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Recommended Guidelines for Preventing
Allergic Reactions to Natural Rubber Latex
Definition
Natural latex is a milky fluid obtained from the hevea braziliensis
(rubber) tree found in Africa and South-east Asia. Various chemical agents
such as vulcanizers, accelerators, stabilizers and anti-oxidants are added
to natural latex.
Background
The latex allergy is an enormous public health problem faced by health care
workers and patients. Healthcare workers have become the fastest group to
experience latex sensitivity and more often its adverse affects.
Latex is a
common component in health care products and consumer products. In 1989
there were 400 reported anaphylactic reactions and 15 deaths due to latex
contact.
The
implementation of universal precautions in 1987, to prevent HIV and other
blood borne pathogen infections resulted in an increased demand for gloves.
Manufacturing processes may have temporarily changed to meet this
dramatically increased demand for gloves, resulting in latex products with
higher allergic and irritant properties being produced and used. Repeated
exposure to latex products can cause hypersensitivity reactions locally and
systemically. Reducing exposure to latex products will definitely decrease
sensitization and symptoms. There is no treatment for latex allergy except
complete avoidance of latex.
Goals in Management:
The two major goals in the management of latex reactions are successful
identifications and treatment of all dermatitis, to prevent future
sensitization and identification of latex allergy to prevent serious life
treating sequelae whenever possible.
Types of reactions to
latex:
a)
Irritant contact dermatitis
- Most
common type of reaction
- Not
an allergic reaction involving the immune system but rather a skin
irritation caused by the chemicals added to the latex during the
manufacturing the glove powder itself, repeated irritation from sweating
under the gloves or from gloves rubbing against the hands characterized by
dry, flaky skin and papules, redness, fissures and thickening of skin.
b)
Allergic contact dermatitis: Type
IV
- Delayed
type hypersensitivity.
- A
cell-mediated allergic reaction to the chemicals used during the
processing of latex. The more common sensitizers/allergens are thiurams
and carbamates (accelerators).
- Results
from prolonged contact with these chemicals in gloves.
- Symptoms
usually appear 6-48 hours after exposure.
- Characterized
by localized redness, clustered vesicles, swelling, itching, cracking,
eczema and fingertip fissures.
c)
Immediate allergic reaction: Type
I
- An
immediate immunoglobulin E mediated allergic response to the
latex protein
themselves.
- Reaction
usually occurs 5-30 minutes after exposure.
- The
response is introduced by direct contact with latex on non-intact skin
resulting in sensitization before manifesting as a generalized reaction.
- Once
sensitivity has been initiated, any contact with latex may cause a
recurrence of the
reaction.
- The
protein allergens have been found in water-soluble extracts from
latex rubber film. It
may also be absorbed by glove powder, which may become airborne.
- The severity
of the immediate reaction will depend in the route of exposure; cutaneous,
mucosal, inhalation and parenteral, the amount of latex allergen and the
degree of individual sensitivity.
- Mild
reactions involve skin redness-hives-itchiness.
- More
severe reactions may imply edema, itching, conjunctivitis around the eyes,
rhinitis, nasal itching, sneezing shortness of breath, asthma, airway
obstruction due to bronchospasm, anaphylactic shock.
Risk factors for latex
sensitivity & allergy
- Persons
with spina bifida.
- Patients
and congenital urogenital defects, history of indwelling urinary catheters
of repeated catheterizations.
- Patients who
have undergone recurrent surgical procedures.
- Workers
with ongoing latex exposure - health care workers, housekeepers, food
handlers, tire manufacture workers, workers in industry who use gloves
regularity.
- Atopic
individuals - persons with multiple allergic conditions, eczema, asthma,
rhinitis.
- Individuals
allergic to certain food, banana, avocado, chestnut, apricot, kiwi,
papaya, passion fruit, pineapple, peach, nectarine, plum, cherry, melon,
fig, grape, potato, tomato and celery may cause a cross reactivity with
latex protein.
- No
treatments are available to cure latex allergy. The best treatment is to
avoid exposure. The treatment for individual allergic to latex is to
ensure a safe environment. Medications are available to alleviate the
allergy symptoms.
Recommendations:
Patients
-
All
patients are assessed for adverse reactions or contraindicated substance
during their admission assessment. We should provide a latex safe hospital
environment for patients allergic and sensitive to latex.
- History for
presence of allergies such as hay fever, childhood or adult eczema, asthma
and food allergies.
- Multiple
surgeries.
- Undiagnosed
reactions or complications during surgery anesthesia or dental work-
angioedema, shortness of breath, rash.
- History of
latex exposure: type of latex device, nature and duration of exposure.
- History of
latex allergy such as cutaneous symptoms (dermatitis-eczema- urticaria)
respiratory symptoms, (rhinitis, wheezing, coughing, sneezing, shortness
of breath).
- Any
respiratory symptoms experienced when in contact with products containing
rubber.
- Other
symptoms such as itchy hands, conjunctivitis, localized angioedema,
possible systemic anaphylactic symptoms with the use of household latex
cleaning gloves, balloons, condoms and diaphragms.
If a patient has any of the above categories the
following measures should be taken:
- Patients
with severe documented allergy to latex should be assessed for the need of
a private room.
- A cart
containing all latex free supplies that are necessary for patient
care from admission to discharge. This cart will follow
patient to other departments.
- Wear
non-latex examination and sterile gloves. Vinyl gloves should he changed
every 15 minutes to protect the health care worker from blood borne
pathogens.
- Identify
chart, patient, bed, medication profile, Kardex, physician order sheet
with latex allergy stickers.
- Post latex
allergy sign on patient's door.
- Wear a cover
gown if the possibility that your uniform contains residues of powder from
latex gloves.
- Tape over IV
tubing ports and do not use.
- Do not
inject via T-connectors, buritrol or IV bag, inject and administer
medication only through plastic stopcock.
- Remove
rubber stoppers form vial then draw up medication. Needle puncturing a
rubber stopper can shear off particles of latex, and cause a systemic
reaction.
- Glass
syringe or latex free syringe must be used, if plastic syringe are used,
the solution must be injected immediately after being drawn up.
- If pulse
oximetry is used, cover finger with tegaderm then apply probe. The inside
surface of most pulse oximeters is covered with latex.
- Avoid skin
contact with the bulb and tubing of the blood pressure cuff by placing
cloth under the rubber to shield the skin.
- Stethoscope
tubing can be covered with a stockinette.
- If
catheterization is necessary, use silastic foley catheter.
- Utilize
single dose ampules for parenteral medication.
- Patients that
are highly reactive, may require medications at the bedside. Epinephrine
should be available if an anaphylactic shock occurs.
- If the
patient develops an allergic reaction, remove suspected allergen and
provide immediate care.
- All staff
interacting with this patient must follow proper hand washing procedures
before caring for these patients in order to minimize the exposure to and
transfer of latex protein.
Health Care worker:
Health care workers should
protect themselves from latex exposure and allergy in the workplace:
-
Use non-latex gloves for
activities that do not involve contact with blood or body fluid.
-
For activities where contact
with infectious materials is expected and latex gloves are used, choose a
reduced protein, powder free glove.
-
Workers with hand dermatitis,
should never wear oil hand cream or lotion with latex gloves. Oil breaks
down latex, damages the glove barrier and release additional allergen.
Detergents and other chemicals also degrade latex glove.
-
After removing gloves, wash
hands with soap and dry thoroughly, never reuse glove.
-
If you experience any symptoms
possibly related to latex allergy, report it to Health and Safety
Department, avoid contact with latex gloves until you see your
allergist.
-
Attend latex allergy education
session.
If allergic to latex:
-
Avoid
contact with latex gloves, latex containing products and objects such
computer keyboards, telephones, that have been in contaminated with latex
gloves or glove powder.
-
Avoid areas
where you might inhale the powder from latex gloves worn by other workers.
- Wear medical alert
bracelet.
- Attend latex allergy
education session.
- Carry an emergency
epinephrine auto-injector.
- Avoid cross-reacting food
such as; kiwi, avocado, chestnut.
-
Follow your
physician's instructions for dealing with allergic reaction to latex.
Institution
To eliminate
or reduce the risk for latex sensitization of
asymptomatic staff and
minimize the risk of latex exposure to staff already sensitized.
a)
Eliminate unnecessary use of latex gloves by
providing workers with non latex gloves when there is minimal potential for
contact with blood or bodily fluid.
b) When selecting a latex glove for barrier
protection from infectious materials, choose a reduced protein, powder free
glove. Glove should be approved by the Canadian General Standard Board.
c) Provide education to employees about
latex allergies, hand care and the importance of early care for dermatitis or
other allergy symptoms. Identify and instruct worker in work practices to
prevent exposure.
d) Implement a latex allergy assessment
protocol including a screening history questionnaire and protocol of
evaluation and treatment of latex reaction symptoms.
e) Conduct a worksite evaluation, identify
areas contaminated with latex dust and make sure
cleaning is done more frequently. Ensure that filtration and
ventilation systems provide adequately recirculated air
in area with high levels of latex aerosols.
f)
Alternative latex free devices must be available.
g)
Identification of medical product containing
latex.
h) Incorporate latex allergy education as
part of the annual safety and infection control program, orientation program
and also conduct in
services.
Once a
diagnosis of latex allergy is confirmed, the employee should accommodate the
affected workers. Extremely sensitive individuals may have to be
re-assigned to areas where no latex gloves are used.
Disclaimer
The Canadian Society of Gastroenterology Nurses and Associates
does not assume responsibility
for the practices or recommendations of any
individual, or for the practices and policies of any Gastroenterology Unit
or Endoscopy Unit.
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