Dr. Barbara Zucker-Pinchoff is not the only person for whom the New York theater scene had her up and out of her seat, but she may be the only person who had to run in fear for the door.
At a production of the acrobatic theater performance De La Guarda about 14 years ago, Zucker-Pinchoff and her family looked on in wonder at the costumed actors and the light show projected on a paper ceiling. But Zucker-Pinchoff felt something was not right.
"I turned to my husband and said, 'There's latex here, I'm going to have to leave,'" Zucker-Pinchoff, now 55, said. "As I left, the ceiling opens up and latex balloons come pouring out. I ran out of the theater."
Zucker-Pinchoff suffers from an allergy to latex, the natural rubber that comes from South American trees. Although the allergy is better understood now than it was 20 years ago, natural rubber latex is widely used and can pop up in unexpected places with serious consequences.
Balloons and other soft dipped rubber products are the classic offenders, and this category includes latex gloves, condoms, rubber bands and plastic bandages. The latex molecules in soft dipped products, where the rubber is kept liquid before the final molding, are quite volatile, free to escape into the air or be transferred to the skin.
With a hard dipped rubber product -- tires or hard plastic toys, for instance -- the latex protein molecules are bound up in the material and are much less likely to cause a reaction.
"[The process] has a direct bearing on how allergenic particular products are to somebody who has a latex allergy," said Dr. Marc Riedl, section head of Clinical Immunology and Allergy at the University of California Los Angeles.
Other every day items that can contain small amounts of latex include newsprint, pacifiers, kitchen gloves and the elastic in underclothing, particularly underwear, stockings and bras.
A Hidden Danger
Dr. Gary Stadtmauer, assistant clinical professor in the Department of Medicine at Mount Sinai School of Medicine in New York, said a latex allergy seems to be one of those where increased exposure leads to increased sensitivity. And the severity can vary over time. Often, those with the allergy find they become highly sensitive almost overnight.
Sue Lockwood, 51, was a surgical nurse and said she wore hundreds of latex gloves each week at the hospital where she worked. She had no history of allergies, but around 1990, she began having contact dermatitis and asthmalike symptoms. Her eyes would swell, and she would get hives. Soon after, her new allergy took a bad turn.
"I had an anaphylactic reaction, and there was nothing I was doing different," Lockwood said. "My body just could not take on any more protein."
Lockwood's latex allergy became so serious that she soon had to file for disability and Social Security, leaving her work in the medical world behind.
"It was a devastating nightmare, to start. It was unbelievable," said Lockwood, who is now co-director at the Milwaukee, Wis.-based American Latex Allergy Association, an organization she founded. "It took my whole life and turned it upside down."
Zucker-Pinchoff, who's allergy developed around the same time as Lockwood's due to her constant contact with latex proteins in hospitals, also left her career as an anesthesiologist at New York's Mount Sinai Medical Center.
"It was not only unsafe for me, this was unsafe for my patients," Zucker-Pinchoff said.
A New Epidemic
The rise in latex allergies, awareness and research began in the late 1980s and early 1990s, around the same time as awareness of the AIDS epidemic. Many in the health, food and other public service industries began to snap on latex gloves to protect themselves from the HIV virus. Manufacturers responded with quick production of more gloves that were cheaper.
But latex gloves pose more threat to those with latex allergies than other products, not only because of their composition but because of the powder used to make it easier to put the gloves on.
"On the whole, latex doesn't jump out and attack you," Zucker-Pinchoff said. Instead, the powder can bind latex protens, which then get aerosolized, making it easier for someone with an allergy to come in contact with or breathe in the latex.
As with most allergens, avoidance is the best way to prevent an attack. After Zucker-Pinchoff and Lockwood left their jobs, they both found their conditions became more manageable. Zucker-Pinchoff needed no medications while Lockwood needed occasional antihistamines and oral steroids.
Riedl said there has been a move toward using powder-free latex gloves as well as nonlatex gloves that use synthetic rubbers in hospitals because people are more aware of latex allergies.
Bringing a personal supply of nonlatex gloves to a hospital or a doctor's office and keeping some epinephrine and antihistamine handy are proactive things one can do in order to prevent or manage a reaction.
If the Glove Fits
But experts say interest in the issue has faded in the last five years.
"It's become blasé to even talk about latex allergy," said Dr. Hugh Windom, an allergy specialist and associate professor of medicine at the University of Southern Florida. "We're not seeing the numbers we used to, which is good news."
The prevalence of latex allergies in the general population has always been relatively low compared to at-risk groups -- health-care workers and people who undergo multiple surgeries.
The National Institute for Occupational Safety and Health estimate that about 1 percent of the general population is sensitive to latex, while about 12 percent of health-care workers, who are regularly exposed to the protein, are sensitive.
But the severity of a latex allergy and the widespread use of latex still call for caution.
Stadtmauer, of Mount Sinai School of Medicine, recalled one case of a woman who got hair extensions at a salon, not realizing that the glue used contained latex. The proteins were absorbed quickly through the scalp, and she had a reaction.
"Really, you don't know," Stadtmauer said. "It can crop up in unusual places."