Julie Marshall's worst nightmare is a latex balloon. "I'll have nightmares about a bouquet of balloons that I can't get away from. It's ridiculous," she says. Other sources of anxiety include rubber bands, elastic and spandex, corn, most fruit, the stickers on those fruits, and any new item that enters her house which she hasn't thoroughly researched. Also part of her reality: constantly washing everything in her home, not being able to eat prepared food since food service workers wear gloves, spending hours on the phone with manufacturers who aren't sure if their products contain latex or were made on equipment containing latex, and RSVPing "no" to every invite from a friend, since she can't be sure of the environment she'd be walking into.
Marshall, who is in her 30s and lives in Pennsylvania, is severely allergic to natural rubber latex, or rather, the proteins in milky sap harvested from rubber trees, which is then processed into latex. As much as 6 percent of the population (or 19 million Americans) have the allergy.
Most people with a latex allergy aren't too affected: Usually they get skin reactions like hives or swelling when they touch highly allergenic items like condoms, Band-Aids, or dishwashing gloves. But some people get asthma from breathing in airborne latex proteins. It's also common to become allergic to foods that contain similar proteins to rubber, like avocados, kiwis, and bananas. And, an unlucky few get full-blown, life-threatening anaphylactic reactions, similar to bee-sting allergies: rapid heartbeat, trouble breathing, shock—or worse.
Latex allergies first made it onto the medical radar in the late 1980s and early '90s, when an alarming number of patients with spina bifida began having severe, life-threatening anaphylaxis during surgery. Around the same time, large numbers of doctors, nurses, and other healthcare workers were reporting health issues, and even leaving their jobs because of it. Researchers concluded that the culprit was latex.
One of those researchers was Kevin J. Kelly, a professor and interim chairman of the department of pediatrics at the University of North Carolina at Chapel Hill. "It turned out that individuals who had frequent surgeries and whose general immunologic natures were allergic were most at risk," Kelly says. "So if you tend to get allergies to pollen and such things, or get asthma, you are at a higher risk of getting a latex allergy."
There's latex in a lot of medical equipment, but the biggest problem was gloves. Latex is present in more than 40,000 products, but the most allergenic items, like gloves and balloons, are made by dipping porcelain molds into latex, then treating them at low heat—about 140 degrees Fahrenheit for a few minutes. By contrast, things like rubber car tires are treated at about 600 degrees for an hour, which destroys the offending protein.
Rises in HIV and hepatitis during the '80s led to increased use of latex gloves, to protect healthcare workers from infection. The gloves not only contained high amounts of allergenic protein, but were lubricated with cornstarch powder, which turned them into airborne allergy bombs. "That cornstarch powder grabbed onto this protein and it would aerosolize into the air," Kelly says. "Estimating conservatively, we were seeing 10 percent of all healthcare workers get sensitized to latex in the early 1990s."
In response, many hospitals banned latex balloons, and some medical facilities have switched to latex-free gloves or make latex-safe procedures available to patients. Many glove manufacturers have also reduced the proportion of latex in their products. Kelly says that many—though not all—medical workers with latex allergy have been able to return to their jobs. However, not every place has made the switch, and problems remain. For example, the stoppers on medication vials are often made of latex. And, because those medications are administered by inserting needles directly through the rubber tops, drawing out the medication, then injecting it into patients, they pick up even more latex along the way.
Beyond medical settings, latex is much harder to avoid than many realize. The American Latex Allergy Association's site mentions the potential for mattresses and sofas made from latex materials to release allergens into the air. And because allergies build on each other, reactions can be unpredictable, which is one reason people sometimes don't realize they have an allergy. A person might have a strong reaction to a tiny amount of latex during the spring, when they're also suffering from other allergies like hay fever; at other times, they might be exposed to larger amounts of latex yet have a very mild reaction.
In theory, anyone should be able to call a manufacturer and find out if a product contains latex. But manufacturers don't always know the answer to this. Consider this statement from the Lance Armstrong Foundation, responding to an inquiry on the ALAA website about LiveStrong wristbands: "LiveStrong wristbands are made of 100% synthetic silicone rubber, and contain no latex. However, we cannot guarantee that the factory where they are manufactured did not have other latex items produced, so if you have a serious, terminal allergy related to latex, we do not recommend wearing the wristband."
For Julie Marshall, all of this means that even if a hospital assures her it's a latex-safe environment, or a product says on its label that it contains no latex, it's hard for her to feel entirely reassured. That anxiety in itself is another major and under-studied aspect of her condition; she feels constantly drained by the stress of maintaining vigilance about her exposure to latex.
To be clear, Marshall is an extreme outlier. Most people with latex allergy don't experience anything close to what she does. And there could be any number of other issues going on with her health, not just latex allergy. But whatever is going on, Marshall wants other people to know that, extreme as it may seem, winding up practically housebound and haunted by nightmares about balloons is, if not likely, at least within the realm of possibility.
"I think there are a lot of people who have [latex allergy] a lot worse than they realize, or would like to admit to. Because you don't want to be sick, you don't want to change your life, you think, 'Oh it's an allergy, no big deal,'" she says. "I'm hoping the situation I'm in, if nothing else, has a positive impact on other people, to encourage them to take precautions before it's too late."