Allergic contact dermatitis from natural rubber latex without immediate hypersensitivity

Case Reports Patient no. 1. A 42-year-old female nutritional support nurse presented with a 2-month history of itchy dry hands. She was treated initially with 1% hydrocortisone cream, but subsequently developed blisters on her hands, particularly the lateral fingers. Her job involved handling central lines, frequently requiring her to wear disposable NRL gloves. She had had previous episodes of eyelid dermatititis, apparently related to using powdered disposable NRL gloves. In 1988, she had an episode of acute generalized dermatitis which resolved spontaneously. She had had rhinitis as a child, her mother had asthma and her sister hay fever. She was patch tested to the European standard, preservative, vehicle, medicament and rubber series, together with small samples of Ansell Conform gloves and Marigold gloves. On both D2 and D4, she had positive reactions (π) to NRL and Marigold rubber gloves (both inside and outside surfaces). All other patch tests were negative. She was also prick tested to latex extract (Alyostal ST-IR, Stallergenes SA, France) and had an allergen-specific IgE test to NRL (Pharmacia CAP method; fluorometric assay): both were negative. Patient no. 2. A 78-year-old retired female shop assistant presented with a several-year history of a dry scaly eruption on contact with certain rubber products, occasionally associated with peri-orbital oedema. She would develop a sore mouth 24 h after dental treatment. She had a past history of hypertension, hypothyroidism,