reaction
at the site of contact. Urticaria may represent a
transitional stage in the progression from ACD to
immediate hypersensitivity. Reactions that occur
within 60 minutes of exposure to a latex product
are highly suggestive of IgE-mediated allergy,
while delayed or persistent urticaria is suggestive
of delayed hypersensitivity.44

proteins) on the mucosal surfaces of the eyes and

upper respiratory tract initiate the IgE-mediated
allergic response. If sufficient aeroallergens
penetrate below the level of the glottis, the
allergic response progresses to include asthma.22
An estimated 2.5% of healthcare workers are
susceptible to asthma induced by exposure to
latex aeroallergens.21
Anaphylaxis
Anaphylaxis is the most severe manifestation of
a type I hypersensitivity reaction. Latex proteins
interact with IgE antibodies found on tissue mast
cells and peripheral blood basophiles. A massive
release of histamine and other mediators initially
results in weakness, dizziness, and cutaneous
symptoms such as flushing and urticaria.
Anaphylaxis progresses rapidly and sequentially
to include laryngeal edema (resulting in stridor),
bronchospasm (resulting in wheezing); followed by
hypotension, tachycardia, and vascular collapse as
a result of decreased systemic vascular resistance
(Figure 4).45 While anaphylaxis is seldom the first
sign of latex allergy, latex exposure is estimated
to account for 12 to 40 percent of anaphylactic
reactions that occur during adult surgery.30,46,47 In
oral healthcare settings, anaphylactic reactions to
latex products have been reported to occur with

Angioedema
Angioedema may be a feature of urticaria. It
is characterized by episodes of localized, wellcircumscribed, nonpitting swelling commonly
affecting the lips (Figure 3), face, limbs, trunk,
abdominal viscera, and larynx. When edema
affects the larynx, upper airway obstruction can
be severe and life threatening. Involvement of
the gastrointestinal tract is associated with severe
pain.
Allergic Rhinoconjunctivitis and Asthma
Nasal congestion, sneezing, rhinorrhea,
watery eyes, and an itching sensation of the
oropharyngeal mucosa are clinical symptoms of
a type I hypersensitive reaction known as allergic
rhinoconjunctivitis.22 It is generally accepted
that deposits of aeroallergens (in this case latex
5

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

Figure 4. Anaphylactic reactions to latex allergens in the oral healthcare setting

characterized by angioedema of the lips and oropharynx associated with stridor,
wheezing, hypotension, and tachycardia.

exposure to gloves, dental rubber dams, and

exposure to latex-related aeroallergens.7 Rapid
detection of signs and symptoms with immediate
intervention is necessary to prevent serious
complications and death.10,48

known to have allergens that cross-react with

latex.30,36
Many latex proteins, collectively called
pathogenesis-related (PR) proteins, serve
to protect the rubber tree from a variety of
environmental threats such as infections (fungal,
bacterial, and viral), wounding, and chemical
insults.50 These same proteins are also expressed
in numerous other plant species.51,52 For example,
the latex protein -1,3-glucanase shares high
association with the -1-3-glucanase proteins
found in avocado, banana, chestnut, and
kiwi. Other latex PR proteins share moderate
association with analogous proteins in apple,
carrot, celery, melon, papaya, tomato, and potato.
Low or undetermined association exists between
still other latex PR proteins and many other
fruits and vegetables, e.g., turnip and zucchini.53
It is estimated that a patient with a history of
fruit allergy has an 11% risk of concurrent latex
allergy.59 Conversely, up to 50% of patients with
latex allergy are hypersensitive to some plantderived foods.5,30,54

Diagnosis

The diagnostic algorithm

for latex allergy entails
obtaining a thorough medical
history, skin-patch testing for
diagnosing type IV delayed
hypersensitivity, i.e., allergic
contact dermatitis; serum
IgE measurement to confirm
suspected severe latex
allergy, i.e., type I immediate
hypersensitivity; and glove
provocation testing when the patients clinical
history is incongruent with IgE results.7,29,49
Medical History
Obtaining a complete medical history is the
first step in diagnosing latex allergy. OHCWs
and patients who relate a history of papular,
pruritic rash of the skin; rhinitis; conjunctivitis;
urticaria (local or generalized); angioedema; and
coughing, shortness of breath, or wheezing; and/
or a drop in blood pressure following exposure
to latex should be suspected of latex allergy. As
noted earlier, certain patient populations (i.e.,
those with neural tubal defects and occupational
exposure) are at higher risk for latex allergies
than the general population. Other risk factors
include a history of atopy (persons predisposed
to multiple allergies such as those with a
familial history of hay fever, asthma, dry skin,
or eczema), multiple surgeries, previous hand
dermatitis of any kind, and allergies to foods

Laboratory Testing
There is no standardized testing protocol for
diagnosing latex allergy and screening for latex
allergy in the general population has not been
found useful and is not indicated.7,55 However,
testing may be helpful in high-risk patients (e.g.,
patients with a high number of previous surgical
procedures, a history of atopy, and a history of
adverse reaction to latex).28,47,56
Skin-patch Testing
Skin-patch testing is a sensitive test for diagnosing
type IV delayed hypersensitivity reactions to
rubber additives (e.g., chemical accelerators,
6

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

CA, USA], ImmunoCAP [Phadia AB, Portage,

MI, USA], CLA Allergen-Specific IgE Assay
[Hitachi Chemical Diagnostics, Mountain View,
CA, USA], and HY TECH-288 [Hycor Biomedical
Incorporated, Garden Grove, CA, USA] licensed
by the FDA. Their sensitivity and selectivity is
variable, ranging from 50 to 90 percent and 80 to
87 percent, respectively.30
Glove Provocation Testing (GPT)
GPT is useful when the patients clinical history is
inconsistent with IgE results.30 During the test, the
patient wears one finger of a latex glove while the
physician watches for a reaction. If there is no
urticarial reaction after 15 minutes, the exposed
surface area is increased. The test concludes
when an urticarial response is identified (i.e., a
positive provocation test), or when the patient
is able to wear the full glove for 15 minutes with
no reaction (i.e., a negative provocation test).7,30
Because of variations of latex content in gloves,
this test has varied sensitivity and could be
unsafe in highly sensitized persons.7

antioxidants) and helps to differentiate ACD from

ICD. It is performed by applying allergen samples
to intact skin and covering them with a dressing.
The patient is checked for skin reaction at 30
minutes, 24 hours, and 48 hours.7,30 Swelling,
redness, or blistering characterize a positive
test. If the test is negative, the site is reexamined
again at 72 and 96 hours because weak reactions
may appear later. A refinement of the technique,
the thin layer rapid use epicutaneous (TRUE)
test (Allerderm, Petaluma, CA, USA), has been
licensed by the FDA and is available commercially.
The TRUE test consists of a pre-prepared testing
strip containing 24 of the most common contact
allergens, including four rubber screening mixes
and mercaptobenzothiazole.9

Preventive Strategies for the Oral

Healthcare Setting

To prevent cross-contamination, oral healthcare

workers must perform proper hand hygiene (work
practice controls) and wear gloves (engineering
controls) during the treatment of all patients and
when cleaning and disinfecting instruments,
dental units, and environmental surfaces.58,59
Sterile surgical gloves are used during surgery.
Non-sterile examination gloves are used for
routine examinations, restorative procedures,
and preventive care and thick utility gloves are
used during cleaning procedures. Most available
glove types contain latex proteins in variable
amounts, as well as processing chemicals that
are responsible for precipitating type I or type IV
allergic reactions, respectively.

Skin-puncture Testing (SPT)

The skin-puncture test (SPT) is the most sensitive
testing method for diagnosing type I immediate
hypersensitivity reactions.30,36,55,57 A minute quantity
of allergen, sufficient to react with IgE antibodies
fixed in cutaneous mast cells, is introduced into
the epidermis at a single point. After 15 minutes,
a wheal formation equal to or larger than half the
control signifies a positive response.30 However,
SPT should only be performed at medical centers
with staff experienced and equipped to manage
severe IgE-mediated immediate hypersensitivity
reactions and an FDA-approved latex skinpuncture testing reagent is not available in the
United States.30,42

The proteins responsible for latex allergies fasten

to the powder (cornstarch) used as a donning
lubricant in some gloves. While cornstarch is an
extremely rare sensitizing agent, when powdered
gloves are used, more latex proteins reach the
host. During donning, use, and removal, the
water-soluble cornstarch/latex protein particles
become airborne. These aerosols can be
inhaled and absorbed systemically, causing
conjunctivitis, rhinitis, and asthma. Work areas,

Radioallergosorbent Test (RAST)

The radioallergosorbent test (RAST), a
quantitative measurement of allergen-specific IgE
antibodies, is considered to be the safest testing
method for confirming suspected severe latex
allergy because there is no risk of anaphylaxis.30
There are a number of assays (e.g., Alastat
[Diagnostic Products Corporation, Los Angeles,
7

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

where only powder-free gloves are used, show

low or undetectable levels of allergy-causing
latex proteins.4,9,21,23,24 Consequently, low-protein,
powder-free gloves; or latex-free gloves provide a
primary prevention of latex allergy.32,60-62

by following the recommendations of the National

Institute for Occupational Safety and Health
(Figure5).28

Treatment Strategies

Once an individual becomes allergic to latex,

special precautions are needed to prevent
exposure at home, at work, and during medical
and dental care. They should also be aware
of common natural rubber latex products, as
well as foods with cross-reactive proteins.30
Pretreatment with antihistamines, corticosteroids,
and bronchodilators do not predictably prevent
latex or other IgE-mediated anaphylactic reactions,
consequently, complete latex avoidance is the
most effective approach to this problem.26 While
symptoms of latex allergy resolve quickly with
avoidance, elevated IgE levels can remain
detectable for more than 5 years after exposure,
suggesting the importance of long-term
avoidance.65 OHCWs and patients with a history of
type I hypersensitivity to latex should wear a Medic
Alert bracelet and carry epinephrine for emergency
use.39 Strategies for the management of emerging

The amount of latex exposure to produce

sensitization or symptoms of an allergic reaction
is unknown. However, reductions in exposure
to latex products have been reported to be
associated with decreased sensitization and
symptoms.19,24,36,44,63 Table 1 contains some of the
products used in dentistry that contain latex and a
list of alternative products.52 Practitioners should
routinely check with their suppliers to stay current
on the availability of latex-free substitutes. The
cost of latex alternatives and non-latex gloves
has been analyzed, and it was found to be less
expensive when compared to the disability and
liability costs associated with exposure to latex
products.6,64
Allergic reactions to latex products in the
healthcare setting can be minimized or prevented

52

Table 1. Dental products that frequently contain latex and alternatives.

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

adverse reactions to latex are presented in

Figure6.66,67

Reductions in exposure to latex products have

been reported to be associated with decreased
sensitization and symptoms, consequently, a
reasonable reduction of latex products in the oral
healthcare setting should be considered for the
protection of both OHCWs and the patient. Lowprotein, powder-free gloves, or latex-free gloves
provide a primary prevention of latex allergy.

Conclusion

Adverse reactions to latex products in the

oral healthcare setting can result in potentially
serious health problems; however, such adverse
reactions can be minimized or prevented.

Figure 5. Strategies for the prevention of adverse reactions to latex products.

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

Figure 6. Strategies for the treatment of allergic reactions to latex products.

10

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

Course Test Preview

To receive Continuing Education credit for this course, you must complete the online test. Please go to:
www.dentalcare.com/en-us/dental-education/continuing-education/ce81/ce81-test.aspx
1.

Naturally occurring proteins found in latex are believed to be responsible for inducing what
type of allergic reaction?
a. Type I
b. Type II
c. Type III
d. Type IV

2.

The process in which latex is heated in the presence of sulfur is termed:

a. Leaching
b. Vulcanization
c. Autocoagulation
d. Chlorination

3.

The most commonly used donning powder is ____________.

a. talcum
b. baby powder
c. cornstarch
d. oat starch

4.

During the donning process, donning powder may become suspended in the air for up to
__________.
a. 10 minutes
b. 1 hour
c. 6 hours
d. 24 hours

5.

Residual chemicals associated with the manufacturing of non-latex gloves may also induce
delayed hypersensitivity reactions.
a. True
b. False

6.

The most common form of adverse reaction to latex glove use is ____________.
a. irritant contact dermatitis
b. allergic contact dermatitis
c. immediate hypersensitivity reaction

7.

Factors contributing to irritant contact dermatitis include:

a. Frequent hand washing
b. Constant wearing of gloves
c. Exposure to donning powder
d. All of the above.

8.

Allergic contact dermatitis is ____________.

a. delaying hypersensitivity reaction
b. caused by latex proteins
c. caused by accelerators, promoters and antioxidants added during glove manufacturing
d. A and C

11

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

9.

One of your assistants develops a hand rash while working in the office. She relates that the
rash only occurs when she wears brand X, but not brand Y. She is most likely describing
what type of adverse reaction?
a. Irritant contact dermatitis
b. Allergic contact dermatitis
c. Immediate hypersensitivity reaction

10. The most common presentation of a type I hypersensitivity reaction is:

a. Asthma
b. Angioedema
c. Urticaria
d. Allergic rhinitis
11. Type I hypersensitivity reactions are mediated by:
a. IgA
b. IgD
c. IgE
d. IgM
12. The most serious manifestation of a type I hypersensitivity reaction is:
a. Anaphylaxis
b. Asthma
c. Angioedema
d. Allergic rhinitis
13. The diagnostic algorithm for latex allergy include _______________.
a. obtaining a thorough medical history
b. skin-patch testing for diagnosing type IV delayed hypersensitivity and serum IgE measurements
to confirm type I immediate hypersensitivity
c. glove provocation testing when patients clinical history is incongruent with IgE results
d. All of the above.
14. Historical clues to a possible latex sensitivity include:
a. Signs and symptoms of an allergic response after exposure to latex
b. Atopy
c. Multiple surgical exposures
d. All the above.
15. The risk of latex allergy in an individual with a fruit allergy is estimated to be ______.
a. 1%
b. 11%
c. 20%
d. 50%
16. Patch testing is diagnostic of a:
a. Type I hypersensitivity reaction
b. Type II hypersensitivity reaction
c. Type III hypersensitivity reaction
d. Type IV hypersensitivity reaction

12

Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

17. To reduce latex exposure, when performing routine restorative dentistry which of the
following is not recommended?
a. Use only properly sized surgical gloves.
b. Use reduced protein, powder-free gloves.
c. When possible, use latex-free products
d. Practice proper hand hygiene
18. When managing a patient who has a confirmed type I hypersensitivity to latex, which of the
following is not recommended?
a. Premedicate the patient with an antihistamine one hour prior to the appointment.
b. Schedule the patient for the first appointment of the day.
c. Schedule the patient for the last available appointment of the day.
d. A and C
19. The most effective medication available to manage allergic contact dermatitis is
____________.
a. Epinephrine
b. Benadryl
c. A topical corticosteroid
d. An oral H1 receptor antagonist
20. Which of the following medication is most critical for managing anaphylaxis?
a. Epinephrine
b. Benadryl
c. An inhaled beta2-adrenergic agonist
d. An oral H1 receptor antagonist

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Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

References

1. Newsom SWB. Pioneers in infections control Joseph Lister. J Hosp Infect 2003;55:246-253.
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About the Authors

Michaell A. Huber, DDS
Associate Professor
Head, Oral Medicine Division
Department of Dental Diagnostic Science
The University of Texas Health Science Center at San Antonio, Dental School
Dr. Huber is an Associate Professor, Head, Division of Oral Medicine, Department
of Dental Diagnostic Science, the University of Texas Health Science Center at San
Antonio, Dental School, San Antonio, Texas.
Dr. Huber received his DDS from the University of Texas Health Science Center at San Antonio Dental
School, San Antonio, Texas in 1980 and a Certificate in Oral Medicine from the National Naval Dental
Center, Bethesda, Maryland in 1988. He is certified by the American Board of Oral Medicine as an
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Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014

officer of the Dental Corps, United States Navy. Dr. Hubers assignments included numerous ships
and shore stations and served as Chairman, Department of Oral Medicine and Maxillofacial Radiology
and Director, Graduate Program in Oral Medicine, National Naval Dental Center, Bethesda, Maryland.
In addition he served as Specialty Leader for Oral Medicine to the Surgeon General of the United
States Navy, Washington, DC; and Force Dental Officer, Naval Air Force Atlantic, Norfolk, Virginia. He
has many professional affiliations and over the past 24 years, he has held a variety of positions in
professional organizations.
Since joining the faculty in 2002, Dr. Huber has been teaching both pre-doctoral and graduate dental
students at the University of Texas Health Science Center Dental School, San Antonio, Texas, and is the
Director of the schools Oral Medicine Tertiary Care Clinic. He is currently serving as the Public Affairs
Chairman for the American Academy of Oral Medicine. Dr. Huber has accepted invitations to lecture
before many local, state, and national professional organizations. He has been published in numerous
journals including: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology;
Dental Clinics of North America, Journal of the American Dental Association, and Quintessence
International.
Email: huberm@uthscsa.edu
Gza T. Terzhalmy, DDS, MA
Professor and Dean Emeritus
School of Dental Medicine
Case Western Reserve University
Dr. Terzhalmy is Professor and Dean Emeritus, School of Dental Medicine, Case
Western Reserve University. In addition, he is a Consultant, Naval Postgraduate
Dental School, National Naval Medical Center; and Civilian National Consultant for
Dental Pharmacotherapeutics, Department of the Air Force.
Dr. Terzhalmy earned a B.S. degree from John Carroll University; a D.D.S. degree from Case
Western Reserve University; an M.A. in Higher Education and Human Development from The George
Washington University; and a Certificate in Oral Medicine from the National Naval Dental Center. Dr.
Terzhalmy is certified by the American Board of Oral Medicine and the American Board of Oral and
Maxillofacial Radiology (Life).
Dr. Terzhalmy has many professional affiliations and over the past 40 years, has held more than
30 positions in professional societies. He has served as editor or contributing editor for several
publications, co-authored or contributed chapters for several books and has had over 200 papers
and abstracts published. Dr. Terzhalmy has accepted invitations to lecture before many local, state,
national, and international professional societies.
Email: TEREZHALMY@uthscsa.edu

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Crest Oral-B at dentalcare.com Continuing Education Course, Revised January 31, 2014