Living with latex allergies
How home health nurses can continue working
Although dentists and operating room personnel with their multiple, daily glove changes are more at risk of latex sensitivity, it’s not unheard of for home health care workers to develop a latex allergy. For some, symptoms may appear only as a bad case of dry skin. Others may proceed without warning to anaphylaxis and possibly death. With symptoms so severe, it’s hard to imagine that anyone who discovers he or she is latex-sensitive could continue to work in the health care profession. After all, the use of latex is widespread and found in everything from rubber gloves to balloons to the soles of tennis shoes.
Nevertheless, a latex allergy does not mandate retirement from home health care. It does require, however, the sufferer to become more aware of the problem and the ways in which to avoid contact. Moreover, it means working with the home health agency’s management to develop policies and protocols for coping with the allergy. What follows is a general overview of the allergy itself, the toll it takes on its victims, and suggestions for coping.
Background brief
As health care workers have becoming increasingly aware — and vigilant — about protecting themselves from the risk of infection, the use of latex gloves has risen dramatically. Unfortunately, so has the incidence of latex allergies. Between 1988 and 1996, roughly 1,700 incidents of severe allergic reactions to latex were reported to the Food and Drug Administration. Of those cases, 23 ended in death, although no deaths were linked to the use of latex gloves.
Even so, estimates based on a study reported in Anesthesia suggest that, of the population at large, 0.8% are allergic to latex. The number rises dramatically when the focus is narrowed to health care professionals. The 1989 study showed 13.7% of dentists displayed an allergic reaction, while operating room doctors and nurses showed rates of 7.5% and 5.6%, respectively. By the time the results of a 1997 National Institute for Occupational Safety and Health study were reported, those figures had risen, showing that anywhere from 8% to 12% of health care professionals are latex-sensitive. Considering that roughly seven billion pairs of latex gloves are used annually by employees in the health care sector, it’s a wonder the statistics aren’t higher.
Because of the prevalence — and potential severity — of latex allergies among health care professionals, and increasingly among their patients as the use of latex products has become more widespread, professionals should be alert. Especially prone to latex reactions are those with certain food allergies such as to avocados, bananas, papayas and other tropical fruits, and kiwis, tomatoes, potatoes, chestnuts, peaches, and even poinsettias.
The least worrisome reaction takes the form of irritant contact dermatitis, a condition that results from direct contact with the skin and typically results in a dry, flaky skin with cracks or sores. Symptoms range in severity depending on the length of exposure, skin contact, and temperature. A second, more severe, reaction known as allergic contact dermatitis, or delayed-type hypersensitivity, is caused by sensitization to ingredients used in the manufacture of latex gloves. Within 48 hours to 72 hours of exposure, the reaction begins, usually affecting the body’s immune system. With it, dry, red skin with hard bumps, sores, and sometimes blisters will appear, and with each further contact symptoms are likely to increase in severity.
Immediate-type hypersensitivity is similar to allergic contact dermatitis in that it stems from prior exposure. However, in this case, the results can be much more severe. IgE, a class of antibodies, are the mediators and can cause anaphylactic reactions as well as contact urticaria and systemic reactions such as asthma and rapid heartbeat. Symptoms typically appear within five minutes of contact and can disappear within 30 minutes to two hours after removal of the latex item. (See box for a list of symptoms, p. 30.)
Studies have shown that powdered latex gloves are the largest culprit in causing latex sensitivity among health care workers. The more times employees change gloves, the greater the chance they will develop an allergy. "Ninety-eight percent of latex allergies are caused by powdered latex gloves. It’s simple to say make sure you don’t touch latex, but as health care workers go, we’re worried about aerosol exposure," says B. Lauren Charous, MD, director of the Allergy and Respiratory Care Center at the Milwaukee Medical Center, and an assistant clinical professor of allergy/immunology at the Medical College of Wisconsin. Minute latex proteins, absorbed by the powder glove lining, become airborne with each glove change and enter the airways of health care workers and patients.
Changing to latex-free gloves will not solve the problem once an allergy has been diagnosed. Latex protein particles settle in carpets and upholstery, notes Charous, especially if latex gloves have been used for a while. However, steam cleaning can reduce levels significantly, he says, noting that in a study he conducted, "levels fell to below a detectable level following a change from powdered gloves and a thorough cleaning."
The source of the allergic reaction may be removed, but the allergy cannot, explains Debra Adkins, editor of Latex Allergy News in Torrington, CT. "Once a person becomes sensitive, there’s nothing you can do. Unlike with hay fever, where you can receive shots, there’s no desensitization for latex allergies."
As such, home health care workers diagnosed with the allergy can only continue working if a latex-safe protocol is put in place by the agency. Agencies may decide to enact a latex-safe policy upon learning of an employee’s allergy, but experts advise taking a proactive rather than reactive approach. (The term latex-safe is used rather than latex-free because it is impossible to completely remove all traces of latex from a given setting.) Not only will your agency be ready in the event someone is diagnosed, but providing a latex-safe environment may also lessen the chances of someone developing an allergy.
By following these basic steps, home health care agencies can make significant strides in providing their employees — and patients — with a latex-safe environment:
• Educate yourself.
First and foremost, learn all you can about the allergy. Sue Lockwood, executive director of Milwaukee-based Allergy to Latex Education and Resource Team (ALERT), suggests agency administrators begin with the Internet. (See list of Web sites, p. 32.) "You really want to educate yourself on the research material out there," she says. "The more you know, the more you’ll be aware and can provide the awareness to prevent contact." Her group provides information packets for a $25 donation to the group. Included are research articles and educational material, support information for the sufferer, a list of latex-containing products, and a list of alternative products.
Amy Romanczuk, RN, MSN, is a pediatric clinical nurse specialist for the department of spina bifida and pediatric urology at the Medical University of South Carolina in Charleston. She knows firsthand the importance of education. She educated patients and their families on coping with latex allergies for 10 years before she was diagnosed with it. "It wasn’t until my third anaphylactic episode that I realized I had it." She explains that "for a negative experience, it’s been rather positive because it’s made me see where we as health care workers can get complacent. We think about the risk to our patient and not ourselves, but we need to be thinking about how we can protect them and ourselves."
• Establish a task force.
Lockwood recommends agencies interested in becoming latex-safe appoint staff to spearhead the protocol’s implementation. "You can have anyone on it who wants to educate themselves on latex allergies. It could be a one-man task force, but it’s nice to have a sounding board. It’s also good if you can get an allergist on board who is knowledgeable about the problem. Then have them gather all the resources and research materials," she suggests.
• Take stock.
The first step toward eliminating latex products from your list of supplies is "having a cognizant awareness of what contains latex," Romanczuk says. (See list of sources, p. 31.)
Task force members should compile a list of all supplies and their corresponding vendors, Lockwood says. "You want to list all your suppliers in a binder and then contact them to see if they offer alternatives." Ask suppliers to send you a list of all products along with information on their latex content.
Many companies today are offering latex alternatives, specifically to powdered latex gloves. "Luckily for us, companies are getting very savvy in looking for ways to make their products safe. They’re making some products like Foley catheters out of plastic, and that patients actually like better, but sometimes it takes going to your supplier to find them," says Romanczuk.
Prices may be nominally more expensive for latex-free items, so take advantage of buying in bulk. And, says Lockwood, some companies will offer discounts to members of ALERT.
• Make a decision.
Once materials have been gathered and lists made, it becomes necessary to make some hard policy decisions. At this stage, it’s best if a person with a latex allergy can be included in the decision-making process.
Among the points to consider, Romanczuk says, is how to handle a latex-allergic employee. "If you suspect an allergy, for example, how will you handle it? Will you have the employee tested or just tell them to avoid latex and good luck? You need to figure out what products have latex and which patients require them. You also need to consider that some products have no latex-free substitutes, and how will you handle that?
"Do you use only latex-free products or just gloves that are? Do you give latex-free products only to the person with the allergy or to everyone? And then how do you handle the employee’s environment?" she asks.
This last issue is particularly tricky for home health workers, acknowledges Romanczuk, because nurses are going into people’s homes where they cannot control the presence of latex-containing products. While not involved in home health, she uses a policy that would well serve all those affected by the allergy — the "In me, on me rule."
"If I’m not wearing it, eating it, touching it, or breathing it, I’m not going to worry about it," she says. "My office mate was worried about having erasers on her desk, but I told her it would be OK because I just wouldn’t be touching them. I have to take some sense of responsibility for this and to be very aware."
Lockwood agrees that home care presents special challenges for the health care professional, noting that "for home health agencies it may be easier to set up a policy for the office but harder for their site visits. Nurses can bring in a latex-free kit on their own, but you can’t control the unknowns within a home. So unless the patient wants to help, this is a big hurdle for the home health workers." Lockwood says she knows a home health nurse who has a policy of conducting a phone interview prior to making any site visit so she would be aware of the potential risks awaiting her.
• Use these tried-and-true suggestions.
For agencies serious about creating a latex-safe environment, cleaning house is perhaps the best thing they can do. Remove all latex gloves from inventory and replace them with latex-free alternatives where practical, says Adkins.
"If your home health workers don’t need to wear gloves, why have them do it?" she asks. For those who must wear gloves, provide employees with diagnosed allergies with latex-free supply kits and develop a questionnaire for them to use in assessing their risks in the home environment.
Then look inward. "Declare your office a latex-free area," suggests Lockwood, and then make it that way. "Clean everything and throw out the vacuum cleaner bags after each pass. Clean out air ducts and wash the walls, then have air samplings done to make sure the area is safe. Providing you’re not sharing a ventilation system with the dentist office next door, once the area is cleaned, it’s done."
• Be an allergy advocate.
Lastly, suggests Romanczuk, agencies should be aware of the latex policies of their affiliated hospitals. "So many are looking at becoming latex safe, so if you’re an affiliated agency, it would behoove you to know the hospitals policy and anchor on to that," she says. "It’s a great chance to be an active part of the policy and not just a tag-along. And if there isn’t a policy, it’s an ideal chance to be a strong advocate for both the employees and the community."
Sources
• Debra Adkins, Editor, Latex Allergy News, 176 Roosevelt Ave., Torrington, CT 06790. Telephone: (860) 482-6869.
• B. Lauren Charous, MD, Director, Allergy and Respiratory Care Center, Milwaukee Medical Center, 30003 W. Good Hope Road, P.O. Box 090996, Milwaukee, WI 53209. Telephone: (414) 352-5161.
• Sue Lockwood, Executive Director, Allergy to Latex Education and Resource Team (ALERT), P.O. Box 13930, Milwaukee, WI 53213-0930. Telephone: (888) 972-5378.
• Amy Romanczuk, RN, MSN, Pediatric Clinical Nurse Specialist, Spina Bifida and Pediatric Urology, Medical University of South Carolina, 135 Rutledge Ave., P.O. Box 250917, Charleston, SC 29425. Telephone: (843) 876-1524.
Tell-tale Signs
- Abdominal cramping
- Anaphylaxis
- Angioedema
- Asthma
- Bronchospasm
- Cardiopulmonary arrest
- Congestion
- Coughing
- Fluid swelling
- Hives
- Hypotension
- Itching
- Nausea
- Rash/dermatitis
- Shortness of breath
- Sneezing
- Stridor
- Tachycardia
- Vomiting
- Watery eyes
- Wheezing
Source: Nursing Management, October 1998.
Likely Sources
- Patient examination gloves
- Elastic bandages and adhesive tapes
- Electrode pads
- Wound drains
- Stomach and intestinal tubing
- Urinary collection devices
- Enema tubing tips
- Hemodialysis equipment
- Rubber marks and oral/nasal pharyngeal airways
- Dental bite blocks
- Endotracheal tubes
- Rubber ventilator circuits, bellows, and hoses
- Injection syringes and ports on IV tubing
- Blood pressure cuffs
Source: Professional Safety, August 1998.
Latex on the Web
For more information on latex allergies, check out these Web sites:
* Allergy to Latex Education & Resource Team (ALERT): www.execpc.com/~alert/
* Delaware Valley Latex Allergy Support Network: www.latex.org
* Education for Latex Allergy Support Team and Information (ELASTIC): www.pw2.netcom.com/~ecbdmd/elastic.html
* Latex Allergy Links: www.netcom.com/~nam1/latex allergy.html
* National Institute for Occupational Safety and Health: www.cdc.gov/niosh/latexall.html
* Physicians Against Latex Sensitization: www.pals.net
* Spina Bifida Association of America: www.sbaa.org/latex.htm
Source: Professional Safety, August 1998.
Latex Allergy Checklist
A. Allergies
1. Do you have a history of hay fever (sneezing, runny nose, itchy eyes)? If so:
a. Does it come and go with the season?
b. Does it cause you problems year-round?
2. Do you have a history of:
a. Asthma?
b. Nighttime cough or shortness of breath?
c. Tightness in your chest or cough with exercise?
3. Do you have a history of:
a. Atopic dermatitis or eczema?
b. Recurring hives or welts?
4. Do you have a history of allergic reactions (rash, swelling, itching, or wheezing) after you ingest certain foods or beverages?
5. Do you have a history of allergic reactions after taking certain drugs?
B. Risk factors for latex allergy
6. Do you have spina bifida (myelomeningocele)?
7. Do you have a urinary tract problem necessitating frequent catheterization?
8. Have you had three or more operations?
9. Are you around latex products (e.g. surgical gloves) at work?
10. Have you ever had a job in a latex-product manufacturing plant?
C. Job-related symptoms
11. Do you think you are having an allergic response to something in your work environment?
12. Do you use latex products for work or hobbies? If so, have you noticed any of the following whenever you are around latex:
a. Itching?
b. Sneezing?
c. Runny nose?
d. Itchy eyes?
e. Cough?
f. Shortness of breath?
g. Trouble breathing later that day or night?
h. A rash anywhere on your body?
13. Has a rash ever developed on your hands after you have worn latex gloves? If so:
a. How long after putting on the gloves did the rash develop?
b. What did the rash look like?
D. Hidden reactions to latex
14. Has a rash, swelling, shortness of breath, cough, wheezing, runny nose, sneezing, or itchy eyes ever developed while you were using household cleaning gloves, balloons, condoms, diaphragms, or any other latex-containing product?
15. Have you ever had an allergic reaction of an unknown cause?
16. Has a doctor ever said you had an allergic reaction or problem of unknown cause during surgery or hospitalization?
17. Have you ever had a reaction of unknown cause during a dental procedure?
Source: Postgraduate Medicine, September 1995.
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