Can I take Repatha (evolocumab) if I have a latex allergy?

Can You Take Repatha if You Have a Latex Allergy?

Yes, you can take Repatha if you have a latex allergy, but you must use the latex-free formulation (the on-body infusor with prefilled cartridge), as certain Repatha presentations contain dry natural rubber in the needle cover that can trigger allergic reactions in latex-sensitive individuals. 1

Understanding the Latex Issue with Repatha

The FDA label explicitly warns that the prefilled single-dose SureClick autoinjector and prefilled single-dose syringe presentations contain dry natural rubber (a derivative of latex) in the needle cover, which may cause allergic reactions in individuals sensitive to latex. 1

The label specifically instructs healthcare providers to:

• Consider prescribing a presentation of Repatha that does not contain dry natural rubber for individuals that are sensitive to latex 1
• Instruct patients to inform their healthcare provider if they are sensitive to latex 1

Which Repatha Formulation to Use

The single-dose Pushtronex system (on-body infusor with prefilled cartridge) is the latex-free option that should be prescribed for latex-allergic patients. 1

The three available formulations are:

• Injection: 140 mg/mL in prefilled SureClick autoinjector - CONTAINS LATEX (avoid) 1
• Injection: 140 mg/mL in prefilled syringe - CONTAINS LATEX (avoid) 1
• Injection: 420 mg/3.5 mL in Pushtronex system (on-body infusor) - LATEX-FREE (use this) 1

Type of Latex Allergy Matters

Your clinical approach should differentiate between:

Type I (IgE-mediated) latex allergy - This is the serious, potentially life-threatening form that can cause:

• Urticaria and angioedema 2, 3
• Bronchospasm and respiratory symptoms 2, 3
• Anaphylaxis 4, 2
• Cardiovascular collapse 4

Type IV (contact dermatitis) latex allergy - This delayed hypersensitivity is less concerning:

• Patients with only Type IV reactions can generally receive vaccines and medications in containers with natural rubber stoppers 5
• However, for Repatha, direct skin contact with the needle cover makes this distinction less relevant—still use the latex-free formulation 1

Risk Assessment for Your Patient

Identify if your patient is in a high-risk group for severe latex reactions:

• Patients with spina bifida or multiple surgical procedures (highest risk) 4, 2
• Healthcare workers with occupational latex exposure 4, 6
• Patients with atopy 4
• Individuals with cross-reactive food allergies (banana, kiwi, avocado, chestnut) 4, 2, 3, 6
• Patients with severe hand dermatitis 4

Clinical Decision Algorithm

1. Document latex allergy status in the medical record prominently 4

2. Determine allergy severity:

   • If history of anaphylaxis to latex → Mandatory avoidance 4
   • If contact dermatitis only → Still use latex-free formulation for direct contact devices 5

3. Prescribe the appropriate formulation:

   • Use ONLY the on-body infusor (Pushtronex system) for latex-allergic patients 1
   • Do NOT use the autoinjector or prefilled syringe 1

4. Ensure emergency preparedness:

   • Have epinephrine available during first administration 4
   • Monitor for 30-60 minutes after first dose 4
   • Prescribe epinephrine auto-injector for home use if severe latex allergy 4

Important Caveats and Pitfalls

Do not assume all presentations are the same - The autoinjector and syringe contain latex while the on-body infusor does not. This is explicitly stated in the FDA label. 1

Rubber stoppers on medication vials are controversial - While some evidence suggests trace latex from vial stoppers rarely causes reactions 7, the FDA label for Repatha does not specifically address this, and the direct contact with needle covers is a more significant concern. 1

Cross-reactivity with foods should prompt heightened vigilance - If your patient reacts to banana, kiwi, avocado, or chestnut, they are at higher risk for severe latex reactions. 4, 2, 3, 6

Anaphylaxis from latex can be delayed 30-60 minutes after exposure, so observation periods are critical for first doses. 4

If anaphylaxis occurs, epinephrine is first-line treatment - Do not delay epinephrine to give antihistamines, as this delay has been associated with fatal outcomes. 4