Latex Sensitivity/Allergy


 
PURPOSE:
 
To outline the management of patients which are high risk for 
latex allergy and/or allergic to latex/rubber products.
 
SUPPORT DATA:
 
Latex sensitivity is an acquired sensitized response to the 
latex protein antigen.  The milky sap of the rubber tree 
Hevea Brasilinies (rubber tree) produces 99% of the latex 
used today.  Latex sensitivity was first reported in 1979 and 
has become a major concern due to the frequent exposure with 
implementation of universal precautions.  Increased use and 
awareness have caused reports of adverse reactions to 
increase dramatically.  The first treatment goal is 
prevention through utilization of products that have the 
lowest protein allergen content or that contain no latex.  
Once sensitization has occurred the avoidance of latex 
becomes necessary.
 
AT RISK POPULATIONS AND/OR RISK FACTORS:
 
Patients known to have increased risk for latex sensitivity 
reactions are those with a history of:
 
     -Multiple surgeries where latex products were used, 
      particularly during childhood.
     -Long term urinary catheterization with latex products.
     -Myelomeningocele, myelodysplasia (spina bifida), and 
      other diagnoses requiring frequent catheterizations.
     -Long term latex exposure in the work setting.
     -History of anaphylactic reactions during  surgical or 
      dental procedures for unknown reasons.

 
     -Allergy to tropical fruits, kiwi, bananas, chestnuts 
      and poinsettia plants.
     -Strong history of asthma, seasonal rhinitis, drug or
      environmental allergies.
     -History of contact urticaria.
 
Patients in above categories are at highest risk for the 
development of latex sensitivity.  Those who have experienced 
localized (contact) reactions to latex are the highest risk 
for developing systemic (anaphylactic) response with further 
exposure.
 
THREE DISTINCT REACTIONS TO LATEX ALLERGY
 
Irritant contact dermatitis: This is a non-allergic reaction 
that results in a dry, red, cracked or crusted skin rash on 
the hands.  It is usually caused by sweating or rubbing under 
the latex product, by detergent, by soap, by antiseptics, 
washing/scrubbing skin, or by latex glove powder.
 
Allergic contact dermatitis: also known as chemical 
sensitivity, contact dermatitis or delayed hypersensitivity.  
This is seen as a blistering/rash resembling eczema where 
latex came in contact with the skin.  It appears 48-96 hours 
after exposure to the latex product.  Skin may become 
thickened and crusted.  This may progress to a generalized, 
systemic allergy if exposure to latex continues.
 
Immediate allergic reaction (Immunoglobin E mediated): 
immediate hypersensitivity reaction.  This results in 
allergic symptoms such as runny nose, sneezing, watery eyes, 
hives, asthma/bronchospasm, anaphylaxis, or death.
 

 
IDENTIFICATION OF AT-RISK PATIENTS
 
1.  Identify patients at high risk or with an actual latex 
    allergy upon admission by interviewing the patient, 
    parent, and/or family, by asking the following questions: 
 
    NOTE: If the patient, parent and/or family answers YES to
    any of the following questions, initiate this protocol.
 
    A.  Has the patient had any of these reactions to any 
        latex/rubber product exposure?  Possible reactions 
        include:
 
        -Unexplained anaphylactic-type allergic reactions
         during surgical or dental procedures?
        -History of Spina Bifida or other congenital disorder
         (confirm with primary care physician)
        -Rash/Hives
        -Running nose/congestion
        -Chapping/cracking of hands
        -Dizziness/lightheadedness/faintness
        -Shortness of breath
        -Difficulty in breathing/wheezing
        -Facial and laryngeal edema
        -Increased heart rate
        -Itchiness/flushing
        -Burning eyes
        -Abdominal cramping and/or diarrhea after exposure 
         to latex products
        -History of cardiac/pulmonary arrest of unknown 
         etiology
 
2.  Document latex allergy information on the patient's 
 

    chart.  If available, place allergy armband on patient.  
 
3.  Notify Medical Director and/or surgeon; determine if 
    patient's procedure will be conducted at the outpatient 
    facility or moved to another site.
 
4.  Avoid patient contact with any latex-containing product.
    Main areas of concern are:
 
    A.  IV starts and blood draws (tourniquet, tape, 
        injection ports, etc.)
    B.  Surgery 
    C.  Any procedure where gloves are worn.
    D.  IV medications
 
 
KEY LATEX/RUBBER PRODUCTS IN HOME ENVIRONMENT INCLUDE:
 
Adhesive Tape         Corsets             Rubber Bands
Baby Bottle Nipples   Erasers             Rubber Cement
Balloons              Face Masks          Rubber Gloves
Bandages              Foam Pillows        Shoe Wear
Belts                 Garden Hoses        Suspender
Brassieres            Hot Water Bottles   Teething Rings
Carpet Backing        Ostomy Bags         Weather Stripping
Condoms               Pacifiers
 
Approved By Governing Board    
EP.2    
Control #74.0
GUPTA GASTRO