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A 32-year-old medical technician had a history of acute eczematous dermatitis on her hands and wrist in the
distribution of the latex gloves she wore. The skin of her hands was dry, crusted, and thickened. The
eczematous reaction cleared after a 2-week vacation. After 72 hours back on the job, the eczematous dermatitis
returned and continued to grow worse. Which of the following characterizes the technician's reaction to the latex
gloves?
A. Irritant dermatitis
B. Type I reaction
C. Type II reaction
D. Type III reaction
E. Type IV reaction
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The correct answer is E. Sensitization to latex has become a major healthcare problem. Local skin irritations
are common but more severe allergic reactions occur, up to and including rare anaphylactic reactions that are
occasionally fatal. The immune responses to latex are immediate-type hypersensitivity (type I) reactions,
expressing themselves in minutes, and/or delayed-type hypersensitivity (type IV) reactions, which will express
themselves in 48-72 hours. The type I reactions are due to the IgE-mediated sensitivity to latex proteins while
the type IV reactions are due to a cell-mediated response to the chemicals that are added in the processing of
latex. The type IV response in this circumstance would be referred to as contact dermatitis.
Irritant dermatitis (choice A) can be observed in the early stages of sensitization and can be due to sweating,
rubbing, and residual soap. The timing of the reaction after 72 hours points to the type IV reaction rather than
an irritant dermatitis.
A type I reaction (choice B) would have been apparent in minutes with characteristic rhinitis, conjunctivitis,
urticaria, asthma, angioedema, or anaphylaxis after she put on her latex gloves.
A type II reaction (choice C) is a cytolytic response mediated by an antibody. The type II reaction is observed
in the context of hemolytic anemias, thrombocytopenia, neutropenia, etc.
A type III reaction (choice D) is an immune-complex response that sets into motion an inflammatory response.
