chapter 15. latex allergy
TRANSCRIPT
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Chapter 15
Latex AllergyConcern about latex allergy in the medical community has increased as health carepersonnel have seen an increase in reactions among both patients and themselves.
Latex is the second most common cause of i ntraoperative anaphylaxis, preceded
only by muscle relaxants (1).
Origin of Sensitivity
Natural latex is obtained from the sap of a rubber tree. During the manufacturing
process, many chemicals are added to the latex, depending on the design and
technical requirements of the f inished product. These substances may also be
allergenic. There may be as many as 240 potential ly allergenic substances in
processed latex products (2).
The increased incidence of latex allergy is b elieved to be due both to c hanges in
the manufacturing processes and increased use of latex-containing products.
Adoption of uni versal and stan da rd prec auti ons (Chapter 34) has greatly increased
latex exposure.
Latex sensit izat ion can occur as a result of contact via the skin or mucous
membranes, inhalation, ingestion, parenteral injection, or wound inoculation.
Latex-containing Products
Latex is ubiquitous in the home, workplace, and health care sett ing but is not
always obvious. In the operating room suite, i t is found in gloves; tracheal tubes;
Combitubes; face masks; mask straps; airways; wrappers on trays; laryngoscope
bulb gaskets; skin temperature monitors; rubber suction catheters; arm boards; bite
blocks; teeth protectors; breathing tubes; oxygen tubing; reservoir bags; v enti lator
hoses and bellows; resuscitat ion bags (black or blue, reusable); blood pressure
cuffs and tubing; stethoscope tubing; intravenous tubing injection ports;
tourniquets; s yringe plungers; rubber-shod c lamps; intravenous bag and tubing
ports; medication vial needle ports; tape and other adhesives (e.g., Esmarch
bandages, adhesive bandages); dental dams; elastic bandages (Ace wraps);
dressings (e.g., Coban, Moleskin, Micropore); rubber pads; protective sheets;
drains; electrode pads; rubber aprons; circulat ing f luid warming blankets; s ome cast
material; goggles; pulmonary artery catheter balloons; epidural catheter adapters;
intravenous (IV) medication pump cassettes; electrocardiogram (ECG) electrodes
and pads; f inger cots; ostomy bags; intest inal and stomach tubes; rubber bands;
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automobile tires; raincoats; computer mouse pads; earphones; household rubber
gloves; and carpet padding to name but a few (8,13).
Clinical Signs and SymptomsReactions to latex include a spectrum of non-immune and immune-mediated
responses. Signs and symptoms may be local or s ystemic and vary widely in
severity and the time of occurrence. Most adverse reactions to latex occur 30 to 60
minutes after induction (14 ,15 ). Symptoms can progress quickly from mild to
severe. In some cases, l i fe-threatening reactions a re the f irst to appear.
There are three types of reactions to latex: irr i tant contact dermatit is, Type IV
delayed hypersensit ivity, and Type 1 immediate hypersensit ivity (2,8,16 ).
I r r i t a n t Con t a c t De rma t i t i s
This is the most common type of glove-related reaction. I t results from the direct
act ion of latex and other irr i tant chemicals and consists of i tching, redness, scaling,
drying, and skin c racking. The rash is usually l imited to the exposed skin area.
Soaps, mechanical irr i tat ion from sc rubbing, and excessive sweating often
exacerbate it . While this is not a true allergy, disruption in skin integrity may
enhance absorption of latex allergens and accelerate the onset of allergic
reactions.
Type I V De l ay ed Hy pe r s en s i t i v i t y
Hypersensit ivity is an immune response that leads to tissue damage. Once
sensit ized, an individual's exposure to an antigen can cause a reaction. I t may take
several years for latex sensit ivity to develop. When it does, most develop as a Type
IV (delayed) reaction.
A Type IV rea cti on (all erg ic con tac t de rmati t is , de laye d hyp ersens i ti v ity) is a T-
cellmediated response characterized by a skin rash that appears up to 72 hours
after init ial contact and may p rogress to oozing skin b listers. Unlike irr i tant contact
dermatit is, al lergic contact dermatit is often spreads beyond the area of contact with
the allergen. Flushing, itching, rhinit is, di zziness, sinus s ymptoms, conjunctivit is,
and eyelid edema may also be present.
Not all individuals who develop Type IV hypersensit ivity progress to Type I, but
most individuals with Type I s ensit ivity have previously had Type IV symptoms
(2,16,17).
Type I Im m ed i a t e Hyp e r s en s i t i v i t y
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This is the most severe reaction and may lead to signif icant morbidity and mortality
(18). Symptoms usually appear short ly after exposure but can occur hours later.
They run the entire spectrum from mild (skin redness, hives, itching, rhinit is,
scratchy throat, i tchy or swollen eyes) to more severe (facial edema, faintness,
nausea, abdominal c ramps, diarrhea, cough, hoarse v oice, chest t ightness) to l i fe
threatening (laryngeal edema, bronchospasm, anaphylaxis). A survey of
anaphylaxis during anesthesia showed that cardiovascular symptoms, cutaneous
symptoms, and bronchospasm were the most common clinical features (19).
Anaphylax is is an imm ed ia te , severe , li fe -t hr eate ni ng al le rgic re spon se. Th ere are a
number of reports in the literature of anaphylactic reactions to latex
(1,2 ,4,7,20,21 ,22 ,23,24 ,25 ,26,27 ,28,29,30,31,32 ,33 ,34).
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Latex allergy should be high on the l ist of possibil i t ies when anaphylaxis occurs
during anesthesia and surgery. I t may not be apparent that latex is the causative
factor. I f medications have been injected in close proximity to the anaphylact ic
reaction, the anesthesia provider may suspect that medication caused the reaction
(32). Failure to recognize latex allergy can delay removal of latex-containing
products and delay effect ive treatment.
Individuals at Risk
Identifying patients at high risk for h aving an allergic latex reaction allows
preventive measures to be targeted (17 ). High-risk groups can be identif ied by
knowing the risk factors and appropriate questioning. Latex anaphylaxis may be
decreased by identifying at-r isk patients (19).
The reported prevalence of latex allergy varies greatly depending on the populat ion
studied and the methods used to detect sensit izat ion. Anyone with frequent
exposure to latex-containing materials is at increased risk of developing latex
allergy. The greater the exposure to latex in a populat ion, the greater the number of
sensit ized individuals. Extended or massive exposure in and of itself is neither
necessary nor suff icient to cause sensit izat ion if the person is not genetically
predisposed (35).
Children and younger adults are more l ikely to become latex s ensit ive than the
general population. Some but not all studies have found that women and members
of non-Caucasian races are more l ikely to have latex alle rgies (17,35 ,36 ,37,38 ).
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The majority of latex-sensit ive individuals have a history of atopy (predisposit ion to
mult iple allergic condit ions) or posit ive tests in atopy sc reening
(2,17,25,27,35,39 ,40 ,41,42 ,43 ). Many have a history of an anaphylactic reaction in
the past (8,36 ,43). Some studies have found a connection between an al lergy to an
anesthesia-related agent and latex (43 ,44).
Many patients with Type I latex allergy have a history of allergy to certain foods,
including bananas, mangoes, watermelons, avocados, peaches, figs, apples,
chestnuts, pineapples, kiwi, passion f ruit , apricots, nectarines, papaya, celery,
peanuts, cherries, strawberries, plums, potatoes, and tomatoes
(2,5 ,25 ,35,37,45,46). There may be cross sensit ivity between latex and f icus,
grasses, and ragweed (47). Patients with milk protein allergies may exhibit al lergic
reactions to latex products containing casein (48).
Individuals with hand dermatit is who wear latex gloves are at inc reased risk (35 ). A
history of glove-related symptoms does not reliably indicate latex allergy;
conversely, absence of symptoms does not rule out sensit izat ion (42 ).
Many latex-sensit ive individuals report swell ing or itching on the hands or other
areas after contact with rubber gloves, condoms, diaphragms, toys, or other rubber
products. Other symptoms include swell ing or i tching at the l ips or mouth from
blowing up balloons or after dental examinations (2).
Latex allergy incidence is highest for patients requiring mult iple operations along
with repetit ive urinary catheterizat ion. This includes patients with myelodysplasia,
congenital orthopedic defects, and congenital genitourinary tract abnormalit ies
(49). Spina bifida patients have a particularly high incidence. However, adults with
spinal cord injuries have a low risk of l atex sensit izat ion (50). Other high risk
groups include patients who undergo repeated esophageal d ilat ions, patients who
have frequent vaginal exams (part icularly those going through an in v itro
fert i l izat ion program) and are examined with a latex-covered ultrasound probe (51),
and patients undergoing barium enema procedures with a latex balloon t ip (17).
Other at-r isk patients for latex allergy include those who use gloves in their daily
act ivit ies: farmers, food-service workers, gardeners, painters, mortuary workers,
auto technicians, law enforcement personnel, waste removal workers, hairdressers,
individuals involved in the manufacture of latex products, and those with prior
reactions to l atex-containing devices.
Approx im ate ly 70 pe rc en t of ad verse ev ents to latex report ed to the Food and Drug
Admi ni stra t ion (FDA) in vol ve hea lth care wo rk ers . Withi n the medic al prof es sion ,
individuals who frequently use disposable gloves, including surgeons; anesthesia
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providers; operat ing room, postanesthesia care unit (PACU), and emergency room
personnel; dentists and dental assistants; and laboratory technicians are more
likely to become latex sensit ive t han other health care workers. Adult
anesthesiologists change gloves more often than pediatric anesthesiologists and
have an increased prevalence of latex sensit izat ion (52).
Diagnosing Latex Allergy
Latex allergy is diagnosed by his tory and confirmatory tests (53).
H i s t o r y
Standard questions to sc reen for latex allergy should be developed. There are
examples of screening tools for patients in the l i terature that can b e of assistance
in developing a questionnaire (46 ,54). The history should include the risk factors
and occupations where latex exposure is common, as discussed previously i n this
chapter.
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Con f i rma t o r y T e s t s
A patie nt wi th a hi story suspiciou s for latex al le rg y ma y be a cand ida te fo r
confirmatory test ing.
Immunologic test ing is not foolproof, part icularly in the case of latex, because of
the numerous dif ferent latex proteins. Testing requires a variety of latex antigens,
and there can be no c ertainty that a part icular antigen wil l be included in the test
solut ion (17). Because false negatives can occur, patients with a strong s uspicion
of latex allergy s hould be managed in a latex-safe environment even if immunologic
test ing indicates a negative reaction (17 ).
Skin-prick Test
The skin-prick test (SPT) is used to detect Type I latex allergy (38 ). A dilute
solut ion of latex allergen is placed on the skin, and the skin is pricked or scratched.
A wheal -an d-f lare react io n is considere d positiv e for latex sen si ti v i ty . Th is te st is
inexpensive and easy to administer and interpret. It offers reasonably good
sensit ivity and specif icity. Retrospective studies show that p atients with
intraoperative latex anaphylaxis are almost invariably latex-SPT posit ive (42).
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Drawbacks to the SPT include absence of an accepted test solut ion (2,5,9,17 ,55).
The risk of a s ystemic anaphylact ic reaction exists, but it is less than with
intradermal test ing.
Intradermal Test
With intradermal test ing, a small amount of a suspension or allergen is injected into
the skin. This method is more sensit ive than skin pricking, but the chance of
anaphylaxis is greater (17,56).
Patch Test
The patch test is available for diagnosis of Type IV delayed hypersensit ivity (8,38).
A sta ndard ize d patc h or a f ra gme nt of the la tex produc t is app lied to the sk in an d
checked over several days. A posit ive reaction includes i tching, redness, swell ing,
or blistering where the patch covers the sk in.
In Vitro Measurement of Antibodies
In vitro tests are used to measure specif ic antibodies against latex allergens in
blood samples (57). These tests are expensive, and the clinical signif icance of a
posit ive serologic test is unclear. Subjects with anti latex antibodies are termed
latex sensit ive , although many are n ot symptomatic and may never become so.
Challenge Tests
Challenge (provocation, use, wear) tests may be used if the results of other tests
are equivocal or if the person has a clinical history highly consistent with latex
allergy but results of other tests are negative (5,35 ,58). The potential ly allergic
person handles, wears, or inhales latex proteins and is observed for reactions.
However, there may be discrepancies in challenge test results, and no challenge
method has become broadly accepted by clinicians.
Preventing Reactions
Successful prevention of latex reactions requires a f acil i ty-wide s trategy. Healthcare facil i t ies should appoint a mult idisciplinary task force that includes
representatives from every professional component of the inst itut ion. I t should
include an allergist or i mmunologist as consultant. I t may be a good idea to have a
latex-sensit ive employee on the team (9). Among the duties of this task force
should be glove select ion, a mechanism for report ing latex reactions, formulat ing
policies and protocols for management of the latex-sensit ive patient, and health
care worker and educational programs (2 ,59 ,60).
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Medical products that contain latex wil l need to be identif ied and alternatives
established before an emergency arises. Manufacturers have made great str ides in
decreasing latex in a variety of products (57 ). I f i t is not possible to remove a latex
product, barriers should be placed between the l atex item and the patient.
Successful prevention of a llergic reactions wil l occur only when inst itut ions adopt
str ict policies to protect at-r isk patients from unnecessary latex exposure. At-r isk
children in a latex-containing environment are more l ikely to have an allergic
reaction than those in an environment where latex-containing articles have been
removed (3,61 ).
I t is impossible to totally eliminate latex exposure. The goal is to create a latex-
safe environment, that is, one in which the presence of latex antigens is minimized.
The need for education cannot be overemphasized. The majority of latex reactions
in a c enter with an established protocol were attr ibuted to human error (61).
Using powderless gloves should be a high priority (5 ,62 ,63 ). I t helps to minimize
reactions to latex at l i t t le added expense and decreases the amount of
aeroallergens i n the working environment. Oil-based hand creams or lot ions should
be avoided. They can break down latex and make the protein more l ikely to st ick to
the hands. When gloves are powdered, pull ing them on and off gently wil l minimize
aerosolizing the latex proteins.
Patients with known or suspected latex allergy should have their records f lagged
and wear l atex-allergy wristbands. Drug prophylaxis is sometimes undertaken (56 ).
Allerg ic re ac tio ns , inc lu ding anaphylax is, ma y occur even when prophylac tic agents
are used (3,64 ). While having these drugs already on board may lessen the
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severity of a reaction, they may mask the early signs of anaphylaxis, delaying
recognition and implementation of more aggressive treatment (17 ). Using H2
blockers may increase the risk of heart block for patients who develop anaphylaxis
(65).
I f pat ients requiring surgery have confirmed latex s ensit ivity or convincing histories
of latex reactions, avoiding latex-containing products is the only effect ive therapy.
This is not always easy, as latex allergens permeate the hospital. Even in the
absence of known latex allergy, some procedures involving patients with syndromes
such as spina bif ida should be performed in a latex-safe area (66 ). For high-risk
patient groups, avoiding latex products should begin at birth (67 ).
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The FDA requires that all medical products that contain latex that may direct ly or
indirect ly come into contact with the body during use to bear labels stat ing that the
product contains latex and that latex may cause allergic reactions in some
individuals (68) (Fig. 15.1). Governmental agencies in many other countries have
similar requirements (68). I f a product does not have this warning, it is l ikely that
the product is latex-free unless it is a pharmaceutical or is not regulated by the
FDA. Drug manufacturers are exempt from the labeling requirement ( 69).
Manufacturers frequently label devices as latex-free (Fig. 15.2).
The term hypoallergenicis no longer used for devices that contain latex. At
present, there is no test that can adequately determine the level of latex proteins in
a product, and there is no manufacturing process that can reduce the level below
the minimum required to produce a reaction in some people. Also, the total protein
content is not analogous to allergic r isk.
The latex-sensit ive patient should be scheduled as the f irst case of the day with al l
latex-containing materials removed the preceding night to minimize exposure to
airborne latex-laden part icles (2). No one should enter that operating room with
latex gloves without scrubbing after taking off latex gloves or while wearing clothing
from previous latex exposure.
View Figure
Figure 15.1Thermodilution catheter clearly marked ascontaining latex.
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Signs saying Latex Allergy or Latex Alert (fo r patients with signif icant r isk
factors for latex allergy but no overt signs or sy mptoms) should be posted inside
and outside the operating room as well as in perioperat ive care areas (Fig. 15.3).
View Figure
Figure 15.2Device labeled latex-free.
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View Figure
Figure 15.3A sign indicating possible latex allergy shouldbe placed outside the operating room door.
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Latex products should be l imited to situat ions where it is thought that they are
superior to nonlatex-containing products. Latex-free gloves with improved f it and
feel are available (70).
A ki t/ cart conta ini ng late x-free produc ts shou ld ac comp an y the pa tien t throughou t
his or her stay. Latex precaution st ickers should be placed on doctors' order sheets
and the l ike. Signs stat ing Latex Precautions or Latex Allergy should be placed
on the walls and doors of the patient's room. Any department that is to receive a
patient with latex allergy or sensit ivity should be notif ied prior to transfer to that
department.
Perioperat ive care areas where mult iple patients are managed in proximity (e.g.,
preoperative holding areas and PACUs) should be re-evaluated. If powdered gloves
are used in these areas, patients may be admitted directly to the operating room
and remain there during their recovery from anesthesia. If PACUs have isolation
rooms, they may be converted to latex-safe environments f or patients recovering
from surgery (71).
Some health care facil i t ies have established a specif ic operat ing room where all
latex-containing materials are banned. Signs should be posted on all entrances to
that operat ing room, reminding medical personnel of the s ituat ion (72 ). Traff ic in
the room should be kept to a minimum (2).
No latex-containing items (i.e., gowns, hats, boots, and compression stockings)
should be placed on the patient. Cords and tubes for al l monitoring devices should
be placed in stockinettes and secured with non-latex tape (73).
Latex-free intravenous s tart kits containing tourniquet, bandages, dressings, tapes,
and gloves are available. Intravenous tubing without latex inject ion ports should be
used or all latex inject ion ports should be taped to p revent inadvertent puncture.
Stopcocks or one-way valves should be used for push and piggyback medications.
Intravenous f luid or commercially prepared medication bags should be pierced
through the intravenous tubing port, not the latex injection port.
Al though reac tions to rub ber syri ng e pl un gers hav e bee n repo rt ed, no pro ble ms
have so far been described in medications freshly drawn and immediately
administered (74 ). I f latex-containing syringes are used, drugs should be freshly
prepared in the syringe immediately before use. Glass syringes offer an attract ive
alternative, and totally plast ic syringes and special needles are available
(75,76,77). I t is best to use medication from glass ampules, if available. Although it
has been advocated that the contents o f a vial should be drawn up after the rubber
stopper has been removed (17,47 ,78 ), this may not be beneficial and may result in
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increased microbial contamination and waste (79). Lyophil ized drugs in containers
with latex should be reconstituted by using a s yringe, not shaken in a mult idose vial
and withdrawn by using a f i l ter. Vials should be kept upright and not shaken (4).
A f i l te r shou ld be us ed at the bre ath in g sys te m pa t ie nt port to pro tec t agains t
airborne latex allergens (80,81).
I t may not be possible to entirely avoid some rubber-containing anesthetic
equipment-rubber bellows, diaphragms, valves, and tubings (82 ). However, when
these parts of equipment do not come into contact with the patient and have been
previously washed, no complicat ions have resulted (83 ).
Latex-free equipment including face masks, airways, mask straps, tracheal tubes,
bag-valve-mask units, reservoir bags, ECG electrodes and pads, s tethoscopes
(tubing or diaphragm), pulse oximetry sensors, esophageal stethoscopes,
nasogastric and suction tubes, tape, gas hoses, and breathing tubes should be
used. Unfortunately, some latex-free reservoir bags have such poor distensibil i ty
that their use may compromise patient safety (84).
I f an epidural catheter adaptor contains latex, it should be replaced with a blunt,
latex-free adaptor.
Latex-free reusable blood pressure instruments and accessories are available in a
variety of sizes and models. These include inf lat ing tubing, coiled tubing,
sphygmomanometers, and inflation bladders. Wrapping the area under the cuff with
soft cotton can prevent contact with any l atex in these devices.
In some cases, some improvising may be necessary, as with a pulmonary artery
catheter (85 ,86).
From the surgical point of v iew, using non-latex gloves, drains, and catheters is
mandatory. Special precautions should be undertaken to avoid latex-based
equipment such as i nstrument mats, rubber-shod clamps, vascular tags, bulb
syringes, rubber bands, and adhesive bandages. A non-latex glove can be used as
a
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Penrose drain, which can be a sou rce of latex hypersensit ivity (86A).
When latex-sensit ive patients or staff have been identif ied, it is i mportant to
provide latex-free items. These should be collected into a cart that can be called
into act ion as the need arises. The American Society of Anesthesiologists and
others have made recommendations for t he contents of a latex-safe cart (2,59,86).
Suggested items are listed in Table 15.1. Each item should give information on
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latex content and should be reviewed for this information prior to adding the item to
the latex-safe cart or before use.
TABLE 15.1 Suggested Contents of a Latex-safe Cart
Latex-free or glass syringesSyringe needlesIntravenous cathetersIntravenous tubing and extensions made from polyvinylchlorideStopcocks (in-line, three-way, and single)Latex-free heparin lock caps and T-pieces with side portAlcohol wipes in a new boxLatex-safe adhesive tape from a new box
Latex-free intravenous tourniquetsSterile gauze padsEsophageal thermometer
Disposable blood pressure cuffs of various sizesIsolation stethoscope
Sterile case paddingLatex-free disposable pulse oximetry finger sensors
Latex-free ECG electrodesLatex-free resuscitation bags sized for infants, children, and adults
Nasal oxygen cannulaOxygen extension tubing
Latex-free tracheal tubes, double-lumen tubes, and styletsLatex-free oral and nasal airways
Silicone supraglottic devicePlastic face masks and head straps (elastic strap may have latex)Medications for cardiac arrest and emergency situationsVinyl gloves for any size staffSterile nonlatex gloves, sizes 6 to 9Silicone urinary catheter in assorted sizesUrimeterEpidural and spinal traysPolyvinylchloride suction catheters, sizes 8 to 14 French
Anesthesia breathing circuits without latex componentsAnesthesia medications in vialsIn-line high efficiency particulate gas filterPolicy binder with all latex policies and protocolsReference guide for latex-containing materialsBrightly colored signs that warn of latex allergy
Treating Latex Reactions
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Heal t h Ca r e In s t i t u t i o n Respo ns i b i l i t i e s
Institutions should provide education programs and training materials about latex
allergy (71). This includes educating all staff members, not just p rofessional health
care providers. For example, environmental and nutrit ional service workers are
required to wear gloves; therefore, they should be knowledgeable about their glove
choices.
Staff should be encouraged to report al lergic symptoms and be periodically
screened for la tex-allergy symptoms. Detect ing symptoms early and protect ing
symptomatic workers from latex exposure are essential for preventing long-term
health effects. Prevention strategies should be re-evaluated whenever a worker is
diagnosed with latex allergy. Studies have s hown that economically feasible
interventions to reduce latex exposure can s uccessfully allow latex-allergic
individuals to continue working as well as decrease the number of new cases of
occupational latex allergy (5).
The use of powderless gloves (Fig. 15.4) should be encouraged. In a s tudy in which
health care workers used both powdered and powder-free gloves, the rate of
conversion to latex sensit ivity was the same i n each group, but the c onverters using
powdered gloves were s ymptomatic whereas the ones using powderless gloves
showed no symptoms (92 ).
Using non-latex gloves for act ivit ies that are not l ikely to involve contact with
infectious materials (food handling, housekeeping, transport) should be
encouraged. This can greatly reduce the levels of latex antigens in the
environment.
Wearing non-latex gloves or using some type of barrier between the latex gloves
and the skin should be encouraged. Non-latex gloves are usually more expensive
than gloves containing latex (97 ). I t is l ikely, however, that the price dif ferential can
be decreased if the facil i ty were to choose a single vendor of latex-free gloves. I f a
worker must move to another job to avoid latex-containing materials and the new
job pa ys les s, tha t wo rk er ma y be eligibl e fo r workers' compens ati on . It is also
possible that workers could become so sensit ized that employment is not possible.
Very low levels of permanent disabil i ty are needed to make the conversion to l atex-
free gloves cost effect ive (97).
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View Figure
Figure 15.4Gloves that are both powderless and latex-freewill help to prevent latex allergy.
Facilit ies should ensure that good housekeeping practices are performed to remove
latex-containing dust from the workplace. This can be accomplished by identifying
areas that a re contaminated with latex dust (carpets, upholstery, and venti lat ion
ducts) for frequent cleaning and changing venti lat ion f i l ters and vacuum bags
frequently.
Some health care institutions require that balloons that often accompany flower
arrangements be non-latex (98 ).
For sensit ized health care workers, the Americans with Disabil i t ies Act guarantees
workers reasonable modification of the workplace to accommodate the disability.
The Occupational Safety and Health Administrat ion (OSHA) rules state that in
addit ion to gloves that are normally provided, non-latex g loves, glove l iners,
powderless gloves, or other similar alternatives shall be readily accessible to those
employees who are allergic to l atex gloves (9).
Heal t h Ca r e Wo r ke r Respo ns i b i l i t i es
Workers in health care need to take advantage of latex allergy education and
training to become famil iar with ways to prevent l atex allergy and to learn to
recognize the s ymptoms.
Workers should protect themselves from latex exposure inside and outside the
workplace. Non-latex gloves should be used for act ivit ies that are not l ikely to
involve contact with infect ious materials. Intact skin is an effect ive barrier, and it is
important to maintain good hand care. Cuts and open sores should be covered with
a plast ic barrier dressing prior to wearing latex gloves (99). Oil-based hand creams
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or lot ions should be av oided, as they may enhance the release of latex proteins
from the gloves (54). After removing latex gloves, hands should be washed with a
mild soap and dried thoroughly. This wil l decrease the load of allergen.
Health care workers should avoid wearing work clothes (scrubs) home after working
in the operating room (99). Indirect exposures have caused latex allergy in children
and spouses.
If signs and s ymptoms of latex al lergy develop, the person should avoid contact
with latex-containing products unti l he or she can be seen by a physician who is
experienced in diagnosing and treating latex allergy. A diary of symptoms should be
kept. Delay and
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self-treatment can delay diagnosis, allowing the problem to become more serious.
The Hea l t h Ca r e Wo r ke r w i t h L a t e x Sens i t i v i t y
Depending on the severity of the reaction, latex sensit ivity in health care workers
can be an inconvenience or a l i fe-threatening hazard. I t can mean the end of a
career (100,101 ). Often, health care personnel are unaware of their sensit izat ion,
as the s ymptoms can be nonspecif ic (99 ). The only clue might be the temporal
relat ionship with working. Denial can be a problem.
Latex-allergic anesthesia providers should be counseled on the risks of continued
work in envi ronments with high latex use and on strategies to l imit exposure. They
should have proper allergy identif icat ion, including a medical alert device, and
should inform their health care providers ( including dentist and local hospital). They
may want to carry an allergy kit , including an epinephrine auto-injector device, non-
latex gloves to wear or give to others to wear if they must care for them, and a
complete l ist of medications taken. Friends and family should be given information
about latex allergy. The individual must be on the lookout for hidden latex.
Considerat ion should be giv en to avoiding foods that may contain proteins similar
to those in latex.
Once latex allergy is diagnosed, the only option is to av oid contact with latex and to
try to c ontrol the symptoms. Almost all the products that health care workers
encounter in their daily work can b e made latex-free. A latex-safe environment also
prevents exposure of other workers.
There are many non-latex gloves available, both steri le and nonsteri le. These
include vinyl, nitr i le, styrene butadiene, and neoprene (2,53 ,97 ,102). Unfortunately,
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these may not match the physical characterist ics of la tex gloves such as high
elast icity, strength, f lexibil i ty, tear resistance, tact i le sensation, and barrier
integrity (5,53 ,10 3). Latex gloves are biodegradable and do not produce hazardous
and toxic emissions when incinerated, as do synthetic gloves. Non-latex glove
liners and latex gloves with integral non-latex layers are available (9). Co -workers
should wear powderless, low-latex allergen gloves. This reduces the exposure to
latex by those who are not yet sensit ized and may decrease symptoms in sensit ized
patients (2,10 ,12 ,16 ,96,10 4,105).
Health care workers with latex sensit ivity are not at increased risk when
incidentally exposed to dry, molded, or extruded rubber products in the health care
environment; however, i f direct contact with such objects is routine, exposure
should be minimized by covering the object or exposed body part (5).
Because of the many factors that disseminate latex allergens and because latex
allergens are so prevalent in some areas, it may not be possible to completely
isolate workers from these allergens. In this case, job reassignment may be
necessary. In the severely allergic worker, i t may not be possible to f ind an area in
the health care facil i ty that wil l be safe.
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P.441
QuestionsFor the following questions, answer
i f A, B, and C are correct
i f A and C a re correct
i f B and D a re correct
is D is correct
i f A, B, C, and D are correct.
1. What factors contribute to the increasing incidence of latex allergy?
A. Inc re as ed le ngth of surgi cal procedu res
B. Changes in the manufacturing process
C. Younger people entering the health care industry
D. Increased use of latex products because of univ ersal precautions
View Answer2. Which are likely routes of sensitization to latex?
A. Sk in contac t
B. Inhalat ion
C. Ingestion
D. Parenteral inject ion
View Answer3. Which item(s) listed below is unlikely to cause latex
allergy?
A. Whe elc hai r t ires
B. Washed venti lator bellows
C. Syringe plungers
D. Products steri l ized with ethylene oxide
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View Answer4. Powdered gloves pose a greater threat than those without
powder because
A. Latex pro tei ns bind to the po wd er
B. The powder contains all ergens
C. Powder may spray into the operating room when they are donned or removed
D. Filters in the venti lat ion system may become clogged
View Answer5. What are the symptoms of irritant contact dermatitis?
A. Sk in crac king
B. I tching
C. Scaling
D. Dryness
View Answer6. What are the characteristics of Type IV hypersensitivity?
A. De la yed hyp ers ens i t iv ity
B. Always stays within the area of the antigen
C. May be associated with d izziness
D. Skin rash is s een within 5 hours
View Answer7. Characteristics of Type I hypersensitivity include
A. Re ac tio ns ma y le ad to mo rta li ty o r mo rb id i ty
B. Symptoms can occur days later
C. Reactions range from mild to severe
D. They are mediated by IgF antibodies
View Answer8. Primary clinical features of Type I hypersensitivity
include
A. Bronc hospasm
B. Cutaneous s ymptoms
C. Cardiovascular s ymptoms
D. Neurologic sy mptoms
View Answer9. What are the important points to look for when taking a
history in an attempt to determine the presence of latex allergy?
A. Ha nd de rmati t is in conj un c ti on wi th weari ng late x g lo ves
B. Sensit ivity to ragweed
C. Food allergy to watermelons, pineapples, strawberries, and t omatoes
D. Predisposit ion to mult iple allergic c ondit ions
View Answer10. Which conditions are associated with a high incidence of
latex a llergy?
A. Genitourina ry tract abn orma l it ie s
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B. Congenital orthopedic defects
C. Esophageal str ictures
D. Spinal cord injuryView Answer11. Important features of the SPT include
A. High inc ide nce of an ap hylaxis
B. Reasonably good sensit ivity and specif icity
C. Availabil i ty of a good test solut ion
D. Patients with anaphylaxis during s urgery are almost invariably skin-prick posit ive
View Answer12. Preventive measures for latex allergy include
A. De termin in g th e products tha t con tain la tex
B. Using oil-based hand creams or lot ions
C. Using powderless gloves
D. Totally eliminating latex exposure
View Answer13. Considerations for drug prophylaxis include
A. H2 blockers may increase the risk f or patients with heart block
B. I t may mask the signs of anaphylaxis
C. I t may delay implementat ion of treatment, i f anaphylaxis occurs
D. I t wil l prevent anaphylaxis
View Answer14. Regarding labeling for latex content,
A. I f the la bel do es no t indic ate th at i t conta ins latex, it is latexf ree
B. Products not regulated by the FDA must be labeled if they contain latex
C. Drug manufacturers must label products regarding latex
D. The FDA requires that all medical products that may d irect ly or indirect ly contact
the body be labeled if they contain latex
View Answer15. Surgical precautions that need to be taken if a patient is
known to be latex sensitive include
A. No on e shou ld ente r the opera ting ro om we ari ng late x gl ov es
B. The case should be posted for the f irst case of the day
C. Clothes that have not been exposed to latex should be worn
D. Latex alert signs s hould be posted inside and outside the room
View Answer16. Which steps can be taken to limit the likelihood of latex
allergy resulting from intravenous or parenteral injec-tions?
A. Us ing medic ati on s supp li ed in ampules
B. Using glass s yringes
C. Preparing drugs just before use
D. Using rubber syringe plungers
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View AnswerP.442
17. Methods to treat irritant contact dermatitis include
A. Re duce ex pos ure to the irr i tan t
B. Use of a plast ic glove l iner
C. Topical c ort icosteroids
D. Protect ive hand cream
View Answer18. Steps that health care workers can take to protect
themselves against latex exposure include
A. Was hing hand s afte r latex glov es are remov ed
B. Using n on-latex gloves where infect ious material wil l not be encountered
C. Covering breaks in the skin with a plast ic barrier
D. Using oil-based creams or lot ions
View Answer