LATEX ALLERGY

Latex Sensitivity vs Allergy Latex allergy is an IgE-mediated sensitization to naturally occurring latex proteins. Repeated exposure to proteins in NRL causes: Sensitivity – the development of an immunologic memory (IgE) to a specific protein (i.e. latex) Allergy – the demonstrated outward expression of the disease (hives, rhinitis, anaphylaxis, etc.) AORN Perioperative Standards and Recommended Practices, 2012 IgE is the protein antibody released as part of the body’s immune response to what it views as harmful. i.e. latex in this situation. Sensitivity is more common than actual allergic reactions but anyone who has a reaction to latex has the potential to have a life threatening reaction.

History of Latex Allergy Turn of Century, Latex gloves commonly used 1927- First recorded apparent allergic reaction to latex- Dental partial plate 1933 – Latex hypersensitivity to rubber gloves was reported 1979 – Immediate-type allergic reactions (Type1) reported with increasing frequency Since 1974- US FDA reports over 1,700 incidences of allergic reactions with 17 deaths AORN Perioperative Standards and Recommended Practices, 2012 Advantages to using rubber-based products in health care was recognized as early as 1834 when it was first used for surgical gloves and by 1900’s, surgical gloves were the standard to guard against the spread of disease. In 1927- A partial plate with a rubber base caused uticaria and oral angioedema in a patient.

Why Latex Allergy Became More Common Probable Causes: 1987 CDC implemented Universal Precautions 1992 OSHA Mandated Universal Precautions New and/ or inexperienced manufacturers New routes of sensitization Familiar with signs of hypersensitivity/ better reporting AORN Perioperative Standards and Recommended Practices, 2012 Latex Allergy, Christine Calson, Wild Iris Medical Education,Inc. 2011 Remember HIV scare…Blood exposure became scary and the use of latex items such as gloves and condoms increased tremendously. Shortage of gloves in the 80’s and 90’s was attributed to the increased demand due to Universal Precaution implementation. There was an estimated 20-fold increase in medical glove use ( in billions of pairs) since introduction of U.P.. The growing demand for latex gloves lead to manufacturers changing techniques for extracting rubber which contributed to leaving more water-soluble latex proteins in the gloves. Young Hevea brasiliensis (Hev b) trees in Africa and Southeast Asia were stimulated with chemicals to increase production as well as the use of shortened storage periods contributed to the production of more allergens in the latex. Sensitization increased with the combination of increased allergens in latex and transfer of these protein allergens into glove powder, which in turn aerosolized and became inhalation as well as cutaneous and mucous routes. In more recent years, individuals environmentally exposed to latex are more familiar with the signs of latex sensitiviy or a true allergy and reporting methods have improved.

Latex Sensitivity Prevalence Rates General population range: 0.8-6.5% Health Care Workers: 10 – 17% Spina Bifida/Congenital Defects:35 – 70% AORN Perioperative Standards and Recommended Practices 2012 By mid-1990’s, epidemic proportion of allergic incidence in healthcare workers. Numbers vary….

CLINICAL MANIFESTATIONS OF LATEX Delayed type contact dermatitis Reaction develops gradually over a day or weeks Red, scaly, itchy skin Climactic irritation, damage of skin Not an allergic reaction Allergic contact reaction (Type IV) Symptoms within six – 48 hours Previous exposure to latex- sensitized chemicals Sneezing/runny nose, coughing/wheezing, watery eyes AORN Standards and Recommended Practices, 2012 Contact dermatitis is generally caused from frequent hand washing, insufficient rinsing, use of antiseptics, dry Alaska climate and the powder in gloves. Type IV is T cell-mediated and the result of exposure to chemicals used in latex harvesting, processing and manufacturing.

CLINICAL MANIFESTATIONS TO LATEX TYPE 1 ANAPHYLAXIS REACTION Immediate (Within 5 – 30 minutes of exposure) True allergy to natural rubber latex Systemic reaction Pathways- Skin, mucous, inhalation, internal organs Symptoms: Hives Eyelid/ Facial swelling/ Edema Swelling of throat, nasal passages, bronchi Difficulty breathing/ Wheezing/ Bronchospasms Anaphylaxis/ Death AORN Standards and Recommended Practices 2012 Results from latex protein exposure from gloves or proteins bound to powder suspended in the air, on objects or directly tranferred by touch.

GROUPS AT RISK FOR LATEX ALLERGY Children with myelodysplasia (Spina Bifida)/ multiple surgeries since infancy Occupational Exposure- Health care/Food service employees Atopic individual w/ hx of eczema, rhinitis History of Type 1 reaction to multiple environmental allergies including food allergies such as apple, avocado, banana, carrot, celery, chestnut, kiwi, melons, papaya, raw potato and tomato. Cross reactivity that exists between NRL and certain food allergens. Those with known latex allergy or are at high risk should be treated in a latex-safe environment. http://acaai.org/allergies/types/skin-allergies/latex-allergy AORN Standards and Recommended Practices

TRIGGERING LATEX PRODUCTS Just to name a few: Pacifiers/ bottle nipples Dental dams/ Orthodontic elastic Condoms/ Diaphragms Latex gloves/ powder Catheters- Urinary, Barium enema Nasogastric tubes Bandages/ Adhesives (Tapes)

Prevention Big Deal! 1988- FDA required warning statement on latex products Goals Prevent reaction in latex-sensitized individual Prevent initial sensitization AORN Standards and Recommended Practices, 2012

PRE-OPERATIVE ASSESSMENT OF LATEX ALLERGY PATIENT Careful assessment of risk: Watch for patients that have problems with: Blowing up latex balloons Wearing rubber bands at wrist/ elastic underwear Dentist issues – dental dam Diaphragm / Condom Adhesive bandages/ tapes Fruits such as bananas, kiwi, etc Patient has latex allergy: In addition to above - Describe allergy and severity Check if filled out questionaire

MANAGEMENT OF LATEX- ALLERGIC PATIENT Create a latex-safe environment by: Careful assessment of risk Communicating risk to all care-givers Schedule first case of day All cases are set of using latex free gloves-routine! ID band/ Flag chart/ Signs for OR & Patient bed Educate patient/ family about plan Latex-free environment - GLOVES/ CATHETERS/ANESTHESIA PRODUCTS Remove all latex gloves/ products from room Monitor for reactions/ Assist with treatment - Trendelenberg, Epi, Benadryl, Albuterol, CPR Document laser-safe environment/ patient response Christine Calson, Wild Iris Medical Education, Inc, 2011

MANAGEMENT OF LATEX-ALLERGIC EMPLOYEE Create a latex-safe environment Provide latex free/ powder free gloves Don’t use oil-based hand creams/lotions w/ latex gloves (causes deterioration of rubber) Wash hands after wearing gloves Educate self about latex allergy Reduce exposure and seek medical advice if latex allergy is suspected Recommend change of environment as necessary Christine Calson, Wild Iris Medical Education, Inc, 2011 Allergy band, flag chart, note on schedule. Improvement in Latex free gloves. Do not have to call all the manufacturers anymore. Each one complies with FDA requirement to clearly mark latex products. Encourage employees to wear latex free gloves, wash hands after removing gloves.

Best and most effective treatment is AVOIDANCE!! Where are we today? Considerable reduction in prevalence Elimination of donning powder Introduction of synthetic rubbers Education of the public Resource for latex alternatives - American Latex Allergy Association Best and most effective treatment is AVOIDANCE!! American Latex Allergy Association –latex alternatives