Latex allergies: What you should know
Here’s how to protect yourself and patients
(Editor’s note: The problem of latex allergy is certainly not restricted to wound care. But we believe it is a serious problem and widespread enough to warrant coverage in Wound Care. In the following series of articles, we’ve drawn from a number of sources to summarize the problems and some of the steps that can be taken to minimize the risk to clinicians and patients.)
According to some estimates, approximately 8% of health care workers are allergic to latex. Other sources put the proportion higher — as great as 17%. Whichever number you settle on, the fact is that the problem of latex allergy is growing.
One reason may be that an individual’s risk of latex sensitization increases with the number of latex contacts. Ironically, the widespread use of universal precautions designed to protect health care workers from pathogens such as HIV and hepatitis has resulted in an ever-growing use of latex gloves — clinicians tend to respond automatically and don latex gloves whenever patient contact is required. Though dozens of medical products contain latex, gloves are ubiquitous, and the common design of most of them (high protein content, powdered) only adds to the threat.
Within the medical community, nurses might be at even higher risk than physicians because they tend to wear gloves more often. Of course, patients as well as health care workers are at risk for latex allergy, and those with chronic wounds are in a high-risk category because latex contact often occurs in areas where the skin is broken.
The main source: Latex gloves
The allergic responses are caused by one or more allergens in the protein component of natural rubber latex. Natural rubber latex (NRL) comes from the sap of the rubber tree and consists of from 30% to 40% hydrocarbon and 2% to 3% protein. Gloves are made by dipping porcelain molds into a solution of liquid latex. In subsequent steps, some of the water-soluble protein is leeched out and the rubber is vulcanized. Glove powder can be removed as well. It is the protein component that causes allergic reactions.
Powdered latex gloves present an even greater threat to allergic individuals than do nonpowdered gloves. The powder binds to the NRL proteins, and when the powder becomes aerosolized, it can be breathed in by individuals in the area. Therefore, even those who do not come into direct contact with latex are at risk for sensitization simply by breathing in airborne NRL protein particles. Aerosolization commonly occurs when latex gloves are put on and removed. Low-protein, nonpowdered gloves also can generate airborne particles, but in notably less quantities.
New Food and Drug Administration requirements will make it easier to identify products containing latex. As of Sept. 1, 1998, any medical product that comes into contact with humans must have a warning label if it contains latex.
Keep in mind that common balloons that often accompany flower arrangements delivered to hospitalized or long-term care patients are usually powdered and contain high amounts of NRL protein. Some hospitals have begun to restrict balloons to those made of mylar.
Reaction intensity varies
Adverse reactions to latex can range from mild to severe and include hives, rashes, dermatitis, and anaphylaxis. Symptoms may develop on the hands within minutes after donning latex gloves. When mucosal sites of allergic individuals come into contact with latex, the reactions are generally more severe. For example, dental patients who are allergic to latex can suffer severe mouth swelling and can even experience narrowing of the airway. Mucosal contact also can lead to life-threatening conditions such as anaphylaxis, which may manifest as hives, swelling, hypotension, asthma, and arrhythmias. Of note to wound care professionals is that anaphylaxis has been reported after latex has come in contact with disrupted skin. Anaphylaxis also has been reported during surgery, vaginal examinations, and catheterization.
Airborne exposure to NRL proteins can lead to asthmatic reactions, allergic rhinitis and conjunctivitis, hives, swelling, and occasionally anaphylaxis.
Interestingly, people allergic to latex are sometimes allergic to foods containing cross-reacting allergens. These include avocado, banana, chestnut, kiwi, and mango. Eating these foods may cause swelling of the lips and mouth and potentially anaphylaxis. Allergies to these foods occur in a minority of latex-sensitive individuals.
Who’s at risk?
According to an article on latex allergies by Susan Tarlo, MBBS, MRCP(UK), FRCPC, associate professor at the department of medicine at the University of Toronto, there are four primary risk factors for allergy to NRL:1 allergic predisposition, significant exposure to NRL products, exposure to NRL products at mucosal sites or at sites where the normal skin barrier is disrupted, and as mentioned previously, food allergy.
Allergic predisposition may include a history of preceding infantile eczema, allergic rhinitis, or asthma. Latex-allergic patients are five times as likely to have had these conditions or to test positive to common environmental aeroallergens, Tarlo writes.
Other than many health care workers, groups who have frequent exposure to natural latex products include those who manufacture latex products, children with spina bifida or congenital urological abnormalities who have had frequent NRL contact from sources such as latex catheters, and people who have undergone numerous surgical procedures.
The mucosal site risk factor is highly significant for chronic wound patients since the body processes allergens more quickly and efficiently when the skin barrier is absent, explains Gary Sibbald, MD, a dermatologist and associate professor of medicine at the University of Toronto. "You get more absorption of anything applied topically or beside a wound." The development of hand eczema increases the risk of developing a latex allergy by a factor of four, he adds.
Sibbald has developed a list of questions to determine an individual’s risk for latex allergy. (See questionnaire, inserted in this issue.) In addition, a skin prick test for latex allergy is widely available in Europe and Canada.
Sibbald notes that a number of products used in wound care, other than gloves, also present latex risks. For instance, he has treated patients with venous stasis ulcers and venous edema who have reacted to compression stockings and bandages that contained latex. "There are usually non-latex alternatives, or sometimes you can put in a barrier layer such as cotton bandaging or nylon stockings between the latex and the skin." Health care workers, he adds, should be aware of non-latex substitutes. For instance, vinyl or synthetic rubber gloves may be substituted for latex gloves in many situations.
Other medical products that may contain natural rubber latex include blood pressure cuffs, stethoscopes, syringe plungers, anesthesia masks, catheters, and wound drains. Health care workers, says Sibbald, should always be aware of non-latex substitutes.
When non-latex gloves are not readily available, Sibbald suggests using low-protein, nonpowdered latex gloves and treating dermatitis and other skin irritations as quickly as possible. Always be on the lookout for increased risk factors, he emphasizes.
When allergy occurs
Clinicians who find themselves dealing with latex-allergic patients should immediately take steps to make sure that the patient does not come into contact with any products containing latex. This advice holds true even when the patient has exhibited only mild symptoms, such as hives, because the potential still exists for more serious reactions. If allergy symptoms appear, the individual should be treated with appropriate medications.
Patients who are aware that they are latex-allergic should be instructed to inform all health care professionals before or at the time of care. Tarlo’s article suggests that those patients should consider wearing a Medic Alert bracelet for situations where communication with health professionals is impossible. Some clinicians advocate prescribing an auto-injectable epinephrine syringe to highly sensitized patients in case of accidental contact with natural rubber latex.
Some institutions have taken aggressive steps to stem the latex threat. At Optima Health Visiting Nurse Services in Manchester, NH, employees receive two pages of questions and answers about latex allergy. The agency’s health system even has a latex allergy committee dedicated to protecting employees and patients from unnecessary exposure to latex.
St. Joseph Hospital in Bellingham, WA, formed a latex task force to develop a policy on latex allergy, conduct hospitalwide inservices, and create a latex-free cart.
"This wasn’t in response to any particular incident — we wanted to act before a serious problem occurred," says Janice Taylor, RN, CEN, a staff nurse in the hospital’s emergency department. "We’re a small community hospital, so we expected to use the latex-free cart three or four times a year. We were shocked when, during the first six months, we used it over 15 times."
Tarlo writes that there is no reason why latex-free kits cannot be maintained for ostomy and wound care.
Reference
1. Tarlo S. Latex allergy: A problem for both healthcare professionals and patients. Ostomy Wound Mgmt 1998; 44(8):80-88.
Sources of information
• To report your latex allergy to MedWatch, the FDA Medical Products Reporting Program, contact MedWatch, Food and Drug Administration, 5600 Fishers Lane, Rockville, MD 20852. Telephone: (800) 332-1088. Fax: (800) 332-0178. The patient’s identity is held in strict confidence by the FDA and protected to fullest extent of the law.
• E.L.A.S.T.I.C. (Education for Latex Allergy Support Team and Information Coalition) is a national support group with representatives in 40 states that provides numerous resources to latex-allergic individuals. Contact Elizabeth C. Borel at 196 Pheasant Run Road, West Chester, PA 19380. Telephone: (610) 436-4801. E-mail: 102246.126@ compuserv.com.
• Latex Allergy Information Service offers a newsletter, Latex Allergy News. A one-year subscription is $40, and back issues are available for $10 each. To subscribe, contact Debra Adkins, 176 Roosevelt Ave., Torrington, CT 06790. Telephone: (860) 482-6869. Fax: (860) 482-7640. E-mail: [email protected]. World Wide Web: http://www.latexallergyhelp.com.
• Spina Bifida Association of America offers information and updated listings of latex-free equipment; 4590 MacArthur Blvd. NW, Suite 250, Washington, DC 20007. Telephone: (800) 621-3141 or (202) 944-3285. Fax: (202) 944-3295. E-Mail: [email protected]. WWW: http://www.spaa.org.
• A video, "How to Make Your Medical Facility Latex Safe," has been produced to assist health care facilities and workers in addressing the problem of latex allergy. An educational packet containing a video, computer disk, and written materials is available for $149. To order, contact Medical Educational Services Inc. at (888) 665-2839.
• Emory University System of Health Care, Crawford Long Hospital of Emory University Hospital and Clinic. Natural rubber latex allergy: Guidelines for allergic patients. Atlanta.
• The National Institute for Occupational Safety and Health (NIOSH) Alerts: Preventing Allergic Reactions to Natural Rubber Latex in the Workplace is available free of charge (publication No. 97-135). Contact Publications Dissemination, NIOSH, 4676 Columbia Parkway, Cincinnati, OH 45226. Telephone: (800) 356-4674. Fax: (513) 533-8573. E-mail: [email protected].
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