Medicines Q&As
Q&A 331.1a
Which dental local anaesthetics are latex-free?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
Before using this Q&A, read the disclaimer at www.ukmi.nhs.uk/activities/medicinesQAs/default.asp
Date prepared: January 2012 (reviewed December 2012)
Summary
 Natural rubber latex (NRL) is present in many medical products, including disposable gloves,
adhesive tape and bungs in medicine vials.
 People sensitised to NRL are at risk of developing allergic reactions, which can present with delayed
symptoms such as a localised red itchy rash or with immediate symptoms such as itching of the skin
and eyes, sneezing, bronchospasm or anaphylactic shock.
 People sensitised to NRL should avoid contact with all products that contain it, either in the product
itself, in the packaging or introduced during the manufacturing process.
 This Medicines Q&A provides a list of local anaesthetic preparations used in dentistry which are
latex-free.
Background
Natural rubber latex (NRL) is a strong, flexible, hard-wearing and protective material used to make many
medical products, including disposable gloves, adhesive tape, bandages, dental dams, bungs in
medicine vials, syringes and venepuncture-related equipment [1,2]. Between 1 and 6% of the general
population are potentially sensitised to proteins in NRL and at risk of developing an allergic reaction after
contact or after inhaling powder containing NRL [3,4]. Allergic reactions to NRL include a type IV reaction
resulting in a red itchy rash in the area in contact with NRL, that can become widespread, or less
commonly, a type I reaction presenting as immediate hypersensitivity with itching of the skin and eyes,
sneezing, bronchospasm or anaphylactic shock [2,3]. Type I reactions occur immediately after exposure
to NRL in sensitised individuals and can be life threatening; type IV reactions usually occur six to 48
hours after exposure and may be in response to chemicals used in the rubber manufacturing process,
rather than NRL itself [3]. NRL can also cause irritant contact dermatitis, but this is not a true allergy [3].
People sensitised to NRL should avoid contact with all products containing NRL [1,4-7]. Contact between
NRL and a mucosal surface (such as mouth and nose) causes a more severe reaction than contact with
intact skin [4,6]. Unfortunately most products are not labelled to warn that they contain NRL [1]. NRL may
be found in the product itself, in the packaging or be introduced during the manufacturing process (for
example, through contact with powdered latex gloves worn to ensure sterility of the product). This
Medicines Q&A provides a list of local anaesthetic preparations used in dentistry which are latex-free.
See Appendix One for a glossary of terms and Appendix Two for a list of additional sources of
information on latex allergy including some with specific relevance to dental practice. For advice on
managing patients with allergy to local anaesthetic agents due to other causes, see Medicines Q&A
Allergy to local anaesthetic agents used in dentistry – what are the signs, symptoms, alternative
diagnosis and management options?
Answer
The following tables list products that:


are latex-free – there is no latex in the product or packaging, and the product has not been in
contact with latex during the manufacturing process. This is shown by green highlighting.
contain latex (red highlighting), or may contain latex (orange highlighting) because, although the
products and/or packaging do not contain latex, they cannot be guaranteed to have been free of
contact with latex during manufacture.
Which dental local anaesthetics are latex-free?
From the NHS Evidence website www.evidence.nhs.uk
Medicines Q&As
Latex-free dental local anaesthetics
The following products are latex-free – there is no latex in the product or packaging, and the product has not been in contact with latex during manufacture.
Brand name
Ingredients
Presentation
Company
Ref
Articaine 4% with adrenaline 1:100,000
Articaine 4% with adrenaline 1:100,000
Articaine 4% with adrenaline 1:100,000
Articaine 4% with adrenaline 1:200,000
Articaine 4% with adrenaline 1:100,000
Articaine 4% with adrenaline 1:100,000
Articaine 4% with adrenaline 1:200,000
2.2mL cartridge
2.2mL cartridge
1.8mL cartridge
1.8mL cartridge
2.2mL cartridge
2.2mL cartridge
2.2mL cartridge
Kent Express
Dental Directory
8
8
9
9
8
8
8
Lidocaine 2% with adrenaline 1:80,000
Lidocaine 2% with adrenaline 1:80,000
Lidocaine 2% with adrenaline 1:80,000
Lidocaine 2% with adrenaline 1:80,000
Lidocaine 2% with adrenaline 1:80,000
Lidocaine 2.5% and prilocaine 2.5%
Lidocaine 5%
Lidocaine 10% spray
2.2mL cartridge
2.2mL cartridge
1.8 and 2.2mL cartridge
2.2mL cartridge
2.2mL cartridge
25g tube
15g tube
36g bottle
Septodont
Kent Express
Septodont
Henry Schein
Dental Directory
Dentsply
Mepivacaine 2% and adrenaline 1:100,000
Mepivacaine 3%
2.2mL cartridge
2.2mL cartridge
Septodont
8
8
Prilocaine 3% and felypressin 0.03units/mL
2.2mL standard and 2.2mL self-aspirating cartridge
Dentsply
10
Articaine
Artikent
Bartinest
Espestesin
Isonest
Septanest
3M ESPE AG
Henry Schein
Septodont
Lidocaine
Eurocaine
Lignokent
Lignospan Special
Rexocaine
Utilycaine
Oraqix periodontal gel
Xylonor gel
Xylonor spray
Septodont
8
8
8
8
8
10
8
8
Mepivacaine
Scandonest Special
Scandonest Plain
Prilocaine
Citanest with Octapressin
Which dental local anaesthetics are latex-free?
From the NHS Evidence website www.evidence.nhs.uk
Medicines Q&As
Dental local anaesthetics which are not latex-free
The following products:
 contain latex (red highlighting), or
 may contain latex because, although the products and/or packaging do not contain latex, they cannot be guaranteed to have been free of contact with
latex during manufacture (orange highlighting).
Brand name
Ingredients
Presentation
Company
Ref
Lidocaine 2% with adrenaline 1:80,000
Lidocaine 2.5% and prilocaine 2.5%
Lidocaine 10% spray
2.2mL standard and 2.2mL self-aspirating cartridge
5g tube (with or without dressings)
50mL bottle
Dentsply
10
11
11
Tetracaine 4%
1.5g tube
Smith & Nephew
Healthcare
Lidocaine
Xylocaine*
Emla cream$
Xylocaine spray
AstraZeneca
Tetracaine
Ametop gel$
12
* The product has not been tested for presence of latex – it is assumed, therefore, to contain latex.
$ These products are not dental local anaesthetics but are included in the table because they may be used by dental health professionals for topical anaesthesia prior to
procedures such as venepuncture or venous cannulation.
Limitations
Formulations may be subject to change, but the information contained in this document is accurate at the time of publication. The document will be updated
once a year.
Which dental local anaesthetics are latex-free?
From the NHS Evidence website www.evidence.nhs.uk
Medicines Q&As
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Latex Allergy Support Group. About NRL (natural rubber latex). Available at
www.lasg.org.uk/information/about-nrl-natural-rubber-latex (accessed 14/12/2012).
NHS Plus, Royal College of Physicians, Faculty of Occupational Medicine. Latex allergy: occupational
aspects of management. A national guideline. London: RCP, 2008. Available at
www.hse.gov.uk/healthservices/latex/allergyguide.pdf (accessed 14/12/2012).
Latex Allergy Support Group. NRL (natural rubber latex) allergy. Available at
www.lasg.org.uk/information/nrl-natural-rubber-latex-allergy (accessed 14/12/2012).
Allergy UK. Latex rubber allergy. August 2009. Available at www.allergyuk.org/fs_rubberlatex.aspx
(accessed 14/12/2012).
British Dental Association. Hand dermatitis and latex allergy. Fact file. May 2008. Available at
www.bda.org/Images/hand_dermatitis_factfile.pdf (accessed 14/12/2012).
Latex Allergy Support Group. Patient information sheet: Latex allergy. Available at
www.lasg.org.uk/_common/_core/server/svr-download.asp?fle=/ftp/resource-downloads/Latex-AllergyPatient-Information-Leaflet.pdf (accessed 14/12/2012).
British Association of Dermatologists. Patient information gateway leaflets – How to prevent a latex
allergy. Available via http://www.bad.org.uk/site/1040/default.aspx (accessed 14/12/2012).
Personal communication. Septodont. 5/12/12.
Personal communication. 3M ESPE AG. 6/12/12.
Personal communication. Dentsply. 12/12/12.
Personal communication. AstraZeneca. 7/12/12.
Personal communication. Smith & Nephew Healthcare. 6/12/12.
British Association of Dermatologists. Patient information gateway leaflets – Latex Allergy. What is
latex allergy? Available via www.bad.org.uk/site/1031/default.aspx (accessed 14/12/2012).
British Association of Dermatologists. Patient information gateway leaflets – Latex allergy. Glossary.
Available via www.bad.org.uk/site/1030/default.aspx (accessed 14/12/2012).
Quality Assurance
Prepared by
Joanne McEntee. Medicines Information Pharmacist.
North West Medicines Information Centre, 70 Pembroke Place, Liverpool, L69 3GF.
Date Prepared
December 2011/January 2012 (date of review December 2012)
Checked by
Christine Randall (Senior Medicines Information Pharmacist) and Christine Proudlove (Director).
North West Medicines Information Centre, 70 Pembroke Place, Liverpool, L69 3GF.
Date of check
January 2012 (review checked December 2012)
Search strategy (completed Dec 2011)
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Embase ([*LATEX/] and [exp LOCAL ANESTHETIC AGENT/).
Medline ([LATEX/ or LATEX HYPERSENSITIVITY/] and [exp ANESTHETICS, LOCAL/ or LIDOCAINE/
or CARTICAINE/ or MEPIVACAINE/ or PRILOCAINE/ or EPINEPHRINE/ or FELYPRESSIN/]).
In-house database/ resources.
UKMi Latex database www.ukmicentral.nhs.uk/secure/L1/latex_database/default.asp
Evidence in Health and Social Care www.evidence.nhs.uk (free text [latex]).
Latex Allergy Support Association www.lasg.org.uk
British Association of Dermatologists www.bad.org.uk
Allergy UK www.allergyuk.org
National Patient Safety Agency www.npsa.nhs.uk
Health and Safety Executive www.hse.gov.uk (free text [latex]).
Which dental local anaesthetics are latex-free?
From the NHS Evidence website www.evidence.nhs.uk
Medicines Q&As


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Medicines and Healthcare products Regulatory Agency www.mhra.gov.uk
European Medicines Agency www.ema.europa.eu
Pharmaceutical manufacturers’ websites and medical information departments
External reviewers
 Ms Ann Clarke. Honorary Secretary, Latex Allergy Support Group.
 Dr Tina Dixon. Consultant Allergist, Royal Liverpool and Broadgreen Hospital.
 Dr Anne Field. Clinical Director and Consultant/Honorary Professor in Oral Medicine, Liverpool
University Dental Hospital.
 Dr Lesley Longman, Senior Lecturer/Honorary Consultant in Special Care and Restorative Dentistry, and
Clinical and Teaching Lead for Sedation and Special Care Dentistry, School of Dental Sciences,
Liverpool.
 Dr Mike Pemberton. Consultant in Oral Medicine, University Dental Hospital of Manchester.
 Dr Gavin Spickett. Consultant Clinical Immunologist, Royal Victoria Infirmary, Newcastle.
 Catherine Stephenson, Medicines Information Manager, Nottingham University Hospitals NHS Trust.
Appendix One. Glossary of terms [1,2,13,14].
Allergen
Allergy
Latex
Latex allergy
Latex-free
Latex-safe
Natural rubber
Natural rubber latex (NRL)
Rubber chemical allergy
Synthetic rubber
Type I allergy
Type IV allergy
Substance that causes the immune system to overreact.
Excessive immune system response to a substance that is normally
harmless.
Common name for ‘natural rubber latex’.
Allergy to proteins in natural rubber latex.
Contains no natural rubber latex proteins.
Term used to describe an environment that minimises the risk of a reaction
occurring in sensitised or allergic individuals. This is achieved by removing
natural rubber latex products most likely to cause a reaction.
Type of rubber made from natural rubber latex.
Name given to the milky liquid or ‘sap’ that comes from the rubber tree
Hevea brasiliensis, grown mainly in Thailand and Malaysia.
Allergy to chemicals used in the manufacture of natural and synthetic
rubber.
Type of rubber made from petroleum, coal, oil, natural gas, or acetylene. It
contains no plant protein and therefore does not cause latex allergy.
Immediate hypersensitivity reaction characterized by urticaria, conjunctivitis,
rhinitis, bronchospasm and occasionally life threatening anaphylaxis. It is
mediated by immunoglobulin E (IgE) antibodies in sensitised individuals.
Allergy characterised by an eczematous rash often developing six to 48
hours after exposure; it may be due to latex proteins or chemical residues
used in latex processing. It is mediated by T-lymphocytes.
Appendix Two. Sources of information on latex allergy.
General information
Allergy UK
British Association of Dermatologists
Health and Safety Executive
Latex Allergy Support Group
National Patient Safety Agency
www.allergyuk.org/fs_rubberlatex.aspx
www.bad.org.uk/site/1029/default.aspx
www.hse.gov.uk/skin/employ/latex.htm
www.hse.gov.uk/pubns/indg320.pdf
www.lasg.org.uk
www.nrls.npsa.nhs.uk/resources/?entryid45=59791
For dental practice
British Dental Association
Latex Allergy Support Group
www.bda.org/Images/hand_dermatitis_factfile.pdf
www.lasg.org.uk/guidance/dental-practice
Which dental local anaesthetics are latex-free?
From the NHS Evidence website www.evidence.nhs.uk